If I have a spill in my kitchen. And you provide me with 5 different ways to categorize and stratify my spill. But then tell me I'm to use my own judgement on how I clean it. You've done nothing. You've created a distinction without a difference. Waste of time, energy and money.

A trial is negative because the wrong patients were included (even after half a dozen of negative trials). Results of positive trials can always be extended to the whole population

For anyone paying attention... Of course this is the solution. The tech is sold to admin as a way to allow me to see more patients in less time. Not for my wellness, nor the benefit of the patient. But for higher productivity. Their $$ benefit. My liability. Checks out.

EM workrooms are just neurodivergent people trading medical stories to relate to each other.

More poorly designed "AI Trials" with even worse reporting. The frequency with which ppl are using AI to alter care/decision making is rising. AI queries can be a helpful part of the conversation to generate questions... But I'm seeing cases of people using AI as the sole mode of decision making.

Anyone else using music as an anxiolytic for patients either on the vent or for "routine procedure" (excluding low frequency high risk, and procedures while in extremis) #emimcc #icusky #emsky Did dissociated laryngoscopy and intubation and it seemed to keep the room and the patient cool 😎

Interested in the major trials in critical care? We have summarised and critiqued 250 of the most important randomised controlled trials stretching back over the past 25 years. https://criticalcarereviews.com/collections/foundational-trials

ACS (but not the kind I usually worry about now I'm in the micu more) is a serious and sometimes delayed/missed diagnosis. Know about it. Have a plan.

Also, AI can't pass medical exams.

Man in his 60s presented w/ syncope and bilateral knee soreness. No swelling, nor SOB. Progressive hypoxia, diaphoresis and hypotension. Eventually intubated but DNR. Get the admission call for "ACS- new RBBB, elevated trop in shock". Performed POCUS and CT-Angio. Worst RV failure I've ever seen.

Another study showing how we treat women differently. More research is needed to find causes and direct our efforts towards more equitable care. We still have work to do.

Was on call for a small hospital. Finished work for the morning, went home and then to the gym to swim/rehab. Did not keep an extra set of scrubs in the car, so had to go in as is. RN got me a pair of scrub bottoms. Anyone else have fun "just got called into work from doing something else" story?

Stop waiting, start liberating By identifying candidates with reversed insults and successful SBTs, we can bypass the ICU bottleneck safely. It’s the next logical step for Emergency Medicine. Comment to discuss.

Assessment of Congestion in Heart Failure Using VExUS: Current Evidence, Limitations and Clinical Perspectives CCR Journal Watch https://criticalcarereviews.com/latest-evidence/journal-watch

kudos to ACEP for calling out the Surviving Sepsis Campaign 2026 guidelines and not joining in this madness. ACEP is great at making evidence-based policies that actually *help* provide better patient care. When ACEP is politely burning your guideline, you’re in trouble. #EMIMCC

2 very long months off work, getting back to the grind was a lot. But it was incredible to return to a tribe that embraced me, helped me navigate some temporary limits and made me laugh along the way. #icusky #medsky

Only in Texas it is a cowboy extubation. Everywhere else it’s a sparkling grip-it-and-rip-it

I'm frequently asked what I keep on my person as an EM-CC trained doctor. In my pocket I always keep a long 16g angiocath, and a #10 scalpel. Then there is the contents of my fanny pack... What do you keep on you for your shift #emimcc , #emsky #medsky ?

Any recommendations for leadership courses that people have liked? There may be some upcoming opportunities for guiding/leading an intensive care unit and while I'm quite adept at the learn by doing... I feel there may be a better way to do things right the first time. #EMIMCC #ICUsky #medsky

I cannot imagine the devastation this family is experiencing today. This statement is powerful and must be read.

Alex Pretti was a colleague at the VA. We hired him to recruit for our trial. He became an ICU nurse- I lover working with him. He was a good kind person who lived to help and these fuckers executed him. White. Hot. Rage.

This is the moment to identify media accomplices, false-opposition democrats and those who are readily willing to ignore the truth of their own eyes and ears. I sincerely hope this will be a turning point. The schism between the federal fascists and law enforcement is increasing ever more.

Phenomenal write up for anyone working in EMS/Code Team/RRT quality and safety. I will be referencing this. TCP is always thrown out as "what they should have done"-- but lit is showing this is a low success maneuver. I'll still do it-- but good to escalate chronotropes and prep for TVP.

3 weeks into recovery! Had a child sitting with their family and I could hear them talking about my walker and scars. Mom made it a teaching moment, and had her kid ask me some questions-- to talk to me and not about me. She was so kind and got us a gift card. The world needs more parents like this.

Day 10/10 of self-administered enoxaparin inj. I don't particularly enjoy the sensation of subq needles and meds. However the burn was only minimal and short lasting. I do however appreciate not developing a DVT and the pharmacologic profile is phenomenal Final rating: 8/10 - would stab self again

Walking into 2026. (well... walkering for me) Wishing everyone a happy and healthy New Year

As a doc, 13 days as an inpatient gives you some perspective of what our patients go through in severe injury/illness. What an experience. Thankful to have my health, my mental acuity. Here is a photo of the thank you card my partner and I left our Ortho unit. More reflections to come as I recover.

Turns out my superb pre-hospital trauma care was in reality 4 deployments of WMDs. Do I contact FEMA as a victim of terrorism? www.whitehouse.gov/presidential...

There is no greater betrayal of your own body than waking up in 10/10 pain from hypnic jerks while in an ex-fix. Not even naps are safe

Navigating a critical injury far from home. 1/5 stars. Don't recommend. Thankful for all the support shown by my colleagues and family. It means so much.

Humbled to say the least. The doc becomes the patient. On the road to recovery!

Recently, I've been asked whether every baby actually needs HBV vaccination, largely with the implication that doing this is "one size fits all," and that's not a good approach. Implicit in this assumption is the idea that every individual's physiology is so unique that it demands unique care.

Democratic leadership is dead. The legislative branch of the US government is a complicit arm of the autocratic takeover of government dreamed by the right in the 80s, launched by Cheney post 9/11, continued by institution Dems, and now the cult of personality is here. The branches are trimmed.

Our latest blog is out: Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial https://criticalcarereviews.com/blog/current

Today I became double board certified, and won trivia.

The fact that the AOC and Sanders Town Hall isn't all over social media tells me exactly what I need to know... Was SO REFRESHING listening to politicians prioritizing people and values. No hate.

Having recently read Mark Bray's book about Antifascist movements... Not at all surprised that these fascist **cks decided he's a threat. Read. Love. Commune. Fight.

As an US EM/CCM doc attuned to what's happening politically, and how it's impacting people daily, I struggle to find the energy and bandwidth to contribute to fighting the fight when I'm facing it at work 20+ days a month and honestly, feels like I'm losing. Anyone else feeling this? Recs? #emimcc

Why must we the health professionals take advice from the non-health professionals; especially when it is to seek advice from health professionals -- professionals whom the non-health professionals DIDN'T take advice from. The weaponized incompetence is here, dizzying, and deadly in magnitude.

Watching Miller / Trump use the Kirk Memorial to divide, sow malice and show how much they hate anyone who stands for democracy, equity and free society is jarring. I've never been more scared, nor more proud to stand on my beliefs. They show how afraid they are of us, and what we can do.

updated IBCC chapter on anaphylaxis, some new additions: 🆕 methylene blue for anaphylaxis refractory to epi & fluid 🆕 sugammadex for anaphylaxis 2/2 roc or vec 🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help? (emcrit.org/ibcc/anaphyl...) #EMIMCC

It's time to start building. Building community. Building resiliency. Building the world we want to see. When the state demands we step in line and maintain social order-- an order that robs our most vulnerable-- it is our duty, to raise the🖕with one hand, and use the other to lift each other up.

I have a small number of rules for my trainees in ED and ICU: 1) Don't lie. 2) Treat the unit and the people in it like you're a guest in their home. 3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2) pubmed.ncbi.nlm.nih.gov/33485698/ #emimcc

Still chuckling from an angry phone call I fielded earlier in the ICU. Mid-yelling at my residents/apps/nurses. "I'm tired of talking to these 30 something year old infant residents! We will only talk to the much more experienced and older attending physicians". My 32 year old ass...

scout images for CT scans are hidden gold the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan) for example, the scout of a CT C-spine may be great to confirm ET tube position #EMIMCC

🆕💫PROTECT RCT Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social journal.chestnet.org/article/S001...

Escaped the US for a second ... Fingers crossed they let me back in ...

As a new resident of the area I have been waiting for my first haboob. Did not disappoint. Rolled in as I pulled into the taco shop. Spent the evening sipping margaritas waiting for the dust to settle.

Louder for the nephrons in the back

Health and wealth inequality generated by decades of vacuous greedy profiteering at the expense of an unprotected working class, a targeted erosion of trust in our institutions, and a rising populism driven not by seeking a greater good, but by a destructive nihilism --will be our downfall.