Lightnews — Scholar-powered news

Simone Gherardi @drghem.bsky.social · 23d

but not in a hurry😉

Simone Gherardi @drghem.bsky.social · 28d

PLS SHARE. FOR PATIENTS SAFETY SAKE
#EMIMCC
www.tandfonline.com/doi/10.1080/...

2

Reposted by Simone Gherardi

@IM_Crit_ @imcrit.bsky.social · Sep 2

ICU Practice - Return to Basics:

When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient?

Oxygen mask/nasal cannula?
Non-invasive ventilation?

1 3 8

Simone Gherardi @drghem.bsky.social · Aug 31

ED PHEM doc here. I'm using more and more NIV for preox (usually NIV-ST on Hamilton T1). So I'm giving back up breaths on peep during apneic phase. #EMIMCC

2

Simone Gherardi @drghem.bsky.social · Aug 9

Give diuretics as boluses
look at Chloride, k+ and pH
Multimodal diuresis
Not every form of "heart failure" need diuretics in the firsts hours
#EMIMCC
#DiuresisJedi
#Deresuscitation

@IM_Crit_ @imcrit.bsky.social · Aug 8

Food for thought:

Chloride may be a stronger predictor of outcomes than sodium in heart failure

#foamed #foamcc #meded #Medsky #emimcc #cccsky

1

Simone Gherardi @drghem.bsky.social · Aug 3

4. Probably it s better not to try anything "softer" than intubation. But while preoxygenating I d put him on 10 cmh20 of peep at least

Simone Gherardi @drghem.bsky.social · Jul 31

Anyone with similar cases? how did it happen? Just a lack of proper follow up? Some syndromic presentation? It left me kind of unconfortable #EMIMCC is incredibile #FOAMed

Simone Gherardi @drghem.bsky.social · Jul 31

Had a case of elderly M with bilateral carotid stent intubated for sudden collapse and coma. CTA + CTP showed bilateral stent occlusion and complete shut down of anterior brain circulation. Signs of right upper limb ischemia (cold, pulseless). #EMIMCC #FOAMed #Stroke

1

Simone Gherardi @drghem.bsky.social · Jul 28

A case in which V Tach should be prevented with adrenaline and chronotropism #EMIMCC

@IM_Crit_ @imcrit.bsky.social · Jul 27

ICU/ED Snapshots:

Elderly patient with history of atrial fibrillation / HTN (treated with apixaban & b-blocker) came to the ED complaining of dizziness/weakness. Found to have AKI (creat: 2.0) & hyperkalemia (K: 6.0). BP was 128/59. ECG showed:

3

Simone Gherardi @drghem.bsky.social · Jul 28

AHAHAHAHAHAHAHA

Simone Gherardi @drghem.bsky.social · Jul 22

@gx8a.bsky.social tu, midazolam team 🤢

1

Simone Gherardi @drghem.bsky.social · Jun 30

Those "softer" skills usually given for granted or misunderstood, "you have or you dont". In many place where I've trained or worked one spokes about leading as an abstraction and something you don't create or striving for #EMIMCC @emcases.bsky.social
emergencymedicinecases.com/leadership-e...

Leading: Building Teams, Trust and Purpose in Emergency Medicine

Dr. Thom Mayer, Dr. Carolyn Snider, Dr. Howard Ovens, Dr. Anton Helman discuss: Leading is about action, not designation. We are all leaders. Being consistent, kind, and honest. How vulnerability is p...

emergencymedicinecases.com

2

Simone Gherardi @drghem.bsky.social · Jun 26

5. Find a way to enjoy #EMIMCC @emcrit.bsky.social
emcrit.org/emcrit/emcri...

EMCrit Guest Post - In Defense of Dignity by Chris Hicks, MD

Chris Hicks weighs in on dignity

emcrit.org

Simone Gherardi @drghem.bsky.social · Jun 15

Ketorolac coming at 30 mg per vial 🤯🤯🤯#EMIMCC

josh farkas 💊 @pulmcrit.bsky.social · Jun 15

short thread: NSAIDs in the ICU

as a rule I avoid NSAIDs due to risks of GI bleeding & especially AKI

but they may be OK for some patients, perhaps… (?)

🤷‍♂️chronic anuric renal failure

🤷‍♂️very low illness severity (not truly critically ill; stuck in ICU for logistic/monitoring issues)

🧵#1/3 #EMIMCC

a man in a blue shirt and tie is sitting in a classroom and says " my nemesis "

ALT: a man in a blue shirt and tie is sitting in a classroom and says " my nemesis "

media.tenor.com

Simone Gherardi @drghem.bsky.social · Jun 14

Tracheo emergencies toolbox #EMIMCC youtu.be/-2bFRCx0cFQ?...

Ultimate Guide to Tracheostomy Emergencies: What Every Provider Must Know to Save a Life

YouTube video by The Protected Airway Collaborative

youtu.be

2

Simone Gherardi @drghem.bsky.social · Jun 14

If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC

3 4

Simone Gherardi @drghem.bsky.social · Jun 7

Cardioman, you re right, not a STEMI. But.. need the same care aka straight to the cath lab. Time to change paradigm
#EMIMCC #OMI

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💙)

1

Reposted by Simone Gherardi

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

It's entirely possible that bronchodilation is due to the anticholinergic and ketamine isn't doing anything.

Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well.

Pending further data this seems reasonable.🤷‍♂️

1 4

Simone Gherardi @drghem.bsky.social · Jun 1

Mmmmm love ketamine but always I ve always been skeptical on super powerfull bronchodilatatory properties #EMIMCC

josh farkas 💊 @pulmcrit.bsky.social · May 31

for an intubated asthmatic whose bronchospasm won't break:

high-dose ketamine is good, but it should be given with an anticholinergic.

why give glycopyrrolate?

🤤reduces secretions from ketamine

👊it causes bronchodilation!

so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC

1 4

Simone Gherardi @drghem.bsky.social · May 28

Keep your ED infusion pump for something else! #EMIMCC

josh farkas 💊 @pulmcrit.bsky.social · May 27

Loop diuretic infusions!

I was disappointed to encounter this recently in a review article on diuretics.

It states that if a patient doesn't respond to a bolus of loop diuretic, then you should try a continuous infusion.

This is a common misconception.

Let's discuss why it's wrong... #EMIMCC