Mathieu Desgroseilliers

In critically ill pts, avoid adjusting initial doses based solely on early bloodwork. When pts present to ED, SCr/eGFR may not accurately reflect kidney fxn. These early labs represent pre-treatment📷(before IV💧, Abxs & resus). W/ these interventions, SCr/eGFR often improves #emimcc #medsky #pharmsky

Only 2 reasons to renally dose-reduce in ED
1️⃣Prevent toxicity
2️⃣Save💵(↓dose achieves acceptable levels but low-priority)

In critically ill, underdosing early riskier than short-term toxicity so standard doses usually make sense until rpt SCr. SCr often ↓ w/ IV💧& supportive care #emimcc #EMsky #Rxsky

Coagulopathy in critical illness is portrayed as a dynamic hemostatic imbalance, where bleeding and thrombosis coexist, static thresholds fail, and the timing of anticoagulation, transfusion and endothelial protection shapes outcomes. zurl.co/YJ0qU

Today's Paper of the Day is:

Diagnosis and management of autoimmune diseases in the ICU

https://criticalcarereviews.com/latest-evidence/paper-of-the-day

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025

"People’s opinions are mainly designed to make them feel comfortable; truth, for most people is a secondary consideration."

— Bertrand Russell

We Dissent: Lessons From the 2025 Community-Acquired Pneumonia (CAP) Guidelines Evidence to support antibacterial therapy for viral community-acquired pneumonia (CAP) is lacking. Shorter CAP treatment duration remains an important stre

We Dissent: Lessons From the 2025 Community-Acquired Pneumonia (CAP) Guidelines

IDSA withdrew from what was to be ATS/IDSA CAP guidelines b/c of impasse over the panel's recommendation to treat CAP with antibacterial therapy when a viral pathogen is identified.

academic.oup.com/cid/advance-...

“Religion is about turning untested belief into unshakable truth through the power of institutions and the passage of time.”

― Richard Dawkin

We've selected our favourite words from @drmattmorgan.bsky.social's medical dictionary.

Every day between 1 and 25 December, a new word will appear in the 🔗⬇️ #BMJChristmas

Today's word is Cursorcrawl
www.bmj.com/content/391/...

Sugars, ‘Gum,’ Stardust Found in NASA's Asteroid Bennu Samples - NASA The asteroid Bennu continues to provide new clues to scientists’ biggest questions about the formation of the early solar system and the origins of life. As

This discovery, combined with previous findings of amino acids and nucleobases in the samples, reinforces the theory that asteroids may have delivered key ingredients for life to the early Earth.

Read more in NASA's official page: www.nasa.gov/missions/osi...

🧪 ICARUS-ED: Early albumin in sepsis?
📉 Minor gains in numbers, no real outcome benefit
💰 30x the cost vs crystalloids
⚠️ Outcomes > optics

🔍 Full breakdown: https://wp.me/pdrP8b-5oc
❤️ Like 🔁 Repost 🔔 Follow for more
#FOAMed #MedX #MedTwitter #MedEd

PGY2 emergency medicine informational flyer

🚨 calling future EM pharmacists 🚨 Baptist South will be at midyear recruiting for our next EM PGY2! If you’d like to meet with me in a relaxed setting, fill out the form below and let’s get to know each other over coffee - my treat! docs.google.com/forms/d/e/1F...

It took us a while to recognize euglycemic diabetic ketoacidosis (euDKA) in patients treated with Na-glucose cotransporter-2 inhibitors. It seems that we may have to be on the lookout for euDKA in patients treated with glucagon-like peptide-1 receptor agonists (#Ozempic #Zepbound)

"The price good men pay for indifference to public affairs is to be ruled by evil men."

— Plato

Steroids in CAP is a 🔥topic #EMIMCC #idsky

“Real scientist are delighted when they find out they wrong... There are too many people in this world who want to be right. And too few who just want to know.”

― Brian Cox

L'atmosphère de la Terre depuis l'espace !

L'atmosphère de la Terre depuis l'espace ! An orange les radicaux d'hydroxyle, en vert l'oxygène et en rouge l'airglow!

I am all for miracles because the universe we live in is far richer than we can imagine. The alchemy of stars, hydrogen atoms seemingly awakening to explore themselves, the scale and depth of everything around us... nothing we know is short of a miracle.

Plasma p-Tau217 and Amyloid Burden in Older Adults Without Cognitive Impairment This meta-analysis examines data for the accuracy of plasma phosphorylated tau 217 tests from published studies that compared older adults without cognitive impairment who were amyloid positive vs amy...

”Plasma measures of p-tau217 can accurately identify individuals in the preclinical stage of Alzheimer disease where interventions are likely to have the most benefit in delaying or stopping disease progression.”

https://emcrit.org/ibcc/hypoglycemia/

treatment of severe/refractory hypoglycemia (IBCC update)

commonly messed up in practice & literature 🤦‍♂️

key points:

🧃 IV dextrose gtts are good but not super effective

🧃 PO carbs are more effective

🧃 IV steroid for refractory dz

🧃 structured escalation

🧃 rarely needs ICU admit #EMIMCC

Something big is coming 🚀
Quelque chose arrive… Préparez-vous 🎙️

#paratus #paratuspodcast #readyforanything #emergencyresponse #launcingsoon

Crash course in hemodynamics:

updated IBCC chapter on severe influenza

most notable updates are on the pharmacology of newer antivirals (peramavir & baloxavir)

oseltamavir remains 1st line for patients without contraindications

(yeap, data on these isn't great, but we're stuck with them)

emcrit.org/ibcc/influen... #EMIMCC

“The world is not magic — and that’s the most magical thing about it.”

— Sean Carroll

Today's Paper of the Day is:

Update on Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management

criticalcarereviews.com/latest-evide...

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025

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

When I did my Med Ed masters, the course director's research interest was technology-assisted learning. He said he often asked supervisees whether tech was actually helpful.

Chap below just stepped down as Editor-In-Chief of the Journal of Computer-Assisted Learning.

bsky.app/profile/paul...

How extreme weather is making plastic pollution more mobile, more persistent and more hazardous | CNN Microplastics are already an environmental and health threat, but as the world heats up, they are becoming a much bigger and more hazardous problem, according to a new analysis

#PlasticWaste and #PlasticPollution - the #ClimateEmergency is worsening the #PublicHealth dangers

www.cnn.com/2025/11/27/c...

Exercise improves child #ADHD, but this is the first trial to test it in adults:
▪ Large effect (0.9)
▪ Strength/aerobic 30-40 min/day
▪ Brief mindfulness component

pubmed.ncbi.nlm.nih.gov/41244864

Evidence: Moderate (6/10, high drop-outs, small, single-blind)

#mentalhealth #psychiatry #pmhnp

We are flooded with information yet starved of wisdom. Do you think the rise of AI will make things better, or worse?