Matthew Snowsill

Definitely very different levels of engagement.
X/Elon toxicity has waned I guess.
There's still such an important place for medical education in social media.
As education lead it's a source of so many great and thought provoking papers and concepts out residents benefit from

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

"One intangible advantage of capillary refill time is that performing it brings the clinician back to the bedside to reassess the patient. This act may be itself the holy grail of early sepsis management."

great piece on #sepsis

I would normally not have batted an eye at this paper

But it’s by Robert Hahn, and is a nice overview of everything we know about fluid redistribution in the critically unwell- including gel phase, some glycocalyx stuff, 3 compartment models, and albumin escape rates

#foamed

actacc.org/education/meet…

Webinar by the WITCA (Women in Cardiothoracic Anaesthesia) group

For those who might be interested 😊

#emimcc
#medsky

Sad Sad Bean GIF ALT: Sad Sad Bean GIF

normal mentation *doesn't* indicate adequate systemic perfusion

especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion

poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC

I.e. "I wondered if it could be a PE but the Wells Score is low so I don't think it is a PE"
Or
"Someone sent a DDimer which is positive but I checked the Wells Score and it's low risk so I don't think it's a PE"

It sounds basic, and I see you allude to this point in the table, but the main pitfall I see is people using Wells to decide whether they should be considering PE, instead of using it because they've already used their acumen to suspect it and want to determine how to now investigate.

v1.108 is rolling out today 🚚

Now live, at long last: Bookmarks, aka Saved Posts. For all those posts you'll definitely plan to come back to!

Update the app and give it a try. The button is right down there 👇

x.com/ACCESS_Londo...

For those near London interested in #resus, #emimcc

Maternal critical care transfers is the theme of this Clinical Development Day (in person only).

Sorry it's a link to the other place....

📌

Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social

Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service

onlinelibrary.wiley.com/share/author...

minor updates to the antiemetic chapter

🤢 inhaled isopropyl alcohol pads are safe, fast, and underutilized

🤢 ondansetron is often a front-line drug due to favorable safety profile

🤢 olanzapine is a highly effective, broad-spectrum agent that is underutilized

(emcrit.org/ibcc/antieme...) #EMIMCC

UK EM Field Notes #8 My take on sepsis, circulation management in septic shock, peripheral noradrenaline

My take on sepsis, circulation management in septic shock, peripheral noradrenaline

#EmergencyMedicine #EM #Sepsis #MedSky #EMedSky #MedEd #EMSky

Sad news:

Another giant in Critical Care, Professor Rinaldo Bellomo, passed away this morning. He was born in Reggio Emilia, Italy & emigrated to Australia in the 1980s receiving his medical degree from Monash Medical School in Melbourne

He completed fellowships in nephrology,

I work with the best team! Love this battle of the inotrope education: milrinone vs dobutamine.

Blue 🔵 or 🔴?

I’m obviously a bit biased, but I believe there is greater danger in misclassification of non-septic shock (especially cardiogenic) as septic shock than from delayed recognition of septic shock. #emimcc #cccsky

🚨 New: Best Practice Guidelines with the National Poisons Information Service (NPIS) - Management of Patients with Suspected but Unidentified Poisoning in the Emergency Department.

⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...

Relationship between ⌚ spent in A&E & odds of 30-day, post-discharge, all-cause mortality:
Compared with patients who spent 2h in A&E, the odds of post-discharge death were:
🕒 1.1 x ☝️ if spent 3h
🕕 1.6 x ☝️ if spent 6h
🕘 1.9 x ☝️ if spent 9h &
🕛 2.1 x ☝️ if spent 12h

#EMedsky

🔗 shorturl.at/Tvw9e

Sub30: Feasibility study of a pre-hospital extracorporeal membrane oxygenation (ECMO) in patients with refractory out-of-hospital cardiac arrest in London, United Kingdom Out-of-hospital cardiac arrest (OHCA) carries a significantly poor prognosis with fewer than one in ten patients (∼9%) surviving to hospital discharge with some evidence suggesting that survival rates may even be decreasing to 7.8 %1–2 Survival is inversely correlated to the time taken to restore a spontaneous circulation, and cardiac arrests refractory to initial resuscitation attempts lead to very low neurologically intact survival rates.3 Extracorporeal cardiopulmonary resuscitation (ECPR) describes the implementation of extra-corporeal membrane oxygenation (ECMO) during ongoing resuscitation and is emerging as a treatment to improve outcomes for patients in refractory cardiac arrest.

The Barts/London prehospital experience has just been published

www.resuscitationjournal.com/article/S030...

Excellent work by my friends and colleagues.

1/
I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆

It's time for another #POCUS basics #skeetorial 🧵

Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️

#emimcc

Beautifully articulated as always

It's not just about rate of patients seen. *Emergency* Medicine needs time and space to train, reflect, innovate, discuss and enjoy the unique challenges it faces. These aspects are still work and service. They've been devalued but they're more important than ever

a man in a blue shirt and tie is standing in front of a bulletin board with papers on it . ALT: a man in a blue shirt and tie is standing in front of a bulletin board with papers on it .

Since we’re entering the last month of 2024, here is a non-systematic review of #pulmcrit trials published this year that I found particularly noteworthy. Not comprehensive, so please include any that I may have missed!

(🧵1/11)

#emimcc #critcare #pulmsky #medsky

I built and lead a HIU programme and if your unit hasn’t got one, you need one - benefits the patient, benefits the unit, benefits the finances, and can be extremely interesting work

📌

Defibrillation and refractory ventricular fibrillation Of patients with out-of-hospital cardiac arrest (OHCA) presenting in ventricular fibrillation (VF), the majority require multiple shocks.1 Guidelines recom

Interesting article. A lot of what we label as refractory VF isn’t refractory at all. It’s actually recurrent.

Is there a way in which we could change defibrillation strategies or antiarrhythmic drug administration to better address this?

academic.oup.com/eurheartj/ad...

Face mask ventilation vs high-flow nasal oxygenation

Comparison of end-tidal oxygen concentration and the lowest SpO2 after tracheal intubation between parturients.

#AnSky #MedSky

https://buff.ly/4fMvK6u

Look forward to the East Anglian Air Ambulance RAID annual conference this Friday…the theme being ‘Innovations in Pre-Hospital Resuscitation’.

📌

a man in a plaid shirt sits at a picnic table with the words " settle down " on the bottom ALT: a man in a plaid shirt sits at a picnic table with the words " settle down " on the bottom

Skytorial: Five pearls on olanzapine 😁

Between agitation and nausea/vomiting, olanzapine has a wide range of use.

Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....