Anand Swaminathan
@emswami.bsky.social
EM doc | Resuscitationist | Medical Educator | EMRAP Managing Editor
He/Him/His
Instagram: @EMSwami
Anand Swaminathan is an Indian-American researcher and academic. He is the Robert C. Goizueta Chair of Organization and Management and Associate Dean of the Ph.D. program at the Emory University Goizueta School of Business. Previously, he held academic appointments at the University of Michigan School of Business and the University of California, Davis. .. more
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most places here have to get it from pharmacy or gets mixed in ED (particularly if you have ED pharmacists
Insulin Bolus in DKA #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Insulin bolus typically not necessary in DKA but, consider if:
Delay in getting insulin drip from pharamacy.
Severe acidosis: reach therapeutic levels faster + fix the acidosis faster
Bolus dose: 0.1 U/kg
youtube.com/shorts/pYybS...
#EMIMCC
Delay in getting insulin drip from pharamacy.
Severe acidosis: reach therapeutic levels faster + fix the acidosis faster
Bolus dose: 0.1 U/kg
youtube.com/shorts/pYybS...
#EMIMCC
The Urine Drug Screen is Useless #criticalcare #emergencymedicine #toxicology
YouTube video by EMSwami
youtube.com
Urine Drug Screen is useless in ED
-False (+) common due to cross-reactivity
-False (-) common: only looks for THC, cocaine, BZD, amphetamines, pcp + opiates
-Can’t tell you if patient’s symptoms are from the drug
All of this makes the test clinically useless
youtube.com/shorts/GwVh1...
#EMIMCC
-False (+) common due to cross-reactivity
-False (-) common: only looks for THC, cocaine, BZD, amphetamines, pcp + opiates
-Can’t tell you if patient’s symptoms are from the drug
All of this makes the test clinically useless
youtube.com/shorts/GwVh1...
#EMIMCC
Mech Vent Positioning in Obesity #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
HOB 30 degrees not ideal for mech vent in obesity
-Pushes abdominal girth into diaphragm making diffi to deliver breath
-Data (PMID:33432600, 37832782) suggests reverse trendelenberg better position
-If can’t maintain reverse trendelenberg, consider lying flat
youtube.com/shorts/CwiLp...
#EMIMCC
-Pushes abdominal girth into diaphragm making diffi to deliver breath
-Data (PMID:33432600, 37832782) suggests reverse trendelenberg better position
-If can’t maintain reverse trendelenberg, consider lying flat
youtube.com/shorts/CwiLp...
#EMIMCC
Super interesting topic. I’ve done this and teach it but will have to reconsider
Cannabis + CV Risk #emergencymedicine #cardiology
YouTube video by EMSwami
youtube.com
Cannabis + CV Risk
-Regular cannabis use (3x/week) linked to incr risk CAD, stroke, HTN, heart failure + possibly mortality
-Edibles carry same risk
-Regular use a non-traditional ACS risk factor: HIV, CKD, chronic alcoholism, cocaine, lupus
youtube.com/shorts/4LCKx...
#EMIMCC
-Regular cannabis use (3x/week) linked to incr risk CAD, stroke, HTN, heart failure + possibly mortality
-Edibles carry same risk
-Regular use a non-traditional ACS risk factor: HIV, CKD, chronic alcoholism, cocaine, lupus
youtube.com/shorts/4LCKx...
#EMIMCC
Femoral Lines are Awesome #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
Femoral Central Lines are awesome!
1) Infection rate equal to rate with IJ (subclavian are cleaner)
2) Easier to place in the awake patient
3) 0% PTX rate (IJ ~ 0.5%, Subclavian ~ 1.5%)
4) Single prep for CVL + Art line
youtube.com/shorts/wCh2H...
#EMIMCC
1) Infection rate equal to rate with IJ (subclavian are cleaner)
2) Easier to place in the awake patient
3) 0% PTX rate (IJ ~ 0.5%, Subclavian ~ 1.5%)
4) Single prep for CVL + Art line
youtube.com/shorts/wCh2H...
#EMIMCC
Increasing Safe Apneic Time #criticalcare #emergencymedicine #intubation
YouTube video by EMSwami
youtube.com
Incr safe apneic time increases 1st pass success + safety
-Preox w/ NIV: Incr PaO2, recruits alveoli(PMID: 38869091)
-Preox + intubate w/ Bed Up, Head Elevated(PMID: 26866753)
-Apneic O2 w/ nasal cannula at flush
-Use roc over sux(+45 sec PMID 21226882 + 20402874)
youtube.com/shorts/46vt7...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruits alveoli(PMID: 38869091)
-Preox + intubate w/ Bed Up, Head Elevated(PMID: 26866753)
-Apneic O2 w/ nasal cannula at flush
-Use roc over sux(+45 sec PMID 21226882 + 20402874)
youtube.com/shorts/46vt7...
#EMIMCC
Crystalloids in Hemorrhagic Shock #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
Avoid crystalloid in hemorrhagic shock
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting
Patients don’t bleed crystalloid so don’t give crystalloid
youtube.com/shorts/QltA6...
#EMIMCC
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting
Patients don’t bleed crystalloid so don’t give crystalloid
youtube.com/shorts/QltA6...
#EMIMCC
Bicarb Pushes Utility #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Bicarb Pushes
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available
youtube.com/shorts/gQrwA...
#EMIMCC
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available
youtube.com/shorts/gQrwA...
#EMIMCC
Thanks for sharing. Definitely interesting but I question if it would be the same in critically ill non-ventilated patients presenting with metabolic acidosis
Regardless, agree that infusion is the bigger chance for a win
Regardless, agree that infusion is the bigger chance for a win
Roc + Prolonged Paralysis #criticalcare #emergencymedicine #intubation
YouTube video by EMSwami
youtube.com
Prolonged paralysis w/ rocuronium is an advantage
-Once we decide to intubate, patient's getting tubed
-W/sux, can end up in awake pt while trying to intubate if 1st/2nd attempt fail
-W/ roc, plenty of time if you run into a challenging airway
youtube.com/shorts/HXtN7...
#EMIMCC
-Once we decide to intubate, patient's getting tubed
-W/sux, can end up in awake pt while trying to intubate if 1st/2nd attempt fail
-W/ roc, plenty of time if you run into a challenging airway
youtube.com/shorts/HXtN7...
#EMIMCC
Agree with you but, BICARICU2 was infusion not push dose which I think matters
also, dialysis is a bit of a clinician driven thing and this wasn't blinded
regardless, the minimal cost of some bicarb compared to dialysis is a win
also, dialysis is a bit of a clinician driven thing and this wasn't blinded
regardless, the minimal cost of some bicarb compared to dialysis is a win
Can I suggest getting a cup of coffee instead?
only if you really really really really want to
thanks for sharing. I've got to review in full but issues I see: how was bicarb given (this seems like infusion, not push dose), obviously not an RCT (lots of confounding) and they excluded things like DKA which is odd
Bicarb Pushes + Acidosis #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
No role for bicarb pushes in metabolic acidosis
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation
youtube.com/shorts/uS2VN...
#EMIMCC
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation
youtube.com/shorts/uS2VN...
#EMIMCC
Anaphylaxis Observation
YouTube video by EMSwami
youtube.com
Observation Post-Epi in Anaphylaxis
-Epi 0.5 mg IM: only critical med in anaphylaxis. If A, B or C, give E
-Biphasic rxn extremely rare: 0.18% (PMID: 24239340) + can occur days out
-I typically observe X 2 hours. Key is to ensure access to epi autoinjector
youtube.com/shorts/-rL6J...
#EMIMCC
-Epi 0.5 mg IM: only critical med in anaphylaxis. If A, B or C, give E
-Biphasic rxn extremely rare: 0.18% (PMID: 24239340) + can occur days out
-I typically observe X 2 hours. Key is to ensure access to epi autoinjector
youtube.com/shorts/-rL6J...
#EMIMCC
Reposted by Anand Swaminathan
As an TCCC instructor I would add "reassess constantly, consider conversion or removal if not needed, and be prepared to manage Reperfusion injury"
Proper Tourniquet Use #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
Tourniquet is limb/life saving if used properly
-Know where bleeding coming from? Place tourniquet 2-3"/5-6 cm proximal
-Can't tell where bleeding coming from? Put tourniquet as high up on limb as can
-Tightening: pull strap tight then wind windlass 1-2 times
youtube.com/shorts/iHnuM...
#EMIMCC
-Know where bleeding coming from? Place tourniquet 2-3"/5-6 cm proximal
-Can't tell where bleeding coming from? Put tourniquet as high up on limb as can
-Tightening: pull strap tight then wind windlass 1-2 times
youtube.com/shorts/iHnuM...
#EMIMCC
Hypotension + Aortic Dissection #criticalcare #emergencymedicine #cardiology
YouTube video by EMSwami
youtube.com
HTN not universal in aortic dissection: up to 20% hypotensive
-Hypotension can result from measuring BP in arm w/ dissection flap.
- More dangerous: pt dissected back through root + has tamponade.
Dissection + hypotension = POCUS looking for tamponade
youtube.com/shorts/8334r...
#EMIMCC
-Hypotension can result from measuring BP in arm w/ dissection flap.
- More dangerous: pt dissected back through root + has tamponade.
Dissection + hypotension = POCUS looking for tamponade
youtube.com/shorts/8334r...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Jan 14
EVERDAC Trial + Arterial Lines #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
EVERDAC(PMID: 41159885)
-Early art line didn’t affect mortality in shock(mainly sepsis)
Reasons for early art line
-Non-invasive cuff unreliable
-Vasoconstrictive shock(trauma, cardiogenic)
-Need reliable beat to beat SBP (ICH, aortic dissection)
-Cardiac arrest
youtube.com/shorts/BlKbx...
#EMIMCC
-Early art line didn’t affect mortality in shock(mainly sepsis)
Reasons for early art line
-Non-invasive cuff unreliable
-Vasoconstrictive shock(trauma, cardiogenic)
-Need reliable beat to beat SBP (ICH, aortic dissection)
-Cardiac arrest
youtube.com/shorts/BlKbx...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Jan 12
Standard Geometry VL is #1 #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Standard Geometry Video Laryngoscopy (SGVL) still my primary tool for intubation
-Advantages of video but is independent of tech
-If screen fails or video covered in blood/vomit, can rapidly convert to DL
-Hyperangulated VL doesn’t give you the option to go DL
youtube.com/shorts/4WbYc...
#EMIMCC
-Advantages of video but is independent of tech
-If screen fails or video covered in blood/vomit, can rapidly convert to DL
-Hyperangulated VL doesn’t give you the option to go DL
youtube.com/shorts/4WbYc...
#EMIMCC
Difficult Consult Tip #3 #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Dealing w/ a Difficult Consultant Tip #3
-Only emply when crystal clear you’ve got right consultant + consultant refuses w/o good reason
-Make it personal: “what if it was your mother/kid.”
-Appeal to higher authority (attending, chair)
-Document refusal
youtube.com/shorts/SdgtB...
#EMIMCC
-Only emply when crystal clear you’ve got right consultant + consultant refuses w/o good reason
-Make it personal: “what if it was your mother/kid.”
-Appeal to higher authority (attending, chair)
-Document refusal
youtube.com/shorts/SdgtB...
#EMIMCC
Dealing w/ a Difficult Consultant Tip #2 #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Dealing w/ Diff Consultant Tip #2: Restate case + ask for alternate plan
-Often on hearing repeat presentation, consultant agrees w/ you
-On occasion, consultant says need diff consultant/transfer
-Either way, ends w/ clear path to get issue addressed
youtube.com/shorts/IAX1x...
#EMIMCC
-Often on hearing repeat presentation, consultant agrees w/ you
-On occasion, consultant says need diff consultant/transfer
-Either way, ends w/ clear path to get issue addressed
youtube.com/shorts/IAX1x...
#EMIMCC
Difficult Consultant Tip #1 #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Dealing w/ a Difficult Consultant Tip #1: Ask Why?
-Why consultant declining to see/admit pt?
-Often reveals miscommunication issue: wrong consultant, doesn’t understand emergency nature
-Asking for clarity often gets you + pt what’s needed w/o creating conflict
youtube.com/shorts/XYNnB...
#EMIMCC
-Why consultant declining to see/admit pt?
-Often reveals miscommunication issue: wrong consultant, doesn’t understand emergency nature
-Asking for clarity often gets you + pt what’s needed w/o creating conflict
youtube.com/shorts/XYNnB...
#EMIMCC
Stop Panscanning in Trauma #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
Stop Indiscriminate Panscanning in Trauma
-Data: panscanning not better than standard evaluation; found to be better than no evaluation
-Downsides:Rad exposure, incedentalomas ➡️ unnecessary testing/interventions + iatrogenic harm
-Biggest downside: delays in care
youtube.com/shorts/YeA8X...
#EMIMCC
-Data: panscanning not better than standard evaluation; found to be better than no evaluation
-Downsides:Rad exposure, incedentalomas ➡️ unnecessary testing/interventions + iatrogenic harm
-Biggest downside: delays in care
youtube.com/shorts/YeA8X...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Dec 31
Syncope vs Near Syncope #criticalcare #emergencymedicine #syncope
YouTube video by EMSwami
youtube.com
Evaluation same for syncope + near syncope
-Meta-analysis: same rate 30-day bad outcomes
-Same pathology present in both
-Don’t be less concerned if patient “almost” passed out
-Most patients can still be discharged home with f/u after negative ED workup
youtube.com/shorts/gwW65...
#EMIMCC
-Meta-analysis: same rate 30-day bad outcomes
-Same pathology present in both
-Don’t be less concerned if patient “almost” passed out
-Most patients can still be discharged home with f/u after negative ED workup
youtube.com/shorts/gwW65...
#EMIMCC
Reposted by Anand Swaminathan
josh farkas 💊
@pulmcrit.bsky.social
· Dec 30
updated the IBCC chapter on BRASH
added a treatment checklist that walks you through resus of a sick BRASH pt
BRASH is uncommon & there are lots of moving pieces, so the checklist is a helpful cue to provide comprehensive treatment of all the BRASH components
emcrit.org/ibcc/brash/ #EMIMCC
added a treatment checklist that walks you through resus of a sick BRASH pt
BRASH is uncommon & there are lots of moving pieces, so the checklist is a helpful cue to provide comprehensive treatment of all the BRASH components
emcrit.org/ibcc/brash/ #EMIMCC