@barackobama.bsky.social: "When I was POTUS, I suppose I could have simply unilaterally ordered the military to go into some red state and harass and intimidate a governor or cut off funding for states that didn't vote for me... but that is contrary to how I think our democracy is supposed to work."
it's wild how badly people dose hypertonic therapy
60 ml of 23% is equivalent to ~500 ml 3%, so this article makes no coherent sense
best approach: figure out the sodium change you want and calculate the hypertonic dose
math sets you free from dozens of contradictory consensus statements #EMIMCC
Great document for anyone eyeing a resource for CCExAM as well. Doesn’t have every single detail but probably 75%!
ics.ac.uk/product/fusi...
The @ics-updates.bsky.social advanced credential in haemodynamic echocardiography, FUSIC HD, has just received an update
New elements:
1. Measurement of EF
2. RV FAC
3. more advanced RV-PA coupling assessments
4. Simplified LAP assessment
#echosky #emimcc
Illinois is one of the few states in the middle of the country that protects the right to comprehensive reproductive healthcare.
Supporting care here means supporting access for people who have nowhere else to turn.
I’m ok. I’m a survivor so this small agitator isn’t going to intimidate me from doing my work.
I don’t let bullies win.
Grateful to my incredible constituents who rallied behind me. Minnesota strong.
Alex Jeffrey Pretti, an ICU nurse. 😢💔🙏 He spent his life helping people, and now our government is peddling lies in an attempt to make you believe them.
Overheard a nurse at the Children’s Hospital say this to a patient as I was walking by the room tonight:
“I know you were scared but you tried anyway and that’s really brave.”
DEAR REPUBLICANS IN CONGRESS: I KNOW YOU ARE SCARED BUT YOU SHOULD TRY ANYWAY AND THAT WOULD BE REALLY BRAVE.🇺🇸
The large driver of the difference was that more people required vasopressors in the ketamine group - but in the supplement, you’ll see that pre-intubation, more in the etomidate group were empirically placed on vasopressors. To me, this was a neutral trial that shows both are safe with good dose.
Screenshot of a data visualization titled “The Cost of American Exceptionalism,” subtitled “What would change if the U.S. matched the OECD average?” The page explains that each card shows how outcomes would change if the U.S. matched the average of 31 peer democracies. Below, a section labeled “Economy & Inequality” displays eight cards comparing U.S. figures to OECD averages. Highlights include: +$19K per household per year in redistributed income and +$96K in redistributed wealth if the top 1% matched OECD shares; a 71% lower CEO-to-worker pay ratio (from 354× to 101×); 50 million more workers with union coverage; 26 million more people with health insurance; $2.1 trillion saved annually in healthcare spending; $691 less per person per year in prescription drug costs; and intergenerational economic mobility being twice as high. Each card shows the U.S. value alongside the OECD average.
If there's one empirical insight I'd want everyone to understand about American politics, it's this:
America's problems are solved problems. Just not here.
What would change if the US simply matched the average of 31 peer democracies? Not Denmark or Norway. Just the middle of the pack. 🧵
The Nobel Foundation makes yet another statement:
Great question! Kasner et al in 2007 put forward an E/e’ >8 in the critically ill, cited in a great paper on LV Diastology for the Intensivist by Greenstein and Mayo in CHEST 2018. Very useful cutoff, I’ve found.
I’d be interested in how the assessment changes if you add in LUS assessment (which seems to be the most accurate measurement of LAP) and LA strain, which I believe Phillips is going to roll out a POC option for measuring “soon”. Might open up some interesting options for the future of Diastology.
www.jacc.org/doi/10.1016/...
Hehehehe @load-dependent.bsky.social @strain-rate.bsky.social
#echosky
I’ve seen it myself (when I’m talking to the same families from the ICU side later in their course) so can say that those early words make a huge impact.
What I absolutely have to emphasize though, is that those early discussions are SO CRITICAL to introduce those concepts because GOC are an ongoing discussion and I always say “think about when they might not want to continue these measures, or if there are certain lines they wouldn’t want to cross”
Clearly that wasn’t the case with your patient - and I know you’re an expert at these convo’s yourself, being ICU trained. But I’m EM/IM/CC and when I’m on the EM side sometimes my colleagues think I have some magic powers when I do things like this.
And by the time I can circle back to the family with a “have you had any time to reflect on our earlier conversation and think about what that would mean for X” twenty minutes later when they’ve gotten 3L pressure bagged, abx, and peripheral pressors started with a BP compatible with life, DNR/DNI.
Sure, it’s something we do, far too often. But a lot of times it’s because the early goals of care discussions were not good - or often I’ll bring up these goals of care discussions very early, then let them sit for a bit while I resuscitate them (which I’d have to do anyway prior to intubating)
Here’s Kei’s paper on rapid discussions for seriously ill patients in the ED. Excellent talking points.
www.annemergmed.com/action/showP...
Discuss their father’s wishes. Discuss the likely outcome. Tell them intubation isn’t an intervention we should offer and explain my reasoning. It’s a bit of authoritarianism in medicine - or call it expert opinion - that I think takes the burden off families.Kei Ouchi has some nice papers on this.
The era we are living in offers too many illustrations of greed, narcissism, and hatefulness. But I still believe we can recommit ourselves to serving the common good of all Americans. [Artwork by Jennifer Bloomer]
reference for this image: https://www.sciencedirect.com/science/article/abs/pii/S2352556821001685
Single-center RCT finds benefit from sepsis resus that targets perfusion index (Pi)
Intervention group: fix macrohemodynamics, then target Pi >1.4
I think they're right
Pi is similar to cap refill, but continuously displayed number on monitor 😍
pubmed.ncbi.nlm.nih.gov/41033063/ #EMIMCC
New blog: Fresh dueling guidelines about post-arrest care from the AHA and ESICM
💔 BP targets
💔 Who needs an emergent cath?
💔 O2 targets
💔 pan-CT scans
💔 temp targets
💔 neuroprognostication
Which guideline do I love? 😍 You'll have to read the post to find out.
emcrit.org/pulmcrit/202... #EMIMCC
Some people truly do change the world. Dr. Bartlett was one of them ❤️🩹
Seems more like a neostigmine plus miralax drip sort of day, but colace is a choice…
This made my month. I feel nothing will top this in September
Iron deficiency affects TWO BILLION people in the world but because they’re mostly women and children, almost nobody cares.
Had a great time getting on my usual soapbox at a fantastic #SABM25 meeting.
And if you don’t know about patient blood management, it’s very cool so check it out.
Several studies using LUS to guide diuresis have been positive, and it’s just as simple to look at, and has also been shown to be a good surrogate for LAP (though VeXUS plus LUS plus LV function and VTI is my own practice to guide decision making). This was poorly thought out imo.
