Over last few years, have started to feel ketamine for pain probably a rescue tactic at best. Lots of better options. If I can't block, precedex >>>> ketamine for pain control. journals.lww.com/anesthesia-a... #EMIMCC

Way to go, San Francisco!! 👏👏

Prasad is out at FDA

Shift one as an attending intensivist in the books. Thanks for the encouragement y'all. Shout out to @pbafuma.bsky.social for putting up with the new shift jitters and orienting.

Peds: still little adults!

Opioid deaths down significantly in 2024. Anticipate this trend for years, and that Trump will (erroneously but inevitably) claim victory... When it's years I'm the making and multifactorial + this generation just doesn't imbibe in drugs & alcohol like prior genz. www.dea.gov/press-releas...

@omnintensivist.bsky.social are you seeing/hearing about this??

Interesting concept here. Certain antiseizure meds as CV risk for Older folks with epilepsy? pubmed.ncbi.nlm.nih.gov/39804367/ #EMIMCC #neurosky

For no reason: In 🇸🇪, 98% & 99% ⬇️ in HPV16 and 18 (main cervical cancer causing types) prevalence, respectively, in cervical samples from 2000-born (82-83% HPV vaccine coverage) vs 1984-born (unvaccinated) women Vaccines are amazing! academic.oup.com/jid/advance-...

I've had 3 colleagues at @unm.edu reach out to ask if we were ok in the fires. (We're an hour away and totally fine) Even though it's a travel assignment, these folks are top notch people. Love the ICU staff there.

When burning hospitals are no longer news www.aljazeera.com/opinions/202...?

Sometimes you can't spell ECMO without CMO.

I just plugged a USB in the correct way on the first try AMA

Curious what #pharmSky and #icusky think of this ... Gotta say I'm intrigued.... Maybe a 1x dose for delirium preventing vent weaning? 🤔🤔 pubmed.ncbi.nlm.nih.gov/39648603/

The data is week for lifelong ASS for secondary prevention in CAD. Are we causing more bleeds than preventing MI…? It will either take some strong advocates or new trials to overcome status-quo-bias. #cardiosky jamanetwork.com/journals/jam...

Central line hack: That small clear blue plastic piece at the end of the guide wire COMES OFF. If you have ever struggled with initially threading the wire off the plastic holder tubing thing... THIS IS FOR YOU

Getting into the heart of flu season seems like a good time to mention that there's >20% rate of co-infection. A trial of abx for the critically ill flu patient until the smoke clears totally reasonable. #emimcc #IDsky pmc.ncbi.nlm.nih.gov/articles/PMC...

The borg does not win this round.... For now.

Developing: Pennsylvania Burger King chains have updated their slogan: "Here, snitches get stitches"

One of few trials to show a difference for PCT. But is it worth it? They saved a day of abx (8.1d vs 7d PCT vs SoC) 🤷‍♂️ Is the cost of procal for everyone worth it? especially when 1) we know less duration is better 2) no difference in outcomes 3) multiple studies show *more* abx when you use PCT.

ABGs are one of the most overused and medically unnecessary tests.

in @jaccjournals.bsky.social meta-analysis comparing AVR vs clinical surveillance for asymptomatic patients with severe AS Bottom line : no differences in all-cause or CV deaths, reduction in HF hospitalization and strokes www.sciencedirect.com/science/arti... #cardiosky some thoughts ⬇️

Had an attending once make a reference to "the three S's of neurocritical care" Sodium Seizures See-O2 I think about this way more often than I should #neurocrit #emimcc

"Congratulations! You put stop times on 300 abx courses, saving over 5000 exposure says"

This got me thinking, who runs wastewaterSCAN. It's verily, a Google subsidiary. Public Health population level big data. Makes sense- it's a sticky SaaS-like business likely with longgggg recurring revenue streams.

Suboxone with seemingly better mortality/remission vs alternatives. Not perfect, but best of the choices. #EMIMCC #idsky #emsky pubmed.ncbi.nlm.nih.gov/39625756/

😳😳😳 insurance CEO gunned down 😳😳😳 www.reuters.com/world/us/uni...

➡️ 8 major critical care trial results live from Melbourne ➡️ Full free livestream ➡️ Tuesday & Wednesday, December 10th & 11th ➡️ Times are UTC +11 ➡️https://criticalcarereviews.com

Implementing a new alert in epic when pointless antibiotics are ordered - “have you considered that it’s not sepsis?”

This research evaluates the clinical effectiveness and safety of a perioperative algorithm for cardiac output-guided haemodynamic therapy in patients undergoing major gastrointestinal surgery www.bmj.com/content/387/...

BLUESKY MEGA-THREAD Altmetric is thrilled and also LITERALLY RELIEVED to officially announce: We are now tracking research attention as it happens on Bluesky! We have been picking up posts on the site since late Oct. Our team is on Bluesky all day answering questions. Let's get into it!

"If you’re going to give antibiotics to patients who don’t need them, at least do the courtesy of giving them for a brief period of time." #IDQuotes @bradspellberg.bsky.social #idsky #medsky #AMSsky #utisky

using #pocus #ultrasound for cardiogenic shock mechanical circulatory support #iabp #impella #ecmo #emimcc #cccsky #cardiosky academic.oup.com/ehjcimaging/...

I've scrolled from the past hour and it didn't feel like doomscrooling. I learned / was reminded of useful tips/tricks. I laughed. This a wonderful app.

10 INCREDIBLE ways to BOOST your immune system: The Measles vaccine The Mumps vaccine The Rubella vaccine The Tetanus vaccine The Diphtheria vaccine The Polio vaccine The HPV vaccine The Pneumonia vaccine The Hepatitis B vaccine The Covid-19 vaccine

Americans killed annually by All Islamic jihadist terrorists 9 Armed toddlers 21 Lightning 31 Lawnmowers 69 Busses 264 Falling out of bed 737 Being shot by another American 11,737 2017 estimates. The Royal Statistical Society gave this compilation its International Statistic of the Year award.

Seizure --> benzos ---> seemed resolved. Immediate Cerebell with sz burden >50% !!! More benzos + AEDs --> burden vaporized. I'm a believer. Wouldn't have given so much otherwise. Worth it in select cases.

I would vote for the BALANCE paper myself, but that one about anaerobic coverage you posted is pretty great too! www.nejm.org/doi/full/10.....

Practice changing paper of the year? So many to choose from! I love PROPHYVAP, but this one on anaerobic coverage for aspiration may take the cake: Expanded coverage may increase LoS & cdiff rates without any benefits. pubmed.ncbi.nlm.nih.gov/38387648/ #emimcc #medskyPOY

#POCUS #PocuSky shock algorithm, slice protocol SLICE stands for 'In a patient who is Shocked/Short of breath, scan the Lungs, IVC, Cardiac and Extra regions as indicated' #critcaresky #emimcc #cardiosky pubmed.ncbi.nlm.nih.gov/36333871/

Hey there, #neuro enthusiasts! Ever pondered the perfect blood pressure after endovascular thrombectomy (EVT)? ⚖️ Let's dive into the latest trials (with links!) to crack this code! Buckle up, it's brain-savin’ time! 🚀 #Bluetorial #NeuroSky #MedSky #MedEd

Good morning & happy thanksgiving from this great land of enchantment.

Does #randomization ensures balance of risk factors between groups? Consider this: In Denmark 860 individuals were randomly allocated to either intervention or control. Individuals were unaware of their allocation. No intervention took place. Mortality was higher in the intervention group (p=0.003)

critical care ultrasound fellowship #pocus #pocusky #ultrasound

Trying to get into neuromuscular ultrasound? Start here with 'the' expert on this field, Nens von Alfen, via YouTube youtu.be/vQI3oIVrv44?...

When I started a YouTube channel devoted to #Neuroradiology education, I had no idea that so many people would be interested. Now it's at nearly 30,000 subscribers. Help me push it over the milestone! www.youtube.com/c/LearnNeuro...

Rant #5 Please don't tell me what the PaO2 is... Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings. What is the SpO2 I genially ask? In our target range? Well that's fine then. Staff member shifting uneasily, "but the PaO2..." Here we go...

What's your tx for aspiration PNA? And why do we care??? mortality for aspiration PNA is roughly triple that of CAP 😱 .... BUT.... anaerobes are isolated in <1% of cultures performed on those with suspected aspiration. Despite this, the classical teaching is to include anaerobic coverage.... 1/