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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 11h

As an US EM/CCM doc attuned to what's happening politically, and how it's impacting people daily, I struggle to find the energy and bandwidth to contribute to fighting the fight when I'm facing it at work 20+ days a month and honestly, feels like I'm losing. Anyone else feeling this? Recs? #emimcc

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 2d

Why must we the health professionals take advice from the non-health professionals; especially when it is to seek advice from health professionals -- professionals whom the non-health professionals DIDN'T take advice from. The weaponized incompetence is here, dizzying, and deadly in magnitude.

Ken Milne MD @thesgem.bsky.social · 2d

The CDC says people must consult a health professional before COVID shot
flip.it/4YotQn
@dennisrenmd.bsky.social

The CDC says people must consult a health professional before COVID shot

The Centers for Disease Control and Prevention accepted a controversial recommendation from outside vaccine advisers to tighten guidelines for the COVID vaccine.

flip.it

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 5d

A lot more methin around these days. It's been interesting watching the arc of substance use trends with the rise of the opioid epidemic to the combo stimulants/fentanyl speedballs towards the dominance of stimulants.

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 16d

Watching Miller / Trump use the Kirk Memorial to divide, sow malice and show how much they hate anyone who stands for democracy, equity and free society is jarring. I've never been more scared, nor more proud to stand on my beliefs. They show how afraid they are of us, and what we can do.

a poster that says " stay connected build community " on it

ALT: a poster that says " stay connected build community " on it

media.tenor.com

Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 16d

Some of my best worst cases in training were on patients with horrifically severe PAD and bypasses wherein we could not get accurate arterial monitoring nor any accurate NIBP. Titrate pressors to vibes (mental status, urine output).

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 17d

Prepare to be met with "yeah, that was just bluster. He didn't actually mean it literally." It's all a joke to them because it doesn't affect them in any negative way (yet).

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 17d

I like that term p-fracking.
It's not just hacking. It's a toxic degrading means to squeeze out what they want with no regard for the consequences

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Reposted by Steven Ilko 🏥 🚁💨

josh farkas 💊 @pulmcrit.bsky.social · 20d

updated IBCC chapter on anaphylaxis, some new additions:

🆕 methylene blue for anaphylaxis refractory to epi & fluid

🆕 sugammadex for anaphylaxis 2/2 roc or vec

🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help?

(emcrit.org/ibcc/anaphyl...) #EMIMCC

https://pubmed.ncbi.nlm.nih.gov/33653974/

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 20d

Never comply in advance.

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 21d

It's time to start building. Building community. Building resiliency. Building the world we want to see. When the state demands we step in line and maintain social order-- an order that robs our most vulnerable-- it is our duty, to raise the🖕with one hand, and use the other to lift each other up.

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 24d

I have a small number of rules for my trainees in ED and ICU:
1) Don't lie.
2) Treat the unit and the people in it like you're a guest in their home.
3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2)
pubmed.ncbi.nlm.nih.gov/33485698/
#emimcc

The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department - PubMed

Awareness with paralysis occurs in a significant minority of ED patients who receive mechanical ventilation. Potential associations of awareness with paralysis with ED care and increased perceived thr...

pubmed.ncbi.nlm.nih.gov

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Sep 6

And no, I did not let her disrespect/beratement towards my nurses, my app colleagues, nor my trainees go unchecked. Generational expectations are not an excuse for disrespectful harassment. Does anyone else have stories like this in their early career? Please share! #emimcc #medsky

a man sitting in a chair with the words " this aggression will not stand man "

ALT: a man sitting in a chair with the words " this aggression will not stand man "

media.tenor.com

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Sep 6

Still chuckling from an angry phone call I fielded earlier in the ICU. Mid-yelling at my residents/apps/nurses. "I'm tired of talking to these 30 something year old infant residents! We will only talk to the much more experienced and older attending physicians". My 32 year old ass...

a baby is laughing while sitting on a bed with boxes .

ALT: a baby is laughing while sitting on a bed with boxes .

media.tenor.com

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Sep 5

Its a reasonable outcome as a proof of concept for skeptical docs like us. Makes therapeutic sense as it's primary use is an anxiolytic in the outpatient world as well as decent literature in neuro-storming/tbi management. It convinced me. But I have yet to use it very much.

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Reposted by Steven Ilko 🏥 🚁💨

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

scout images for CT scans are hidden gold

the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan)

for example, the scout of a CT C-spine may be great to confirm ET tube position

#EMIMCC

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 31

Great for ETT/NG/CVC and obvious pneumothorax/pneumoperitoneum. Often pulls over to PACS before the rest of the images so I can call these out and the residents think Im an omniscient magician

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 31

The dose is everything... And it's difficult to get right. Agreed, its an okay rescue.

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 30

I love doing this so much.
Yeehaw

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Reposted by Steven Ilko 🏥 🚁💨

Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · Aug 28

🆕💫PROTECT RCT
Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social
journal.chestnet.org/article/S001...

Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT)

This trial was inconclusive regarding the impact of ceftriaxone prophylaxis to reduce the incidence of EOP after OHCA but ceftriaxone was associated with less frequent administration of open-label ant...

journal.chestnet.org

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 27

Escaped the US for a second ... Fingers crossed they let me back in ...

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 27

As a huge APRV stan... APRV does not replace proning unless there is a major contraindication to doing so. Great win!

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 26

Not me rolling the dice as I leave the country and try to come back in a few days

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 26

The grandest irony is that the Dems still think it's a knife fight... The right is the party of the 2A for a reason.

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Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 26

As a new resident of the area I have been waiting for my first haboob. Did not disappoint. Rolled in as I pulled into the taco shop. Spent the evening sipping margaritas waiting for the dust to settle.

Aman Batheja @amanbatheja.bsky.social · Aug 26

This looks like something you would see briefly on someone’s phone in a science fiction movie

AP headline: Towering wall of dust rolls through metro Phoenix, leaving thousands without power

Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · Aug 26

That makes sense. Can't always count on the elderly to show their disease on labs/vs.

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