@IM_Crit_

ICU Snapshots:

Assessment/Plan (ICU Edition):
Day #1: Start Colace qd
Day #2: Change to Colace bid
Day #3: Add Senna
Day #4: Add Miralax
Day #5: The next intensivist comes on service

#medsky #foamed #foamcc #meded #emimcc

Amazon is trying to get a piece of the pie, aka the multi-trillion dollar US health care industry

#Medsky #Healthcare

🤔😳🫣

Friendly reminder:

Science does not progress by popular vote

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Nice review on the role of right-sided heart dysfunction (#RHD) on acute respiratory distress syndrome (#ARDS). The review is covering RHD's pathophysiology, diagnosis & potential treatments:

Hat tip to the authors!

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This will hopefully challenge our belief that prone positioning is universally beneficial in ARDS-associated RHD. As usually happens in any hemodynamic maneuver/intervention, we have to measure/study the physiology at the bedside and see if the experiment actually confirms our theory!

I am biased here (😊) but probably the most interesting part of the review is the reference #69, in which a patient with COVID-19 & ARDS-associated RHD was proned & pressure-volume loop analysis showed ⬆️ RV end-diastolic pressure & ⬇️ stroke volume & RVEF:

Several strategies are employed for the management of RHD in ARDS:

A failing heart in ARDS might behave like this:

Several pathophysiological mechanisms contribute to ⬆️ pulmonary vascular tone & RV afterload in ARDS, including hypoxic vasoconstriction (Euler-Liljestrand mechanism), hypercapnia, acidosis, in situ thrombosis & an imbalance between pulmonary vasoconstrictors & vasodilators:

Nice review on the role of right-sided heart dysfunction (#RHD) on acute respiratory distress syndrome (#ARDS). The review is covering RHD's pathophysiology, diagnosis & potential treatments:

Refresher on Spectral Doppler assessment of the hepatic veins in tricuspid valve disease:

This systematic review included 65 studies & 17,008 patients with #sepsis. The occurence rate of each one of the three #echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), LV diastolic dysfunction (LVDD), & RV dysfunction (RVD) peaked at 48h:

Hat tip to the authors!

#foamed #foamcc #meded #Medsky #pocus #emimcc

Take-home message:
Blunting of the S-wave and SR are not specific
markers of moderate and severe TR, respectively

Various hepatic vein (HV) Doppler patterns can be observed in the setting of TR:

Severe TR mimic:

Severe TR masquerading as moderate TR:

Severe TR during atrial fibrillation:

Severe TR in sinus rhythm:

Moderate TR:

Mild tricuspid regurgitation (TR):

Refresher on Spectral Doppler assessment of the hepatic veins in tricuspid valve disease:

Kudos to the authors! I apologize for taking the liberty of using the paper's data to create this graph👆

Critical Care Medicine : 10.1097 / CCM.0000000000006844, August 25, 2025
DOI: 10.1097/CCM.0000000000006844

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Of note, septic patients with LVSD, LVDD, or RVD showed a higher risk of death (LVSD: relative risk [RR], 1.57 [95% CI, 1.29–1.91], p < 0.0001; LVDD: RR, 1.36 [95% CI, 1.05–1.75], p = 0.02; and RVD: RR, 1.62 [95% CI, 1.35–1.95], p < 0.0001)

This systematic review included 65 studies & 17,008 patients with #sepsis. The occurence rate of each one of the three #echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), LV diastolic dysfunction (LVDD), & RV dysfunction (RVD) peaked at 48h:

Public health message:

We don’t directly absorb NAD (nicotinamide adenine dinucleotide) from the diet. Don't waste your money!

#Medsky

Friendly reminder:

The decision to administer iv fluids is more complex than whether the patient is fluid-responsive or not. Fluid-intolerance and tissue perfusion entered the chat...

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Friendly reminder:

During an intra-arrest #POCUS, the finding of RV dilation alone is generally insufficient to conclude the presence of a pulmonary embolism & justify the administration of thrombolytics. After a few min of CPR, RV tends to dilate due to