Steven Ilko 🏥 🚁💨

It was our local practice pattern to ace wrap the snot out of it and send them with reliable parents. No pressors, no oxygen, no limb/organ threat? No problem.

It's nice to listen how others articulate their practice patterns and acknowledge the limitations of real world application

How is that helpful for the vast majority of travelers who don't have access to airport lounges? Your clever advice may as well read: don't be poor

As a lukewarm bicarb aficionado, a 1 point difference out of 10 in an obscure measure of vertigo symptoms is probably unlikely to be a robust patient centered outcome.

I'm so glad to hear that the Senator was able to be seen and has been able to use his government funded insurance to have a life saving device implanted. Can't wait to hear why he refuses to fight for that same insurance for the rest of those living in the US. @fetterman.senate.gov

a man says " and i will strike down upon thee " in yellow letters ALT: a man says " and i will strike down upon thee " in yellow letters

Pretty sure that was just nature attempting to course correct

a cartoon of perry the platypus wearing a hat and belt ALT: a cartoon of perry the platypus wearing a hat and belt

Long story short: if history is our guide, we're pretty f*cked.

The DNC belief that institutions protect us, fight wrongs and bend towards equality are symptomatic of the Democratic Nationalism poisoning our society and fails to help anyone but those who benefit from power. Those who will lead us out prioritize people above institutions, humanity over profits.

Those fighting to keep these institutions open fail to recognize how it's their blind devotion to institutions themselves, their false belief in the institutions to correct these problems, that are fueling the greatest injury. They're complicit in the harms that will follow. History shows this.

Democratic leadership is dead. The legislative branch of the US government is a complicit arm of the autocratic takeover of government dreamed by the right in the 80s, launched by Cheney post 9/11, continued by institution Dems, and now the cult of personality is here. The branches are trimmed.

Our latest blog is out:

Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial

https://criticalcarereviews.com/blog/current

Acidosis impairs the coagulation: A thromboelastographic study - PubMed Acidosis causes a strong impairment of the coagulation as measured with thromboelastography. The impairment found when lowering pH from 7.4 to 7.15 was almost identical to the impairment seen in another study by Kettner et al. when the temperature was lowered from 36 degrees C to 32 degrees C.

Seems to be dose dependent if you're administering hydrochloric acid to your patients. So don't do that. pubmed.ncbi.nlm.nih.gov/16966998/

a man is speaking into a microphone in front of a crowd and says i 'm a nerd ALT: a man is speaking into a microphone in front of a crowd and says i 'm a nerd

Today I became double board certified, and won trivia.

a bald man with blue eyes is wearing a gray shirt ALT: a bald man with blue eyes is wearing a gray shirt

I low key love it. I order it. It's given. Intervention complete.

I still get hepatology hold outs who futz at me for having given steroids for alcoholic hepatitis...
"They don't have great follow up"
... They have even worse follow up when they're dead...

They definitely lost me at dextran/hetastarch 😂
You can model all you want, but the evidence is clear that these have no purpose. Albumin... Meh. I like it in refractory burn resuscitation which this seems to support. Certainly not a sepsis/ICU panacea.

I'm somewhat curious how this is eminence based... They have created models that seem to be decently reflective of reality. I would consider it eminence based if they just claimed "believe me, it's in the third space" and provided no real support. Seems to me they brought the receipts.

The fact that the AOC and Sanders Town Hall isn't all over social media tells me exactly what I need to know... Was SO REFRESHING listening to politicians prioritizing people and values. No hate.

Finally some public support of push dose dilt for svt. No one appreciates the adenosine doom

Having recently read Mark Bray's book about Antifascist movements... Not at all surprised that these fascist **cks decided he's a threat. Read. Love. Commune. Fight.

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

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.

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.

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

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.

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).

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).

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

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

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

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

Never comply in advance.