Tom Fisher

That's fair- I think the best ones have a good balance between big action vs secret spy/infiltration segments which often have a bit more humour. 8 completely lacked the latter!

I'd put 3 below 4- best villain of the franchise but 4's Dubai and Kremlin sequences are better than any of 3's setpieces imo

Same with respiratory failure imo

Anatomy of a Fall

Synthetic torpor in the rat recapitulates key features of natural torpor and is cardioprotective During hibernation, animals enter torpor, a reversible physiological state typically characterised by reductions in core temperature, heart rate and oxygen consumption. Species that enter this hypothe...

Very excited to post this preprint... making a species that doesn't hibernate do something a lot like it, AND showing it is cardioprotective.
www.biorxiv.org/content/10.1...

The Wrestler!

If you were including documentaries I'd add (as someone with minimal sports interest) Senna, Hoop Dreams and OJ: Made in America (technically 20% sports documentary)

I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty

Some reflections from the day:

(1/n)

"A Few Words About Premature Ventricular Complexes (PVC)" - Page 1 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation!

"A Few Words About Premature Ventricular Complexes (PVC)" - Page 2 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation!

"A Few Words About Premature Ventricular Complexes (PVC)" - Page 3 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation!

"A Few Words About Premature Ventricular Complexes (PVC)" - Page 4 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation!

For all my ECG nerds friends:

What to consider when you see one or more PVCs:

medicusofhouston.com

NEVER a tariff on MY classes!

#ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM

manuscript_draft_v1.4_AAreviewed_13Jul24_final_v2 (2).docx

I recently experienced an endocrine team discussing with ICU whether a CVC was needed for a dose of 2.7% saline in a bed-bound 90+ year old nursing home resident with dementia who had acute symptomatic hyponatremia.....

Delighted to share the Barts echo team’s latest article

“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”

Free to read for 50 days on the following link

www.sciencedirect.com/science/auth...

The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy - Annals of Intensive Care Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV...

Really nice article on TAPSE/TRVmax as a potential prognostic marker

From the team at Nepean ICU, led by Emma Bowcock

annalsofintensivecare.springeropen.com/articles/10....

My pov : patients with good outcomes after OHCA associated with hanging...were probably not in OHCA...

Strong agree

ICU Mini-Stories:

Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:

Credit and huge thanks to Dr Clodagh Beattie (joint first author), Dr Quentin Otto, Joanna Hooper, Prof Jerry P Nolan & Dr Jasmeet Soar for all your work on this article

Full text available here:
authors.elsevier.com/a/1kXSi_6ryq...

@ercresus.bsky.social
#emimcc #medsky
🧵6/6

🔗The chain of survival in cardiac arrest after hanging begins with societal factors.

From a medical point of view clearly more important than interventional ICU trials is equitable access to mental health services

🧵5/6

Bubble plot demonstrating the geographic distribution of included studies, with a large contributions from South Korea, Australia, France and the United States

The literature is quite heterogenous and as with all cardiac arrest studies understanding the system (i.e. country) as well as setting (prehospital/ED/ICU) is crucial for interpreting outcome data - (i.e. can paramedics declare death? Is life-sustaining treatment ever withdrawn?)

🧵4/6

The primary mechanism of cardiac arrest after hanging probably relates more to neck vessel & carotid sinus compression ➡️ bradycardic/apnoeic reflex rather than airway compression ➡️ hypoxaemia ➡️ arrest

Efforts not to be found + cutdown time + asphyxia all contribute to poor outcomes

🧵3/6

Bubble plot of rates of favourable functional outcomes in hanging categorised by cardiac arrest status, demonstrating very poor outcomes in patients who experienced OHCA compared to those who did not

➖Those with OHCA rarely have good functional outcomes
➖Those without OHCA frequently have good outcomes
➖Associated C spine/vascular/airway injuries are uncommon in those who survive to hospital

🧵2/6

Screenshot of an abstract for cardiac arrest after hanging: a scoping review Abstract Background Hanging is a common cause of suicide and asphyxial cardiac arrest. There are few data to inform the treatment of cardiac arrest after hanging. We designed a scoping review to describe evidence relating to interventions and outcomes in patients with and without cardiac arrest after hanging. Methods Medline, Embase and Cochrane were searched from inception to 05/12/2024. Titles and abstracts were screened, and duplicates were removed. Articles were eligible for inclusion if they studied non-judicial hanging in adults or children, included cardiac arrest patients and provided functional or survival outcomes. Results The search retrieved 855 articles. One hundred and nineteen references underwent full-text review. Forty-five studies were included in the review. Studies were mainly from high-income countries and were all observational. There was variation in the terminology for hanging and in the outcomes reported. Survival with favourable functional outcome was rare in patients with cardiac arrest after hanging but was very common in patients without cardiac arrest. Cervical spine, airway and vascular injuries were rare. No studies identified interventions that were associated with improved survival following return of spontaneous circulation. Conclusion There are few data to inform treatment of patients with cardiac arrest after hanging. The available data suggest that cardiac arrest is a critical determinant of poor outcome following hanging. Further research should uniformly report outcomes of patients with cardiac arrest after hanging based on the Utstein template.

🔬 Pleased to share our new scoping review on cardiac arrest after hanging- sadly not an uncommon cause of cardiac arrest which has previously lacked a good quality synthesis of evidence

Link: authors.elsevier.com/a/1kXSi_6ryq...

🧵1/6

I can only do a discharge summary

🤧🦠🤒🥵🫁🆘🚑🏥💊🩻💉🛌💤😑😐🙂🏡

also not sure if the con of ketamine causing hallucinations is particularly clinically relevant in a one-off dose for a critical care RSI

If a picture’s worth 1000 words then this cine loop’s a damn novella dedicated to the pathogenesis of hepatic hydrothorax 😍

#EMIMCC #pocus

Agree however the most useful I've ever got out of chatgpt was turning it into an ACF interview bot to hammer questions while I filmed my responses. Worse than a real person but the unpredictability got adrenaline going more than flashcards! Could similarly be used for viva prep perhaps?

xkcd.com/882/

#echosky #echofirst #pocus

When following a left atrial pressure algorithm that uses 2.8m/s as a binary cutoff, do people give a bit of leeway if it's *almost* 2.8 with severe TR/wide vena contracta?