Dan Harrison, MD

Applications for our APP CCM fellowship open next week!

One year, starting in September. Core ICU rotations include MICU, CICU, CVICU, SICU, STICU, NSICU.

#emimcc

www.camcmedicine.edu/departments/...

Determination of Adult Critical Care Physician Core Knowledge and Skills: Results of a Multidisciplinary, Modified Delphi Process
journals.lww.com/ccmjournal/f...

This is now a political account because I can’t treat your heavy menstrual bleeding and iron deficiency appropriately if ICE disappears or executes you.

As a rule, I do not post about politics, but we must abolish ICE, boycott anyone supporting them, and vote for political candidates who mean business about standing up to this madness.

Memes in Medical Education | Neurology Education

www.neurology.org/doi/10.1212/...

Tiger Man Sign in Sarcoid Myopathy | Neurology

Winner- most creative named sign
www.neurology.org/doi/10.1212/...

ICU documentation pet peeve: is there any cirrhosis that is not "liver cirrhosis"? This must be the "ATM machine" equivalent of medicine. #Medsky

Once you subscribe you get access to all the back issues. Next NCC edition is 2027 if you wanted to target subscribe for 1 year. But maybe @caseyalbin.bsky.social can wave a magic wand/advocate for a non-neurologist rate 🧚🏼‍♂️

Continuum Volume 30, Number 3

continuum.aan.com/toc/con/30/3

Not sure. Many of these patients had demyelinating disease. Pathophys here is very different than most systemic indications for steroids

Not designed to directly compare pulse vs moderate dosing, but the ONTT comes to mind: www.nejm.org/doi/full/10....

Catch up on the latest NCS podcast episodes wherever you listen to podcasts to hear the latest scientific findings, perspectives from experts in the field and conversations on hot topics in ncc: https://bit.ly/4gU1tCr

For me, depends on timing/resources. If the patient is nadiring and I can only get NIFs once per shift, then a page from the nurse prompting an assessment could lead to an acute intervention (intubation). If the patient is past their nadir or already intubated, they probably don't need neurochecks

Important text to read re: #braindeath

www.neurology.org/do...

Almost never, but in manuscripts with good science that need a lot of grammar work, I will at least acknowledge that they "require grammatical correction throughout prior to publication"

Is the peace prize here in the room with us?

article: https://pubmed.ncbi.nlm.nih.gov/37377263/ IBCC chapter about acute liver failure: https://emcrit.org/ibcc/alf/

updated the acute liver failure chapter

biggest change is increasing support for early CRRT to remove NH3 (to reduce elevated intracranial pressure)

now rec'd for clinically overt encephalopathy (Grade 2-4)

if admitting to ICU for ALF & encephalopathy, just dialyze

emcrit.org/ibcc/alf/ #EMIMCC

Do haldol and levodopa next

This could be a series

First "clamp rounds" in NCC with my senior fellow was a huge success! But what is the NCC equivalent? Don't typically hook the EVD up to suction ☠️ Clamp, 20/open, 10/open? Not quite as slick. Either way, thanks for the idea/analogy @gbosslet.bsky.social!

Standard (A) and modified (B) Bland–Altman plots representing the performance of the Fraser equation in an external cohort. In the standard Bland–Altman plot (A), the x axis represents the actual (measured) free valproate concentration while the y axis represents the difference between the Fraser predicted and the actual free valproate concentration. The solid black line represents a difference of 0 mg/L (i.e., an accurate prediction) and the dashed lines represent the 95% confidence interval of the mean difference between the predicted and actual values. Individual dots represent a single valproate concentration. In the modified Bland–Altman plot (B), the x axis represents the actual (measured) free valproate concentration, and the y axis represents the Fraser predicted free valproate concentration. The dashed line represents a perfect y = x correlation while the solid line represents the observed linear relationship between the actual and predicted concentrations. Both figures depict the worsening under-estimation as measured free valproate increases.

Standard (A) and modified (B) Bland–Altman plots representing the performance of the modified Fraser equation with patient effect.In the standard Bland–Altman plot (A), the x axis represents the actual (measured) free valproate concentration while the y axis represents the difference between the Fraser predicted and the actual free valproate concentration. The solid black line represents a difference of 0 mg/L (i.e., an accurate prediction) and the dashed lines represent the 95% confidence interval of the mean difference between the predicted and actual values. Individual dots represent a single valproate concentration. In the modified Bland–Altman plot (B), the x axis represents the actual (measured) free valproate concentration, and the y axis represents the Fraser predicted free valproate concentration. The dashed line represents a perfect y = x correlation while the solid line represents the observed linear relationship between the actual and predicted concentrations. Performance with the modified equation was significantly improved when individual patient effect was included.

Excited to share our newest work on free VPA: improving ability to predict levels with the Fraser equation. We reveal that the orig eq. is modestly accurate in an external cohort and make improvements to the eq, but confirm measurement remains ideal
@cbthepharmd.bsky.social

doi.org/10.1002/phar...

JAMA Research Summary: "Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock." The study analyzes 1467 adults with septic shock. CRT-PHR showed 131,131 wins (48.9%) vs. Usual Care with 112,787 wins (42.1%).

📊 Research Summary: Personalized resuscitation targeting capillary refill time modestly improved organ support–free days and composite outcomes in early septic shock, but showed no difference in mortality vs usual care.

#LIVES2025 @esicm.bsky.social

ja.ma/4huvHOa

Neurologist: It has to be more concentrated than normal saline to work.
Intensivist: Ok, how much more concentrated?
Neurologist: Oh, man. I don't know. Probably a lot. Like... 26 times more concentrated!
Pharmacist: As you wish

Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀

Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)

If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC

Today, on World Trauma Day, empower your team and colleagues to improve patient outcomes during the critical first hours of a patient's neurological emergency. Designed for multidisciplinary practitioners, ENLS provides a consistent set of protocols, checklists and more: https://bit.ly/42HBcE3

Do you use vasopression for MAP augmentation in your SCI patients?

In our newly published series, we describe significant hyponatremia frequently develops when used just to push up the MAP - quite literally induced SIADH

pubmed.ncbi.nlm.nih.gov/41051384/

This is not an unreasonable point

This would be an amazing advance in the care of patients with neurologic disease if true (and accessible to patients)!

A gene therapy buzz: Did AMT-130 really slow Huntington's disease by 75% at 36 months? A press release say YES. The data not yet been subjected to peer review and publication.
uniqure.gcs-web.com/news-release...

Come train with us! The BU/BMC NCC fellowship has an opening for a 1 or 2 year fellow beginning July 2026. Visit sfmatch.org/vacancies or message for details!