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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Study In The Journal Of Pediatrics Finds Trans Youth Care Lowers Suicidality, Few Detransition
The groundbreaking study found that suicidality dropped for transgender youth receiving hormone therapy by nearly 70%, with only 7 patients of 432 discontinuing treatment.
www.erininthemorning.com
1. A landmark study was just published in The Journal of Pediatrics.
It found a 68% reduction in suicidality for trans youth getting HRT.
It also found only 7 of more than 400 stopped taking HRT... and of those that did, 4 still identified as gender-diverse.
Transgender care saves lives.
It found a 68% reduction in suicidality for trans youth getting HRT.
It also found only 7 of more than 400 stopped taking HRT... and of those that did, 4 still identified as gender-diverse.
Transgender care saves lives.
DOPES in Crashing Vent #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
DOPES Mnemonic: structured approach to deal with hypoxia in the ventilated patient
Displacement, Obstruction, Patient factors (ie PE, PTX), Equipment Issues, Stacked Breaths.
Address all of these factors in parallel
youtube.com/shorts/rwumW...
#EMIMCC
Displacement, Obstruction, Patient factors (ie PE, PTX), Equipment Issues, Stacked Breaths.
Address all of these factors in parallel
youtube.com/shorts/rwumW...
#EMIMCC
Flu + COVID PSA
YouTube video by EMSwami
youtube.com
Get your flu + COVID shots now!
-Markedly lowers risk of getting COVID/Flu (doesn't eliminate completely)
-Reduces severity of illness
-Reduces likelihood of hospitalization in older, immunocompromised people
-Reduces the risk of transmission to others
youtube.com/shorts/nxPu5...
-Markedly lowers risk of getting COVID/Flu (doesn't eliminate completely)
-Reduces severity of illness
-Reduces likelihood of hospitalization in older, immunocompromised people
-Reduces the risk of transmission to others
youtube.com/shorts/nxPu5...
I don't hear it but, I will gladly take the compliment!
Discussed in the video
I wouldn’t do pushes but isotonic bicarbonate infusion would be great
I wouldn’t do pushes but isotonic bicarbonate infusion would be great
Fluids in Hyperkalemia #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Fluids in HyperK
-Restore volume, incr kidney perfusion leading to incr urine output + K elimination
-0.9% saline: pH 5.5, big Cl load. Worsen acidosis leading incr serum K
-LR superior: small amount of K in it won’t raise serum K. Won’t contribute to acidosis
youtube.com/shorts/3G4yc...
#EMIMCC
-Restore volume, incr kidney perfusion leading to incr urine output + K elimination
-0.9% saline: pH 5.5, big Cl load. Worsen acidosis leading incr serum K
-LR superior: small amount of K in it won’t raise serum K. Won’t contribute to acidosis
youtube.com/shorts/3G4yc...
#EMIMCC
Reposted by Anand Swaminathan
More data outlining how COVID vaccines reduce the risk of hospitalizations & death, especially among those aged 65 and older.
This aligns nicely with recommendations from Canada's National Advisory Committee on Immunization. 🇨🇦
Link: tinyurl.com/yuwmmtt4 by Hansen et al.
This aligns nicely with recommendations from Canada's National Advisory Committee on Immunization. 🇨🇦
Link: tinyurl.com/yuwmmtt4 by Hansen et al.
Thanks! Not worked anywhere where it was available but maybe just not considered an ED drug
Not available in US so I don't have experience with it
We have octreotide which is very underwhelming
www.thennt.com/cms/nnt/octr...
We have octreotide which is very underwhelming
www.thennt.com/cms/nnt/octr...
Octreotide for Gastrointestinal Hemorrhage from Esophageal Varices – TheNNT
www.thennt.com
The benefit on octreotide is pretty low (though I still get asked to do it and do it on my own)
www.thennt.com/cms/nnt/octr...
www.thennt.com/cms/nnt/octr...
Promotility Agents in UGIB #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
Priorities in UGIB management: blood, ceftriaxone (if varices suspected), GI to bedside + consider intubation
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
SALAD Technique + Desataruation #criticalcare #emergencymedicine #airway #intubation
YouTube video by EMSwami
youtube.com
SALAD Technique + O2 Desaturation
-Does continuous airway suctioning hasten desaturation?
-ED RCT (PMID: 40533376) found no difference in O2 sat drop between group getting continuous suctioning + group that didn’t
youtube.com/shorts/FE5nA...
#EMIMCC
-Does continuous airway suctioning hasten desaturation?
-ED RCT (PMID: 40533376) found no difference in O2 sat drop between group getting continuous suctioning + group that didn’t
youtube.com/shorts/FE5nA...
#EMIMCC
Torsades de Pointes #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
Sustained polymorphic VT almost ALWAYS unstable. Immediate shock 200J
Torsades de Pointes: polymorphic VT w/ prolonged QT
- Stop QT prolonging meds
- Fix HypoK + HypoMg
- If brady, incr rate (isoproteronol, epi or overdrive pacing)
youtube.com/shorts/IUYDl...
#EMIMCC
Torsades de Pointes: polymorphic VT w/ prolonged QT
- Stop QT prolonging meds
- Fix HypoK + HypoMg
- If brady, incr rate (isoproteronol, epi or overdrive pacing)
youtube.com/shorts/IUYDl...
#EMIMCC
Nothing Normal About "Normal" Saline #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
Nothing normal about “normal” saline
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
ER Case Files | Case 01: When Medicaid Policy Kills and the Big Beautiful Bill
“We tell people to improve their lives, point to a higher place they can reach, and then booby-trap the staircase to get there. Then we blame them for falling.”
bit.ly
Check out Building a Better Democracy: bit.ly/3Ltig5v
Alister Martin at the intersection of the ED + Health Policy
This case will ring true to anyone who's worked in EM and, honestly, should be mandatory reading for anyone training in EM: bit.ly/4nQjqW4
Alister Martin at the intersection of the ED + Health Policy
This case will ring true to anyone who's worked in EM and, honestly, should be mandatory reading for anyone training in EM: bit.ly/4nQjqW4
Mechanical Vent in Asthma #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Permissive Hypercapnia
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
FAST in Hypotensive Trauma #emergencymedicine #criticalcare #trauma #fast
YouTube video by EMSwami
youtube.com
FAST in Hypotensive Trauma
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
Safe Apneic Time #emergencymedicine #criticalcare #intubation #airway
YouTube video by EMSwami
youtube.com
Incr safe apneic time important in improving 1st pass success
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
Intubating in Large Vessel Occlusion Stroke #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
youtube.com
Endovasc Stroke Tx + Airway
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
VTach ECG Features #emergencymedicine #criticalcare #cardiology #resuscitation
YouTube video by EMSwami
youtube.com
VT ECG
-ERAD(down I + aVF)
-V6 dominant S wave (all electricity from L heart away from ECG lead)
-RS > 100 msec in precordial leads
-QRS > 160 msec and Either no RSR’ in V1 L rabbit ear > right
In real life, if rhythm fast, wide + regular, assume VT + treat as VT
youtube.com/shorts/glxzf...
#EMIMCC
-ERAD(down I + aVF)
-V6 dominant S wave (all electricity from L heart away from ECG lead)
-RS > 100 msec in precordial leads
-QRS > 160 msec and Either no RSR’ in V1 L rabbit ear > right
In real life, if rhythm fast, wide + regular, assume VT + treat as VT
youtube.com/shorts/glxzf...
#EMIMCC
I've got to review again as well but a couple things pop up aside from the high vs low resource:
-Admitted CAP patients sicker than what I see in US setting
-HIV + TB rates
-Entry criteria likely included lots of viral stuff
Interesting discussion. I would probably defer at this point for most CAP
-Admitted CAP patients sicker than what I see in US setting
-HIV + TB rates
-Entry criteria likely included lots of viral stuff
Interesting discussion. I would probably defer at this point for most CAP
Is there enough different between resource scarce + resource rich populations to not adopt this for all admitted pts w/ CAP?
TB rates clearly higher in Kenya but not crazy. Same w/ HIV though unclear how well controlled HIV was in the specific pt
TB rates clearly higher in Kenya but not crazy. Same w/ HIV though unclear how well controlled HIV was in the specific pt
An important thing to consider: did patients w/o a-lines get more frequent bedside reassessment (just naturally)
It's easy to look at the a-line numbers and if they're w/in norm range, no need to reassess
w/o advanced monitoring, likely get more doc/RN at bedside assessing pt
It's easy to look at the a-line numbers and if they're w/in norm range, no need to reassess
w/o advanced monitoring, likely get more doc/RN at bedside assessing pt
Reposted by Anand Swaminathan
MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Reposted by Anand Swaminathan
New RCT: Avoiding A-line in shock didn't affect mortality (trend towards *reduction*) & decreased line complications
They avoided A-lines despite patients requiring pretty substantial doses of vasopressors
Very #zentensivist
Don't need to rush to an A-line
www.nejm.org/doi/full/10.... #EMIMCC
They avoided A-lines despite patients requiring pretty substantial doses of vasopressors
Very #zentensivist
Don't need to rush to an A-line
www.nejm.org/doi/full/10.... #EMIMCC
Chest Tube Irrigation #emergencymedicine #criticalcare #trauma
YouTube video by EMSwami
youtube.com
Chest Tube Irrigation After Hemothorax Drainage
-Accumulating evidence shows reduction in complications (reaccumulation, effusions, empyema) PMID: 38764139
-Easy to do: place tube, drain blood, instill 500 cc of NS and suction out
-Can repeat 1-2 times
youtube.com/shorts/QhpAN...
#EMIMCC
-Accumulating evidence shows reduction in complications (reaccumulation, effusions, empyema) PMID: 38764139
-Easy to do: place tube, drain blood, instill 500 cc of NS and suction out
-Can repeat 1-2 times
youtube.com/shorts/QhpAN...
#EMIMCC
Absolutely. I like ketamine as an alternate here
I’m not impressed by the lidocaine lit but topicslization may reduce the reflex response to laryngoscopy
Intubating Increased ICP #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
Intubating in elevated ICP
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
Reposted by Anand Swaminathan
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Jul 30;97:193-199. doi: 10.1016/j.ajem.2025.07.061. Epub ahead of print.
first10em.com
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…