@IM_Crit_
@imcrit.bsky.social
Intensivist I Internal Medicine | ☕️, 🍩, 🥐, 🍫 addict |
#emimcc
#emimcc
The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc
February 8, 2026 at 4:37 PM
The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc
during FB significantly ⬇️ serious adverse events (4% vs 96% in conventional). Events were driven by ventilatory failure due to pressure-alarm limitation, with lower delivered Vt (160 vs 400 mL; p<0.001) & minute ventilation (3.2 vs 7.2 L/min; p<0.001) under conventional settings
February 7, 2026 at 4:52 PM
during FB significantly ⬇️ serious adverse events (4% vs 96% in conventional). Events were driven by ventilatory failure due to pressure-alarm limitation, with lower delivered Vt (160 vs 400 mL; p<0.001) & minute ventilation (3.2 vs 7.2 L/min; p<0.001) under conventional settings
#Bronchoscopy:
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
February 7, 2026 at 4:52 PM
#Bronchoscopy:
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
February 7, 2026 at 4:29 AM
Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts:
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
February 6, 2026 at 8:07 PM
Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts:
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The differential pressure (dP) sensor in Impella RP devices may malfunction, causing sensor values to drift over time. If sensor drift occurs, the Automated Impella Controller (AIC) may display inaccurate info, including pump flow readings, PA/CV Placement Signals and PAPi
February 5, 2026 at 2:17 PM
The differential pressure (dP) sensor in Impella RP devices may malfunction, causing sensor values to drift over time. If sensor drift occurs, the Automated Impella Controller (AIC) may display inaccurate info, including pump flow readings, PA/CV Placement Signals and PAPi
According to the guidelines:
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
February 4, 2026 at 2:53 AM
According to the guidelines:
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
TNK is administered in a weight-based fashion:
January 31, 2026 at 8:41 PM
TNK is administered in a weight-based fashion:
Regarding the antibiotic management, there is emphasis on the use of macrolides, especially for severe CAP (not just for CAP due to atypical bugs...)
January 30, 2026 at 7:00 PM
Regarding the antibiotic management, there is emphasis on the use of macrolides, especially for severe CAP (not just for CAP due to atypical bugs...)
There are many different tests for determining etiology in CAP patients
It's worth remembering that urine Streptococcus & Legionella antigen tests are only ~75% sensitive... I see this often...
Also: a negative COVID or influenza test is not 100% trustworthy!
It's worth remembering that urine Streptococcus & Legionella antigen tests are only ~75% sensitive... I see this often...
Also: a negative COVID or influenza test is not 100% trustworthy!
January 30, 2026 at 7:00 PM
There are many different tests for determining etiology in CAP patients
It's worth remembering that urine Streptococcus & Legionella antigen tests are only ~75% sensitive... I see this often...
Also: a negative COVID or influenza test is not 100% trustworthy!
It's worth remembering that urine Streptococcus & Legionella antigen tests are only ~75% sensitive... I see this often...
Also: a negative COVID or influenza test is not 100% trustworthy!
An etiologic agent is not identified in >50% of CAP cases. Streptococcus pneumoniae is the most common bacterial pathogen. A respiratory virus is identified in 30-40% of cases. In 6-10% of CAP cases with identified etiology, both a bacterium & a virus are detected
January 30, 2026 at 7:00 PM
An etiologic agent is not identified in >50% of CAP cases. Streptococcus pneumoniae is the most common bacterial pathogen. A respiratory virus is identified in 30-40% of cases. In 6-10% of CAP cases with identified etiology, both a bacterium & a virus are detected
Nice review (and a refresher) on community-acquired pneumonia (CAP):
In the United States, CAP is estimated to be responsible for 1.2 million emergency department visits & 41,210 deaths annually
In the United States, CAP is estimated to be responsible for 1.2 million emergency department visits & 41,210 deaths annually
January 30, 2026 at 7:00 PM
Nice review (and a refresher) on community-acquired pneumonia (CAP):
In the United States, CAP is estimated to be responsible for 1.2 million emergency department visits & 41,210 deaths annually
In the United States, CAP is estimated to be responsible for 1.2 million emergency department visits & 41,210 deaths annually
ICU (ABIM) Board Review Questions:
January 28, 2026 at 5:43 PM
ICU (ABIM) Board Review Questions:
I am reading this old study of 16 out-of-hospital PEA patients. The researchers used #POCUS plus stable PetCO2 during #CPR pauses to identify pseudo-PEA & administered vasopressin. This led to improved outcomes
Does anybody have any experience with this strategy?
#foamed #foamcc #medsky #emimcc
Does anybody have any experience with this strategy?
#foamed #foamcc #medsky #emimcc
January 27, 2026 at 3:12 PM
I love ESICM but no more SOFAs, please:
January 20, 2026 at 2:06 PM
I love ESICM but no more SOFAs, please:
What do you think that happened next?
Family agreed w patient's wishes
Patient recovered from dementia
Dr "Robby" stepped in
Other ideas?
* Dr "Robby" (if you don't know him):
Family agreed w patient's wishes
Patient recovered from dementia
Dr "Robby" stepped in
Other ideas?
* Dr "Robby" (if you don't know him):
January 17, 2026 at 7:47 PM
What do you think that happened next?
Family agreed w patient's wishes
Patient recovered from dementia
Dr "Robby" stepped in
Other ideas?
* Dr "Robby" (if you don't know him):
Family agreed w patient's wishes
Patient recovered from dementia
Dr "Robby" stepped in
Other ideas?
* Dr "Robby" (if you don't know him):