Critical Concepts

Clint Leonard gives us the scoop on the odd, sweaty place that is the burn ICU. icuscenarios.com/lightning-ro... #medsky #emimcc

After some hemming and hawing on this, I think I agree. VL with Mac is a more versatile skill and helps teach DL. But if you want a single skill for someone who will probably never move beyond a basic skillset, and who can trust always having VL available, hyperangulated is probably easier.

We dive into the subtle art of placing, understanding, and interpreting the PA (Swan Ganz) catheter, on a new lesson at icu101.com.

#emimcc #medsky

either result would seem hard to rationally apply, from a Bayesian perspective

Agreed… this is some skinny love

Bad reason to place: patient is in shock
Good reason to place: shock is labile

No more PSV trials! RSBI is not a weaning parameter! Respiratory muscle fatigue is a myth! And more hot takes from the great Martin Tobin, this week on the show.

icuscenarios.com/episode-95-s...

#medsky #emimcc #intensivecare

Connecticut humans (also a remote option): I will be speaking at the Bridgeport Hospital CME conference on November 8 with a deep dive into shock. Check it out if interested!

e.givesmart.com/events/KFO/

#emimcc #medsky

The great Tom Bleck shares his insights on treating seizures. Which benzo? When do you load an ASM, and which one? What drug to intubate, which drip? What's the ketamine deal? And more.

icuscenarios.com/episode-94-m...

#medsky #emimcc

New lesson on Pacemakers at the Intensive Care Academy - TCP, TVP, epicardial, PPMs, and more, including management in critical illness, the problem of false capture, and more.

#medsky #emimcc

buddy I am with you x.com/critconcepts...

I had two minds to write a letter to the editor on the obvious physiologic error, but ran out of motivation

This week on the podcast, Jon-Emile Kenny on fluid resuscitation and his wireless doppler device for predicting responsiveness

icuscenarios.com/episode-93-f...

#medsky #emimcc

Prophylaxis is growing on me. Nothing worse than withdrawal developing in someone admitted to the ICU for another reason

We explore the rare but scary phenomena of propofol infusion syndrome (PRIS) and propylene glycol toxicity, with our favorite toxicologist Jerry Snow.

icuscenarios.com/episode-92-p...

#emimcc #medsky

Because like all peripherals, they can fail

We demo a simulated goals of care conversation on this week's episode at icuscenarios.com/episode-91-a...

#medsky #emimcc

But like amio, I think many times, after a day or two the need has passed. Much of our RVR is transient

same as amio

hard to hurt anyone with a dose or two

Agree somewhat, but should acknowledge the dosing issue, as these folks were on a high dose range. Not sure if it’s generalizable to a low dose strategy.

My mind became a little more open when I rechristened this method as “asking someone to Google it for you,” which is more or less what I would have done otherwise, and I already understand the pros and cons of that well.

Subdissociative dosing at most for pain. Stay way out of a partial dissociation range

How does a town get a cervical collar named after it

Had a great time chatting with you guys about residual NMB and reversal strategies in the ICU! Thanks so much for the conversation and for highlighting this topic.

#emimcc #medsky #pharmsky

I am both

I guess it would make sense for the two systems to behave similarly, but I could just as easily see the opposite being true

But what of the venous side?

ACCRAC Podcast Anesthesia and Critical Care Reviews and Commentary

I joined the ACCRAC podcast to discuss one of my favorite topics: physiologic methods to determine the best PEEP. Check it out if you're into that! accrac.com/episode-314-...

#emimcc #medsky

#medsky peoples: alpha agonists cause more venoconstriction than vasopressin. Agree/disagree?

#emimcc

The great @sarajpharmd.bsky.social tells us how to use sugammadex in the ICU, why we should, and how many of our patients may have occult residual paralysis. #medsky #emimcc icuscenarios.com/episode-90-s...

Then you gotta hold it like a mountain climber until the wire’s in

epic case 🤯

man trying to eat a better diet asks ChatGPT how to eliminate chloride, it advises him to use *bromide* instead

he buys NaBromide from the internet

develops bromism (with psychosis)

key diagnostic clue = negative anion gap!

(more on low anion gap emcrit.org/ibcc/agma/#l...) #EMIMCC