💬 Editorial: While capillary refill time shows promise for early #SepticShock management, integrating it into broader, multimodal resuscitation strategies remains key to improving outcomes.
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
New RCT: Avoiding A-line in shock didn't affect mortality (trend towards *reduction*) & decreased line complications
They avoided A-lines despite patients requiring pretty substantial doses of vasopressors
Very #zentensivist
Don't need to rush to an A-line
www.nejm.org/doi/full/10.... #EMIMCC
Interesting, I’d have to try this. How about rapid onset bradycardia? With an infusion I feel like I have time left to act, ie give atropine.
Do you happen to know if the reference values for DOACs actually are linked to bleeding outcomes? It would be useful to have some sort of cut off when it comes to neuraxial anesthesia, which doesn’t necessarily need to be in the upper range of the reference value.
Do you bolus the 5 mcg/kg? Or infused slowly over xxx minutes?
Nederland sluttet met lotteri fom 2010 og innførte en ny søknadsprosess basert på «motivasjon, egnethet og erfaring». De siste årene har man derimot innsett at også dette systemet har sine svakheter og ikke fører til «bedre leger». Lotteri er nå igjen mulig etter en lovendring.
Your palm on the plunger? Not your thumb?
Would it be okay to ask for some tips on the adult inhalational induction? I’m part of this generation that has pretty much only done it in peds, so it feels a bit uneasy to do it with adults.
Correct
Continuous pressure, and after engaging ligamentum flavum aiming to only push the needle by applying force with my thumb on the syringe/plunger. The sudden loss of resistance usually makes the needle stop because any remaining force is transferred to the saline column in the syringe.
It’s baffling to me that this hasn’t been studied in humans before in this way, considering how long we’ve known about the metabolic switch to lactate in shock states.
Does using 12 leads on a monitor remove some of the filtering then?
Would you say that one should therefore by cautious using printouts of monitor ECGs? Regardless of them being 3, 5 or 12 lead for examples. Nurses always look at me slightly frustrated when I request a “classic 12 lead” instead of just a printout from the monitor.
🚩In a 2.5-year national surveillance in the Netherlands, incidence of high neuraxial block requiring ventilatory support was low (1:12,758). 3 of 5 cases occurred after spinal anesthesia for #CesareanDelivery after epidural analgesia
@iarsjournals.bsky.social
journals.lww.com/anesthesia-a...
Intraoperative neuromonitoring in spine or brain surgery?
Me neither, as mentioned it’s most relevant in infants. It’s called Slice Thickness artifact. Nicely explained over here on Baby Blocks www.baby-blocks.com/vascular-acc...
In-plane technique is prone to imaging artifacts where the needle tip might appear in the lumen but it’s actually outside. This effect is more pronounced the smaller the vessel.
