David Lewandowski, MD, MS

The BICAR-ICU-2 trial just dropped!

RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI

Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia

VERY similar conclusions to BICAR-ICU-1

🧵 #1/

jamanetwork.com/journals/jam... #EMIMCC

The American Thoracic Society (ATS) updated its recommendations on some aspects of the diagnosis and management of community-acquired pneumonia (CAP)

Donate to Summit for Ubuntu: A Climb To Change Lives - November 2025, organized by Wazha Dube Dear friends, family, and supporters, This year, I’ll be ful… Wazha Dube needs your support for Summit for Ubuntu: A Climb To Change Lives - November 2025

Please help a friend of mine and fellow @arsenalfc.bsky.social supporter on his journey to climb Mount Kilimanjaro for Ubuntu Life Foundation!! www.gofundme.com/f/summit-for... #hiking #fundraiser #donation #epilepsy #ubuntu #africa @ohanlonsbarnyc.bsky.social @arsenalnyc.bsky.social

You’re always welcome!
Open crowd and made great friends. They’ve welcome me with open arms when Blind Pig fell apart and welcomed be back when I was gone working hard during COVID pandemic. Now it’s a home away from home and I know it is for many other fans!

Timeline cleanse

Mental Practice to Maintain Procedural Competency of Faculty with Decreased Opportunities
@atscommunity.bsky.social #medsky

🔗 tinyurl.com/23bkc6kn

GOP May Cut Off Student Loan Forgiveness For 4.8 Million Healthcare Workers Republican lawmakers in Congress are considering a move that could cut off student loan forgiveness for millions of healthcare workers.

So now the GOP thinks it's come up with a clever way to renege on student loan forgiveness for nurses and doctors--take away tax exempt status of hospitals, so workers no longer qualify for PSLF. Shameful. www.forbes.com/sites/adammi...

Let’s us know how it sounds!

Love a fat strat. That was my first guitar. Beautiful, burgandy. Played the hell out of her in bands in the 00s.

My dad then claimed it when he started learning when I didn’t have enough space in my closet apartment during med school. 😅

Agreed. Even in urban centers I’ve seen, I’m not sure if it helps and doesn’t seem to improve efficiency. It often creates lowest denominator work ups that aren’t focused on the patient’s problem/CC and leads to additional testing.

And lower resourced, as you mentioned, is it feasible?

We should absolutely be using POCUS in patients with dyspnea, chest pain, or sepsis. All of these I believe have assessments that can directly affect treatment and outcomes. #pocus

That was atrocious. The classic first half feckless domination while still conceding a goal and then no platform to threaten given the lack of January moves you’ve mentioned.

Trump Administration Stalls Scientific Research Despite Court Ruling Using an arcane law, officials have effectively delayed funding from the National Institutes of Health, leaving medical studies in jeopardy.

www.nytimes.com/2025/02/21/s...

Such an innocent time!

Amen! We had a Saturday celebration as well. Cheers to you and yours.

Brand New World
Figure all these dystopian novels bring a certain perspective and insight in our current state of affairs

KNOW YOUR RIGHTS IN CASE OF ICE: CONOCE TUS DERECHOS EN CASO DE ENCUENTRO CON ICE:

DO NOT OPEN YOUR DOOR. ICE cannot enter your home without a warrant signed by a judge. Tell the agents to show you the warrant by sliding it under the door. NO ABRAS TU PUERTA. ICE no puede entrar a tu casa sin una orden firmada por un juez. Diles a los agentes que te muestren la orden deslizándola debajo de la puerta.

ASK THEM TO LEAVE. If ICE doesn't have a warrant, tell them you do not consent for them to enter your home and ask them to leave. At work, ICE cannot enter employee-only areas without permission. 2 PÍDALES QUE SE VAYAN. Si ICE no tiene una orden judicial, diles que no das tu consentimiento para que entren a tu casa y pídeles que se vayan. En el trabajo, ICE no puede ingresar a áreas exclusivas para empleados sin permiso.

REMAIN SILENT. You have the right to remain silent. If the agents ask you questions, tell them, "I wish to remain silent." PERMANECE EN SILENCIO. Tienes derecho a permanecer en silencio. Si los agentes te hacen preguntas, diles: "Deseo permanecer en silencio".

It is perfectly legal to know your rights and to educate others about them, too.

EVERYONE in the United States, citizen or not, has rights. I will not allow this administration to intimidate us from helping you know about them.

Here’s our shareable guide ⬇️: (pt. 1/2)

Key being that the fourth year has to be something meaningful. Not just cheap labor at an essentially newly minted attending productivity just to bump department metrics/throughput. It has to bring tangible educational benefit to the resident.

Competency based makes the most sense. 3.5 seems like the sweet spot but the half year mark isn’t realistic for a work calendar.

3 year required. If meeting certain competencies then graduate.
4th for those who need the extra year or desire it as part of a 3+1 model for academics.

I’ll be deleting my account soon. Almost never check it. Was hoping to bring some followers over or find previous mutual connections before closing it. But it’s time to discard.

They talk about it at Montefiore’s CV ICU boot camp they run for new CT ICU RNs, fellows, and intensivists (for CME). Seen it once in fellowship there. I’ve wanted to try it subsequently at multiple places and had difficulty getting it from pharmacy. CCU colleagues use it occasionally.

JUST IN:

Federal judges orders HHS, CDC, and FDA to restore “by no later than 11:59 pm” today their websites and datasets to pre-January 30th status.

storage.courtlistener.com/recap/gov.us...

What's the Best Fluid for Pancreatitis? Could it possibly be (anything but normal saline)?

More feathers in the "balanced crystalloid" cap – as if anyone would ever expect normal saline to be the best answer to virtually any question regarding IVF. #medsky

open.substack.com/pub/medicine...

Was there ever any surprise? These are sycophants who want oligarchy and absolutism.

Amen! As The Strokes once said: “Monday Tuesday is my weekend…”

I’ve followed the instructions but still cannot get the labels to apply.
Assistance is appreciated. Thanks.

In a 54-year-old male athlete, echocardiograms obtained 3 weeks after diagnosis of AL amyloidosis showed classic features of amyloid cardiomyopathy and evidence of progressive disease. Read the full case details: nej.md/3WpUsC8

#MedSky #CardioSky

Skiing selfie

View down from top of Mount Mansfield

Beautiful day yesterday at Stowe! Perfect conditions.

Thanks for sharing! Will have to read this one on the train today.