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josh farkas 💊 @pulmcrit.bsky.social · 14h

antibiotic stewardship pearl:

Pneumonia patient on ampicillin-sulbactam

Blood grows Strep pneumo, sensitivity pending

Patient is improving

Sulbactam adds *nothing* to ampicillin for S. pneumo (resistance not mediated by beta-lactamase)

So you can immediately narrow to ampicillin #IDsky #EMIMCC

a close up of a woman 's face with the word skymed written on the bottom

ALT: a close up of a woman 's face with the word skymed written on the bottom

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OLS @olofl-s.bsky.social · 2d

A man in his 50s seeks the ED for the umpteenth time since his abdo pain started a few years ago. He says that it’s his gallbladder, surgery has been denied because of diffuse pain and normal blood tests. Today CRP 9, Leukocytes 11. #POCUS He got his operation the next day. #EMIMCC

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xenwan @xenwan.bsky.social · 2d

Surely LLMs are getting better by the hour, but still they suffer from intrinsic flaws that need to be addressed when using them in real life clinical scenarios.

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xenwan @xenwan.bsky.social · 3d

You pay for its constant peer-review and update process, instead of relying on LLM. I personally use both (my hospital pays for UTD)
medium.com/@underwaterc...

OpenEvidence Sounds Promising, but is it Reliable?

In the 1940s, almost half of Americans were smoking cigarettes. There was very little research to show that cigarettes were harmful, and…

medium.com

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josh farkas 💊 @pulmcrit.bsky.social · 12d

if you’re getting a CT chest for a critically ill patient in respiratory failure of unclear etiology, it should be a CT angio to evaluate for PE (& other stuff)

sometimes being thorough is more effective than being smart

also, contrast allows evauation of cardiac chamber size & IVC reflux

a man in a black shirt is standing in front of a fire and the words do it

ALT: a man in a black shirt is standing in front of a fire and the words do it

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KASIC @kasic.bsky.social · 21d

Pondering Penicillin? Check out this week’s KASIC pearl to learn that when it comes to Penicillin for S. aureus, Is it Aye or Nay? kymdro.org/kasic/?p=8559

#IDSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs

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NEJM.org @nejm.org · 21d

Orforglipron is an oral, small-molecule, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist being evaluated for the treatment of type 2 diabetes. Research findings from the ACHIEVE-1 phase 3 trial are summarized in a new Quick Take video. nej.md/42tGbHh

A visual representation of the ACHIEVE-1 phase 3 trial, which evaluated orforglipron for the treatment of type 2 diabetes

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KASIC @kasic.bsky.social · 28d

Is Cefpodoxime Active? Check out this week’s KASIC pearl to learn about Ceftriaxone Guided IV to PO kymdro.org/kasic/?p=8544

#IDTSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs

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NEJM.org @nejm.org · Sep 9

Algorithm for the Management of Type B Aortic Dissection.

Read the full review by Firas F. Mussa, MD, and Panos Kougias, MD (@KougiasP): nej.md/4mKYgcb

A diagram showing the algorithm for the management of type B aortic dissection.

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Ken Milne MD @thesgem.bsky.social · Sep 4

Some days in healthcare.
#MedSky

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Stanford Antimicrobial Safety & Sustainability Program @stanfordasp.bsky.social · Sep 3

🌟 ABX Pearl of the Day:

❓ Q: I’m looking for oral ABX options for UTI. When might oral fosfomycin be appropriate?

#IDsky #medsky #meded #pharmsky #skyRX #AMSsky

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REBEL EM @rebel-em.bsky.social · Sep 3

🚨 NEW POST: MDCalc Wars 🛑💥
Are you using PERC and Wells correctly?

✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!

👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky

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REBEL EM @rebel-em.bsky.social · Sep 2

🎧 NEW CoreCast!
🫁 Confused about hypoxia vs hypoxemia?
We’ve got a simple bedside approach‼️
🚫 Shunt ≠ Dead space
💡 Know when FiO₂ fails & PPV saves
🔗 https://loom.ly/hJFaydE
#FOAMed #MedSky #EMIMCC

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Nephrology Journal Club @nephjc.bsky.social · Sep 3

T3f:
What’s a nephrologist to do?? If we are powerless to prevent excess CV mortality and hospitalizations in patients on dialysis then the real answer likely lies in dialysis prevention & early initiation of the pillars of CKD treatment. #NephJC

www.mdpi.com/1999-49...

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KASIC @kasic.bsky.social · Aug 30

My Life is a Lie. Check out this week’s KASIC pearl to learn how to answer life’s most important question - Bactericidal vs. Bacteriostatic: Does it Matter? kymdro.org/kasic/?p=8511

#IDSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs

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Rossana Rosa @drrossanarosa.bsky.social · Aug 26

Prompted by my dear friend @ambrx2003.bsky.social

How to befriend a steward 🥰😉
#IDSky #AMSSky #PharmSky

How to befriend a steward: know your antibiogram, delabel penicillin allergies, stop the vanco

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JAMA @jama.com · Aug 23

In patients with salvageable brain tissue identified by perfusion imaging who did not initially receive thrombectomy, alteplase given 4.5 to 24 hours after acute ischemic #stroke onset may improve functional outcomes.

ja.ma/4oOAoWx #MedSky #NeuroSky

Figure 2. Distribution of Modified Rankin Scale Scores at 90 Days

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Giovanni Xotta @gx8a.bsky.social · Jun 7

61yo M from Ghana. Complaining CP since 3 hours.

This ECG looks tasty. Could mislead a lot of physicians.
@drghem.bsky.social @emcrit.bsky.social @eusem.bsky.social @criticalcarenow.bsky.social
(My first Bluesky post💙)

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REBEL EM @rebel-em.bsky.social · Aug 1

🚨 NEW POST: MDCalc Wars 🛑💥
Are you using PERC and Wells correctly?

✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!

👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky

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josh farkas 💊 @pulmcrit.bsky.social · Aug 1

rapidly pushing IV calcium may cause:

😦 vasodilation, bradycardia, hypotension
😦 nausea/vomiting, flushing

if patients are conscious, this can make them feel horrible

if the patient is obtunded & not intubated, emesis can be a big problem

whenever possible, give IV Ca slowly #EMIMCC

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josh farkas 💊 @pulmcrit.bsky.social · Jul 22

the distinction between “bactericidal” vs “bacterostatic” antibiotics is some irrelevant BS.

this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC

Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · Jul 22

We implore authors, peer reviewers,and journal editors to stop perpetuating the concept of static and cidal antibiotics, given the aforementioned evidence demonstrating it is a myth. In a clinical context, these terms are not complex. Rather,they are simply incorrect
journals.asm.org/doi/10.1128/...

Static vs. cidal: it’s not complex; it’s simply incorrect | Antimicrobial Agents and Chemotherapy

In the first sentence of their recent study (1), Gil-Gil and Berryhill cite a 2018 review article (2) to support the statement, “The clinical outcomes of antibiotic treatments involving the administra...

journals.asm.org

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · Jul 19

That’s exactly our point - the Spanish data made no sense www.nephjc.com/news/chronot...

IMO use long acting meds once a day and timing does not matter

Chronicles of Chronotherapy in Controlling Cardiovascular Complications — NephJC

Dr Hiremath gives the chronotherapy literature a Swap.

www.nephjc.com

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ID:IOTS Podcast @idiots-pod.bsky.social · Jul 18

Good question! #idsky #microsky
🪡
Co-amoxiclav is generally dosed in the UK as follows:

PO: 500mg Amox / 125mg Clavulanate
IV: 1000mg Amox / 200mg Clavulanate
Both 8-hourly.

This gives you differing ratios of Amox to Clav (4:1 for PO, 5:1 for IV). What gives?

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Nephrology Journal Club @nephjc.bsky.social · Jul 18

Another #NephJCshorts, by @hswapnil.medsky.social

✍️Edited by @kidneyboy.bsky.social

🎨VA by @nephroseeker.medsky.social

🌊The long discussions mirror the old FLUID war. Despite the nuances, the conclusion is firm: Ringer's lactate offers no benefit over NS

www.nephjc.com/news/fluid-t...

NephJC Shorts: The end of the Fluid Wars? — NephJC

N Engl J Med . 2025 Jun 12. doi: 10.1056/NEJMoa2416761. Online ahead of print. A Crossover Trial of Hospital-Wide Lactated Ringer's Solution versus Normal Saline Lauralyn McIntyre , Dean Fergus...

www.nephjc.com

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