Alex Koyfman
@emhighak.bsky.social
EM Physician+Educator+Pt Advocate // emdocs.net EIC & Co-founder // #EMRA45u45 // #GirlDad // #citizenofworld // #selfmade
Reposted by Alex Koyfman
#4/4) ascenting cholangitis generally IS infected & OFTEN causes septic shock
be wary of patients w/ ascending cholangitis who seem OK (may crash)
source control is usually obtained via ERCP. this should be done regardless of how sick the patient is (nobody is “too sick” for source control).
be wary of patients w/ ascending cholangitis who seem OK (may crash)
source control is usually obtained via ERCP. this should be done regardless of how sick the patient is (nobody is “too sick” for source control).
a man wearing sunglasses and a green jacket is standing in a crowd and says `` do it '' .
ALT: a man wearing sunglasses and a green jacket is standing in a crowd and says `` do it '' .
media.tenor.com
October 19, 2025 at 1:11 PM
#4/4) ascenting cholangitis generally IS infected & OFTEN causes septic shock
be wary of patients w/ ascending cholangitis who seem OK (may crash)
source control is usually obtained via ERCP. this should be done regardless of how sick the patient is (nobody is “too sick” for source control).
be wary of patients w/ ascending cholangitis who seem OK (may crash)
source control is usually obtained via ERCP. this should be done regardless of how sick the patient is (nobody is “too sick” for source control).
Reposted by Alex Koyfman
#3/4) percutaneous drainage is over-utilized for acute calculous cholecystitis (2/2 pressure to do something now)
no high-quality data supporting drain insertion (RCTs failed to find benefit)
the ideal therapy for most patients is medical stabilization followed by early laproscopic cholecystectomy
no high-quality data supporting drain insertion (RCTs failed to find benefit)
the ideal therapy for most patients is medical stabilization followed by early laproscopic cholecystectomy
a group of surgeons are dancing in an operating room with the words happy surgery team great results
ALT: a group of surgeons are dancing in an operating room with the words happy surgery team great results
media.tenor.com
October 19, 2025 at 1:11 PM
#3/4) percutaneous drainage is over-utilized for acute calculous cholecystitis (2/2 pressure to do something now)
no high-quality data supporting drain insertion (RCTs failed to find benefit)
the ideal therapy for most patients is medical stabilization followed by early laproscopic cholecystectomy
no high-quality data supporting drain insertion (RCTs failed to find benefit)
the ideal therapy for most patients is medical stabilization followed by early laproscopic cholecystectomy
Reposted by Alex Koyfman
Answer: #2 normotensive cardiogenic shock
It’s sneaky, easy to miss but important to identify, diagnose cause, manage and admit to ICU—not the floor tele unit
Occurs in about 12% of CS patients
Mortality 17%
www.jacc.org/doi/10.1016/...
It’s sneaky, easy to miss but important to identify, diagnose cause, manage and admit to ICU—not the floor tele unit
Occurs in about 12% of CS patients
Mortality 17%
www.jacc.org/doi/10.1016/...
Continuum of Preshock to Classic Cardiogenic Shock in the Critical Care Cardiology Trials Network Registry:
www.jacc.org
August 10, 2025 at 7:49 PM
Answer: #2 normotensive cardiogenic shock
It’s sneaky, easy to miss but important to identify, diagnose cause, manage and admit to ICU—not the floor tele unit
Occurs in about 12% of CS patients
Mortality 17%
www.jacc.org/doi/10.1016/...
It’s sneaky, easy to miss but important to identify, diagnose cause, manage and admit to ICU—not the floor tele unit
Occurs in about 12% of CS patients
Mortality 17%
www.jacc.org/doi/10.1016/...
Incredible work. Thx for regularly elevating core clinical practice.
July 30, 2025 at 10:27 PM
Incredible work. Thx for regularly elevating core clinical practice.
Reposted by Alex Koyfman
to recap: the dosing of antiepileptics for true, ongoing, life-threatening convulsive status epilepticus in an adult:
1st line:
👊Lorazepam 0.1 mg/kg IV (VA-COOP RCT)
👊Or if no IV access: Midazolam 10 mg IM (RAMPART RCT)
2nd line:
👊Levetiracetam 60 mg/kg up to a max dose of 4.5 grams (ESSETT RCT)
1st line:
👊Lorazepam 0.1 mg/kg IV (VA-COOP RCT)
👊Or if no IV access: Midazolam 10 mg IM (RAMPART RCT)
2nd line:
👊Levetiracetam 60 mg/kg up to a max dose of 4.5 grams (ESSETT RCT)
two women are sitting next to each other and one is pointing at the camera
ALT: two women are sitting next to each other and one is pointing at the camera
media.tenor.com
May 29, 2025 at 10:06 PM
to recap: the dosing of antiepileptics for true, ongoing, life-threatening convulsive status epilepticus in an adult:
1st line:
👊Lorazepam 0.1 mg/kg IV (VA-COOP RCT)
👊Or if no IV access: Midazolam 10 mg IM (RAMPART RCT)
2nd line:
👊Levetiracetam 60 mg/kg up to a max dose of 4.5 grams (ESSETT RCT)
1st line:
👊Lorazepam 0.1 mg/kg IV (VA-COOP RCT)
👊Or if no IV access: Midazolam 10 mg IM (RAMPART RCT)
2nd line:
👊Levetiracetam 60 mg/kg up to a max dose of 4.5 grams (ESSETT RCT)
Agree with a lot of this. Thx for your high-level work and time.
March 17, 2025 at 12:02 PM
Agree with a lot of this. Thx for your high-level work and time.