Josh Kimbrell
@joshkimbre.bsky.social
Paramedic and medical student interested in resuscitation science and health equity. #Medsky
Reposted by Josh Kimbrell
you couldn't waterboard this out of me
October 30, 2025 at 3:24 PM
you couldn't waterboard this out of me
Reposted by Josh Kimbrell
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
October 29, 2025 at 3:19 PM
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
Reposted by Josh Kimbrell
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
October 29, 2025 at 3:37 PM
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 Josh Kimbrell
Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.
"One intangible advantage of capillary refill time is that performing it brings the clinician back to the bedside to reassess the patient. This act may be itself the holy grail of early sepsis management."
great piece on #sepsis
great piece on #sepsis
💬 Editorial: While capillary refill time shows promise for early #SepticShock management, integrating it into broader, multimodal resuscitation strategies remains key to improving outcomes.
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
October 29, 2025 at 4:08 PM
Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.
Reposted by Josh Kimbrell
New ACLS guidelines highlight the perils of failed capture during pacing.
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
October 26, 2025 at 3:45 PM
New ACLS guidelines highlight the perils of failed capture during pacing.
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...
authors.elsevier.com
August 25, 2025 at 6:08 PM
I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...
Reposted by Josh Kimbrell
The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine.
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
July 5, 2025 at 4:06 AM
The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine.
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
Reposted by Josh Kimbrell
📢 Check out our study in Academic Emergency Medicine: Systematic review of +32K patients in US EDs finds:
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
June 17, 2025 at 3:37 PM
📢 Check out our study in Academic Emergency Medicine: Systematic review of +32K patients in US EDs finds:
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
Reposted by Josh Kimbrell
Wow 😳
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Among patients with opioid-associated out-of-hospital cardiac arrest, chest compression and ventilation CPR was associated with a higher odds of favorable neurologic outcomes at hospital discharge.
ja.ma/4l7We4q
ja.ma/4l7We4q
June 17, 2025 at 4:54 PM
Wow 😳
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Reposted by Josh Kimbrell
Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
onlinelibrary.wiley.com
June 3, 2025 at 12:03 PM
Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...
buffalo.zoom.us/j/9848537719...
April 9, 2025 at 1:42 PM
Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...
buffalo.zoom.us/j/9848537719...
Why is Transcutaneous Pacing so difficult, and how can we do it better?
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
Episode 179 - Transcutaneous Pacing Pearls and Pitfalls
MCHD Paramedic Podcast · Episode
open.spotify.com
March 24, 2025 at 11:31 PM
Why is Transcutaneous Pacing so difficult, and how can we do it better?
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest.
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
Measuring Intra-Arrest Transport in Out-of-Hospital Cardiac Arrest: A Methodological Study of Registry-Compatible Definitions
For out-of-hospital cardiac arrest (OHCA) with refractory arrest, transport to hospital with ongoing cardiopulmonary resuscitation (CPR)—“intra-arrest…
www.sciencedirect.com
February 6, 2025 at 1:37 AM
We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest.
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023.
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
Prehospital Cricothyrotomy for Emergency Airway Management
www.sciencedirect.com
February 6, 2025 at 1:28 AM
We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023.
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
Reposted by Josh Kimbrell
If you have a patient arrive with a STEMI who took their daily 81mg aspirin that morning, how much more do you give them?
I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost
#Pharmsky #EMsky #Medsky
I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost
#Pharmsky #EMsky #Medsky
January 24, 2025 at 2:13 AM
Reposted by Josh Kimbrell
Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky
Study: Only 25% of pulse oximeters tested for skin-tone bias post-FDA guidance
These devices, crucial for measuring blood oxygen levels, have shown discrepancies in accuracy when used on darker skin, leading to potential health risks for non-white patients, the study states
www.ems1.com
January 13, 2025 at 7:29 PM
Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky
Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
January 12, 2025 at 1:05 AM
Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025.
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
January 9, 2025 at 5:28 PM
Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025.
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"What do I do if I'm concerned about someone's drinking? Speak up!"
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
January 9, 2025 at 5:17 PM
"What do I do if I'm concerned about someone's drinking? Speak up!"
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
"It's okay to not be okay."
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
January 9, 2025 at 5:06 PM
"It's okay to not be okay."
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
@qipunks.bsky.social leading a debrief after learning about PDSAs through deliberate play at the quality and safety course at #NAEMSP2025.
January 7, 2025 at 7:53 PM
@qipunks.bsky.social leading a debrief after learning about PDSAs through deliberate play at the quality and safety course at #NAEMSP2025.
Gabe Gan presenting a dissection of the anatomy of the run chart. This is one way to measure improvement in your system!
#NAEMSP2025
#NAEMSP2025
January 6, 2025 at 10:19 PM
Gabe Gan presenting a dissection of the anatomy of the run chart. This is one way to measure improvement in your system!
#NAEMSP2025
#NAEMSP2025
Reposted by Josh Kimbrell
Headed to San Diego for the @naemsp.bsky.social meeting next week?
📸 We will have FREE professional headshots on Thurs., 1/9/25 from 10-3 at our booth, #104! 📸
Pack your cutest shirt, fave lipstick and finest hair gel... we'll send you the digital image to enhance your budding #EMS career!
📸 We will have FREE professional headshots on Thurs., 1/9/25 from 10-3 at our booth, #104! 📸
Pack your cutest shirt, fave lipstick and finest hair gel... we'll send you the digital image to enhance your budding #EMS career!
January 1, 2025 at 7:51 PM
Headed to San Diego for the @naemsp.bsky.social meeting next week?
📸 We will have FREE professional headshots on Thurs., 1/9/25 from 10-3 at our booth, #104! 📸
Pack your cutest shirt, fave lipstick and finest hair gel... we'll send you the digital image to enhance your budding #EMS career!
📸 We will have FREE professional headshots on Thurs., 1/9/25 from 10-3 at our booth, #104! 📸
Pack your cutest shirt, fave lipstick and finest hair gel... we'll send you the digital image to enhance your budding #EMS career!
At least 20% of EMS patients report with pain, and only 15% of those with a pain score have pain reduced. Prehospital pain management is important, and we suck at it. How do we improve?
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
January 6, 2025 at 6:41 PM
At least 20% of EMS patients report with pain, and only 15% of those with a pain score have pain reduced. Prehospital pain management is important, and we suck at it. How do we improve?
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
Reposted by Josh Kimbrell
I thought this was worthy of a longer discussion so I made it into a blog post.
#ECGsky #medsky #cardiosky #EPeeps
#ECGsky #medsky #cardiosky #EPeeps
December 24, 2024 at 3:44 PM
I thought this was worthy of a longer discussion so I made it into a blog post.
#ECGsky #medsky #cardiosky #EPeeps
#ECGsky #medsky #cardiosky #EPeeps