@IM_Crit_

🔥Fresh blog🔥 Hot take on RSI trial of ketamine vs etomidate

RSI & EvK trials both show *more* BP instability with ketamine *but* lower mortality with ketamine 🤔

Cause of BP drops with ketamine?
- Less pressor pre-intubation?
- Ketamine provides analgesia (eliminating pain-as-a-pressor)?

... #1/2

The fetishization of #albumin is perpetuated by persistent misconceptions & entrenched beliefs among both nurses & physicians

A new graduate nurse (still working under supervision and alongside a preceptor) just asked me if I want to give albumin to his pt who is still on norepi

50%

#foamed #foamcc #meded #Medsky #pulmsky #emimcc

#ICU Quiz:

Day #2 of mechanical ventilation. A patient with ARDS has a plateau pressure of 25 on a PEEP of 5 (VCV; Vt 7 ml/kg). Comfortable - synchrony with the vent - ABGs: "OK".

Would you decrease the tidal volume to bring the driving pressure closer to 15?

Yes?
No?

CDC advisory panel votes to limit hepatitis B vaccines for newborns Move from RFK Jr’s advisers mirrors Trump team’s regressive approach to longstanding vaccine guidance

CDC advisory panel votes to limit hepatitis B vaccines for newborns

Fun fact: HBV can be spread by household objects (toothbrushes, razors) used by an infected person. Only ~50% of cases before 1991 were a result of transmission from an infected mother

www.theguardian.com/us-news/2025...

#Wegovy #Mounzaro #foamed #foamcc #meded #Medsky #emimcc

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)

#VEXUS:

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

He is a nice guy (and colleague), but assesses the inferior vena cava only in the longitudinal view

#foamed #foamcc #meded #medsky #vexus #pocus #emimcc

Crash course in hemodynamics:

True

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

I call it KVO (keep the vein open) rate of Precedex

Of course these experiences highlight significant policy challenges influencing patient care and the allocation of resources; however, the practice of defensive medicine serves only to perpetuate these issues

#Medsky #foamed #foamcc #meded #Healthcare #emimcc

2. On another occasion, a ground ambulance service refused to transport a patient on insulin infusion for similar policy reasons. To address this, I administered insulin glargine and paused the insulin infusion for the 30-minute ground transport

1. The helicopter crew declined to transport a patient receiving a Precedex infusion due to policy restrictions. In response, I administered 4 mg of intravenous lorazepam, discontinued the Precedex, and the patient successfully arrived (and woke up) at the other facility

A medical helicopter transport in the United States typically costs approximately $50,000...

Previously, I have encountered situations such as:

If you remain unconvinced regarding the extent of inefficiency & resource waste within US health care, please read this:

Today, I admitted to the ICU a pt in etoh withdrawal who was transported by helicopter —a 10min flight— solely for being on Precedex (dexmedetomidine) infusion at 0.2 mcg/kg/min

Brain Death/Death by Neurologic Criteria Guidance on Communication, Objections, Pregnancy, and Public Trust | Neurology This position statement provides updated member guidance from the American Academy of Neurology (AAN) regarding (1) communication with surrogate decision makers about brain death/death by neurologic c...

Ethical review of brain death in the context of familial objections or pregnancy.

This is largely intuitive and common sense, but it's useful to have a guideline if needed for reference. #EMIMCC

www.neurology.org/doi/pdf/10.1...

Bicarb for the win!

There are plenty of sodium bicarbonate haters (😊) in the Critical Care & ED world

But what will they say now that an RCT on patients with acute peripheral vertigo found combo therapy with diphenhydramine (Benadryl) provided better symptom relief than diphenhydramine alone?

#foamed #meded #Medsky

You are right…

woah, Tay-tay is vanco? A mildly toxic agent that is problematic to dose, adds little to pipazo, and is generally unnecessary and stopped within <48 hours?

I feel like she deserves to be the beta-lactam backbone since she has greater versatility and influence.

All you need to know about antibiotics in 🇺🇸 EDs/wards/ICUs

#Medsky #idsky #emimcc

JAMA Intern Med
Published Online: November 17, 2025
doi: 10.1001/jamainternmed.2025.6088

I have no COI

After the administration slashed millions in National Institutes of Health funding, grants for 383 clinical trials were terminated, and the funding disruptions affected more than 74,000 trial participants, according to a new study in JAMA Internal Medicine

Good to remember:

Steroids in community-acquired pneumonia

#foamed #foamcc #meded #Medsky #idsky #pulmsky #emimcc

Nope, it was V fib but he has AICD, so I guess it was interrogated

The term "ventricular fibrillation flare-up" is not one that I would typically employ in an official statement...