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Critical Care Notes @criticalcarenotes.bsky.social · Aug 24

I do this pretty regularly

Critical Care Notes @criticalcarenotes.bsky.social · Aug 7

Point-of-care ultrasound is being used by an increasing number of nurse practitioners, but its utility is not limited to the ICU, nor even to Acute Care.

journals.lww.com/jaanp/abstra...

Expanding the horizon: The case for point-of-care... : Journal of the American Association of Nurse Practitioners

enhanced diagnostic accuracy, faster decision-making, and improved patient satisfaction. With growing access to affordable handheld devices and expanding educational opportunities, POCUS is becoming i...

journals.lww.com

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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

a man wearing sunglasses and a green shirt with breaking bobby bones on the bottom

ALT: a man wearing sunglasses and a green shirt with breaking bobby bones on the bottom

media.tenor.com

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Critical Care Notes @criticalcarenotes.bsky.social · Aug 1

The other thing to remember is that patients in HFNC typically benefit more from “flow” than FiO2. So wean the FiO2 before the flow.

@IM_Crit_ @imcrit.bsky.social · Aug 1

Another thing I hear often in the ICU is this:

The patient is on high-flow nasal cannula (HFNC) (or high-flow oxymask)

When I specifically ask "how many liters?", often the answer is: 6 or 7 l/min

HFNC is a respiratory support system delivering heated-humidified O2 @

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Critical Care Notes @criticalcarenotes.bsky.social · Jul 22

And remember, ST is often compensatory. Don’t slow it down blindly.

REBEL EM @rebel-em.bsky.social · Jul 21

🫀 Sinus tachycardia = a sign, not a diagnosis.
Don’t just treat the rate—find the cause.
Use this 8-point checklist & skip reflexive beta blockers.

🎧 REBEL Core Cast 137: https://wp.me/pdrP8b-5nI

#EMIMCC #FOAMed #MedEd #MedSky

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Critical Care Notes @criticalcarenotes.bsky.social · Jul 22

“But WHY did they fail?” All too often I get, “they failed SBT” from someone who also wasn’t there, and that’s that. Do it again and see for yourself. Often you can get them off the vent after all.

josh farkas 💊 @pulmcrit.bsky.social · Jul 21

great thread on SBTs

💨 if someone “failed” for unclear reasons before your shift, repeat the SBT with direct observation

💨 look for treatable causes of SBT failure

-but-

💨 for most patients, repeating multiple SBTs daily doesn’t help

more: emcrit.org/ibcc/extubat... #EMIMCC

@IM_Crit_ @imcrit.bsky.social · Jul 19

ICU Practice:

The conventional teaching is to perform spontaneous breathing trials (SBT) only once daily when we try to wean a patient from mechanical ventilation. The rationale is to prevent precipitating respiratory muscle fatigue. It has been shown that SBT failures are often

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Critical Care Notes @criticalcarenotes.bsky.social · Jul 21

Big news for lung ultrasound #POCUS

@IM_Crit_ @imcrit.bsky.social · Jul 21

This is the summary of the recommendations:

1. Lung ultrasound versus chest x-ray to diagnose CAP

For adults with suspected CAP, we suggest lung US is an acceptable diagnostic alternative to CXR in medical centers where appropriate clinical expertise exists

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Critical Care Notes @criticalcarenotes.bsky.social · Jul 4

I sadly see this not rarely. Especially with overworked interns. They run out of time and rather than admit this, and risk being perceived as failing, they lie. And they ALWAYS get caught.

Anand Swaminathan @emswami.bsky.social · Jul 4

Advice for New Trainees #5: Never Lie. It’s not worth to tell what may seem like a small lie to cover up for something you forgot to check or do.

Better to simply say, “I don’t know or I didn’t check. Let me find out and I’ll get back to you.”

youtube.com/shorts/x6L6G...
#EMIMCC

Advice for New Trainees 5: Never Lie #emergencymedicine #residents #internship

YouTube video by EMSwami

youtube.com

Critical Care Notes @criticalcarenotes.bsky.social · Jul 2

I’ll add to this, communicate when you want to be called. Don’t just start NE with a MAP goal>65, add, “call me if you get to X.” This prevents you getting busy and checking back to find that they’re almost maxed.

Anand Swaminathan @emswami.bsky.social · Jul 2

Advice for New Trainees #3: Communicate
If you want something done, not enough to just order it
Best approach: put orders in, find nurse + discuss
Gives nurse opportunity to share observations, clarify orders, catch errors + creates a shared mental model

youtube.com/shorts/nLh20...
#EMIMCC

Advice for New Trainees 3: Communicate #emergencymedicine #residents #internship

YouTube video by EMSwami

youtube.com

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Anand Swaminathan @emswami.bsky.social · Jul 1

Occult VF in Cardiac Arrest: 5.3% of patients with cardiac arrest showed VF on echo but ECG w/ PEA/asystole

Study does not show improved outcomes but not powered to do so

Strong argument for intra-arrest echo as it can dramatically change management

#EMIMCC

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Anand Swaminathan @emswami.bsky.social · Jul 1

Advice for New Trainees #2: Listen to your nurses

Don’t mistake your short time as a doctor as equivalent clinically to their years and decades of experience

If a nurse asks you to reevaluate a patient, GO TO THE BEDSIDE AND RE-EVALUTE THE PATIENT, EVERY TIME.

youtube.com/shorts/c0o5F...
#EMIMCC

Advice for Interns 2: Listen to The Nurses #emergencymedicine #internship #residents

YouTube video by EMSwami

youtube.com

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Eddy Joe Gutierrez @eddyjoemd.bsky.social · Jun 26

Might we be correcting hyponatremia too slowly? May our patients be suffering because we're too fearful of the risk of central pontine myelinolysis? Here's data that may challenge our regular approach. Hat tip to the authors.
eddyjoemd.com/foamed

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Critical Care Notes @criticalcarenotes.bsky.social · Jun 27

Interesting. Had never thought of this before. How many other things in medicine to we get wrong because if assumptions?

Lars Mølgaard Saxhaug @load-dependent.bsky.social · Jun 26

The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc

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Saskia Middeldorp @middeldorps.bsky.social · Jun 22

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%!

Practice changing investigator-initiated RCT.

#ISTH2025

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Critical Care Notes @criticalcarenotes.bsky.social · Jun 18

Recently had @ebtapper.bsky.social on the Critical Care Scenarios podcast talking GI and this topic came up.

icuscenarios.com/lightning-ro...

Lightning rounds 53: GI Q&A with Elliot Tapper – Critical Care Scenarios

icuscenarios.com

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Critical Care Notes @criticalcarenotes.bsky.social · Jun 18

Totally agree regarding docusate. I start bowel regimen (typically senna) on admission. Like pain, much easier to get ahead of than to fix when out of control. Escalate as needed. BM at least every 3 days.

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Critical Care Notes @criticalcarenotes.bsky.social · Jun 18

Not anesthesia but all my attendings are. We typically reverse prior to extubation in cases like you mention.

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Intensive Care Academy @icacademy.bsky.social · Jun 17

New lesson in the POCUS course: Abdominal ultrasound!

#medsky #emimcc #POCUS

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Critical Care Notes @criticalcarenotes.bsky.social · Jun 16

Mottling is one of this signs that gets me real worried.

Eddy Joe Gutierrez @eddyjoemd.bsky.social · Jun 13

When a patient presents with mottling among their constellation of signs, symptoms, and labs, there is a look that team members give each other that we've all seen. It's not a positive look. Here is some data reinforcing our intuition. 🎩 tip to the authors.
eddyjoemd.com/foamed

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

beta-blocker in sepsis trials continue to mystify me

you have patients on reasonable doses of pressor (0.5 mcg/kg/min norepi equivalent) with an average MAP ~80 (mean diastolic BP ~60!)

you're worried about catecholamine toxicity

instead of reducing the pressors you add a beta-blocker😳 #EMIMCC

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Critical Care Notes @criticalcarenotes.bsky.social · Jun 16

Don’t be distracted by the obvious pleural yuck…

@IM_Crit_ @imcrit.bsky.social · Jun 14

ICU Snapshots:

If you have a sharp eye, what is the worse finding here 👇?

Critical Care Notes @criticalcarenotes.bsky.social · Jun 16

My students know well of my disdain for the d-diner…

Will Preston @willpreston.bsky.social · Jun 14

No, no. Wells is the scientist’s name, you’re referring to Wells’ monster. #emimcc

From MD calc: “The model should be applied only after a history and physical suggests that venous thromboembolism is a diagnostic possibility. it should not be applied to all patients with chest pain or dyspnea or to all patients with leg pain or swelling. This is the most common mistake made. Also, never never do the D-dimer first [before history and physical exam]. The monster in the box is that the D-dimer is done first and is positive (as it is for many patients with non-VTE conditions)”

Critical Care Notes @criticalcarenotes.bsky.social · Jun 16

About all it’s good for.

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Will Preston @willpreston.bsky.social · Jun 14

No, no. Wells is the scientist’s name, you’re referring to Wells’ monster. #emimcc

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Critical Care Notes @criticalcarenotes.bsky.social · Apr 23

Anyone ever done peer review for Optum InterQual? I was approached about doing some reviews but not sure what to make of it. Sounds good, they send you material in your area of expertise and you review it for accuracy. I’ve done similar work before but never heard of this particular company.

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