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grahamabra.bsky.social @grahamabra.bsky.social · Sep 5

A famous nephrologist getting ready to go see the most famous guy who plays a nephrologist @glaucomflecken.bsky.social @stanforddeptmed.bsky.social Grand Rounds!

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𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · 13d

great name they chose, will be a pleasure watching the pronunciation happen real-time

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Vivek Bhalla, MD, FASN, FAHA @bhallaresearch.bsky.social · 14d

We are thrilled to announce that we have generously received funding for a one-year hypertension fellowship, and we are recruiting now for a candidate to start fellowship July 1, 2026 .
med.stanford.edu/hypertension/e…

-Jehan Zahid Bahrainwala
HTN Fellowship Program Director

https://med.stanford.edu/hypertension/e…

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 13d

Go to Stanford and learn from the best for hypertension!

#NephSky

Vivek Bhalla, MD, FASN, FAHA @bhallaresearch.bsky.social · 14d

We are thrilled to announce that we have generously received funding for a one-year hypertension fellowship, and we are recruiting now for a candidate to start fellowship July 1, 2026 .
med.stanford.edu/hypertension/e…

-Jehan Zahid Bahrainwala
HTN Fellowship Program Director

https://med.stanford.edu/hypertension/e…

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𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · 22d

Very key point for learners regarding stressed vs unstressed volumes and how our Rx/pressors change that balance

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Lars Mølgaard Saxhaug @load-dependent.bsky.social · 22d

Secondly, loop diuretics act as venodilators, which means if you look at vena cava shortly after a diuretic dose, vena cava (and RAP/CVP for that matter) may suggest normovolemia even if the patient is still volume overloaded. www.ahajournals.org/doi/10.1161/...

Direct Vascular Effects of Furosemide in Humans | Circulation

Background In humans, hemodynamic changes observed within minutes after systemic administration of furosemide are often referred to as direct vasoactivity. However, these immediate changes do not per ...

www.ahajournals.org

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Lars Mølgaard Saxhaug @load-dependent.bsky.social · 22d

First of all, I think it’s well overdue that we abandon the use of vena cava size (or at least downgrade it). It’s the poorest parameter! Vena cava circularity/sphericity is much better! pubmed.ncbi.nlm.nih.gov/28065586/

Estimation of Central Venous Pressure Using the Ratio of Short to Long Diameter from Cross-Sectional Images of the Inferior Vena Cava - PubMed

S/L of an IVC cross-section measured using three-dimensional echocardiography may be a reliable parameter to estimate CVP compared with standard grading by 2DE.

pubmed.ncbi.nlm.nih.gov

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Lars Mølgaard Saxhaug @load-dependent.bsky.social · 22d

Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky

Damien BARRAUD MD @damienbarraudmd.bsky.social · 23d

La veine cave inférieure n'est pas un bon examen pour décider de remplir un malade ? En toute logique, elle n'est pas meilleure pour guider la vidange...
www.jacc.org/doi/10.1016/...

Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial

www.jacc.org

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

☝️DIGIT trial shows benefit from digitoxin in HFrEF (even in context of reasonable GDMT)

numerous limitations but consistent w/ the seminal DIG trial (👇 hospitalizations)

digitoxin is hepatically metabolized making dosing easier (not available in USA) #1/2 #EMIMCC

www.medscape.com/viewarticle/...

Five Big Messages From the DIGIT-HF Trial

Will reassuring safety data and a good efficacy signal increase use of digoxin in heart failure? John Mandrola MD reviews the DIGIT- HF trial from the 2025 European Society of Cardiology congress.

www.medscape.com

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

for those of you worried about the safety of PPIs among critically ill patients:

this RCT evaluated the effect of using insanely ridiculously ginormous mega-doses of esomeprazole in septic patients and...

...absolutely nothing happened. #EMIMCC

journals.lww.com/ccmjournal/f...

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Lars Mølgaard Saxhaug @load-dependent.bsky.social · Aug 17

Case in point: vasopressin is probably only a wise choice if EF is supranormal pubmed.ncbi.nlm.nih.gov/37030157/

Echocardiographic profiles and hemodynamic response after vasopressin initiation in septic shock: A cross-sectional study - PubMed

Pre-drug echocardiographic profiles differed in hemodynamic responders after vasopressin initiation versus non-responders.

pubmed.ncbi.nlm.nih.gov

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Lars Mølgaard Saxhaug @load-dependent.bsky.social · Aug 17

Extremely striking difference in utilisation of Impella in the US vs UK and Canada. #cardiosky #cccsky #emimcc jamanetwork.com/journals/jam...

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

P-values are fraught with hazard, but SO IS BAYESIAN STATISTICS

the Achilles heel of Bayesian stats is that someone determines a pre-test probability distribution (usually arbitrarily)

The pre-test probability is often too high

This inflates the final posterior probability

🧵 #1/4 #EMIMCC

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josh farkas 💊 @pulmcrit.bsky.social · Aug 13

assessing the severity of methemoglobinemia:

people get too hung up on % methemoglobin

*functional hemoglobin level* is more important

30% MeHb is OK if total hemoglobin is 15 mg/dL, but a big problem if total hemoglobin is 7 mg/dL

same idea as O2 saturation vs. O2 carrying capacity 👇

#EMIMCC

https://emcrit.org/ibcc/methemoglobinemia/

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

technically this is true “up to 40%”

my bank account contains “up to 10 billion dollars”

the words “up to” are doing a lotta work here 😆

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𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · Aug 12

As @bradspellberg.bsky.social would say CRP is missing a letter as a test "A" (CRAP) - www.sciencedirect.com/science/arti...

Revisiting diagnostics: erythrocyte sedimentation rate and C-reactive protein: it is time to stop the zombie tests

www.sciencedirect.com

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josh farkas 💊 @pulmcrit.bsky.social · Aug 11

Myth busting: Antibiotics don't reduce mortality in variceal hemorrhage!

I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va...

We probably don't need antibiotics at all🤦‍♂️

Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC

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Juan Carlos Q Vélez, MD @juancarlosqvelez.bsky.social · Aug 12

Convoluted RBC cast; case of endocarditis-associated crescentic necrotizing glomerulonephritis #UrinarySediment #UrineMicroscopy #PisseProphet #OchsnerNephrology #Glomerular #GN #AKI

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Alex Crits-Christoph @acritschristoph.bsky.social · Aug 12

I will never get over how creepy it is how the NIH X account is a full time propaganda machine now

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𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · Aug 12

Important to note that it depends on the immunoglobulin in question...

IgA anionic -- high AG
IgG/M cationic -- low/neg AG

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Juan Carlos Q Vélez, MD @juancarlosqvelez.bsky.social · Jul 28

The Maltese Cross 🇲🇹🛡️sign is not unique to lipids, other structures can manifest it under polarized light (eg, starch, leucine crystals). Here, a rare sighting of a cast containing suspected ciprofloxacin crystals. #UrinarySediment #UrineMicroscopy #PisseProphet

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𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · Jul 28

time to whip out the FECl

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𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · Jul 25

Sanford cites at least 3 days

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Lars Mølgaard Saxhaug @load-dependent.bsky.social · Jul 24

We use aminoglycosides widely, and gentamicin specifically, in Norway. Only case of clear ototoxicity I’ve encountered was in an endocarditis case with overdose over many days (after weeks of therapy, medical error).

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josh farkas 💊 @pulmcrit.bsky.social · Jul 24

we're under-utilizing aminoglycosides for urosepsis in patients with good renal function

rising % ESBL is pushing us to use carbapenems for empiric therapy... leading to more resistance (CDiff, CRE)

aminoglycosides have minimal gut penetration = low CDiff risk & protect microbiome 🧵 #1/4 #EMIMCC

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