Simone Gherardi

Faith, Evidence and the Stars The most up-to-date critical care website in the world.

"CRT, like a star, is not the destination but a guide for the journey". AS-2 it's not just a trial, it's a manifesto, an act of faith #EMIMCC #Andromeda #AndromedaShock2 #Sepsis
criticalcarereviews.com/blog/current

ICU Snapshots:

Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU

BP control can be achieved w sympatholysis and sedation + positive pressure ventilation. I don't see the urgency of put in the mix any antihypertensive med before intubation and I think it's a very dangerous move. If BP high after tubing lets add some drugs. But come on...is not an aortic rupture

PulmCrit - 2025 AHA & ESICM guidelines on post-arrest care The ESICM and AHA both just released new guidelines on post-arrest care. It's always interesting when two professionals produce "evidence-based"

emcrit.org/pulmcrit/202... #EMIMCC Some @pulmcrit.bsky.social 's highlights about aha vs erc cardiac arrest guidelines #Emcritters

The 2025 European Resuscitation Council Guidelines have been released

All 11 plus the executive summary included below

CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch

but not in a hurry😉

PLS SHARE. FOR PATIENTS SAFETY SAKE
#EMIMCC
www.tandfonline.com/doi/10.1080/...

ICU Practice - Return to Basics:

When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient?

Oxygen mask/nasal cannula?
Non-invasive ventilation?

ED PHEM doc here. I'm using more and more NIV for preox (usually NIV-ST on Hamilton T1). So I'm giving back up breaths on peep during apneic phase. #EMIMCC

Give diuretics as boluses
look at Chloride, k+ and pH
Multimodal diuresis
Not every form of "heart failure" need diuretics in the firsts hours
#EMIMCC
#DiuresisJedi
#Deresuscitation

4. Probably it s better not to try anything "softer" than intubation. But while preoxygenating I d put him on 10 cmh20 of peep at least

Anyone with similar cases? how did it happen? Just a lack of proper follow up? Some syndromic presentation? It left me kind of unconfortable #EMIMCC is incredibile #FOAMed

Had a case of elderly M with bilateral carotid stent intubated for sudden collapse and coma. CTA + CTP showed bilateral stent occlusion and complete shut down of anterior brain circulation. Signs of right upper limb ischemia (cold, pulseless). #EMIMCC #FOAMed #Stroke

A case in which V Tach should be prevented with adrenaline and chronotropism #EMIMCC

AHAHAHAHAHAHAHA

@gx8a.bsky.social tu, midazolam team 🤢

Leading: Building Teams, Trust and Purpose in Emergency Medicine Dr. Thom Mayer, Dr. Carolyn Snider, Dr. Howard Ovens, Dr. Anton Helman discuss: Leading is about action, not designation. We are all leaders. Being consistent, kind, and honest. How vulnerability is p...

Those "softer" skills usually given for granted or misunderstood, "you have or you dont". In many place where I've trained or worked one spokes about leading as an abstraction and something you don't create or striving for #EMIMCC @emcases.bsky.social
emergencymedicinecases.com/leadership-e...

EMCrit Guest Post - In Defense of Dignity by Chris Hicks, MD Chris Hicks weighs in on dignity

5. Find a way to enjoy #EMIMCC @emcrit.bsky.social
emcrit.org/emcrit/emcri...

Ketorolac coming at 30 mg per vial 🤯🤯🤯#EMIMCC

YouTube video by The Protected Airway Collaborative Ultimate Guide to Tracheostomy Emergencies: What Every Provider Must Know to Save a Life

Tracheo emergencies toolbox #EMIMCC youtu.be/-2bFRCx0cFQ?...

If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC

Cardioman, you re right, not a STEMI. But.. need the same care aka straight to the cath lab. Time to change paradigm
#EMIMCC #OMI

It's entirely possible that bronchodilation is due to the anticholinergic and ketamine isn't doing anything.

Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well.

Pending further data this seems reasonable.🤷‍♂️

Mmmmm love ketamine but always I ve always been skeptical on super powerfull bronchodilatatory properties #EMIMCC

Keep your ED infusion pump for something else! #EMIMCC

YouTube video by TBS Zermatt Life 2.0 - What the dead can teach us about living | Matt Morgan | TBS Zermatt 2025

Inspirational talk for EM DAY 27 may. Add yours
. youtu.be/Au4L3H6oRaI?...
. youtu.be/GFX_tocJShA?...
. youtu.be/crjsmj4G0MU?...
. emcrit.org/odr/should-m...
#EMIMCC

We Debrief #Meu #EMIMCC #Simulation #Sim #Debriefing #HumanFactor #ZeroPointSurvey

Ooooh but it's not open access!

Do you have a another link?

Things we do for no reason.
Kudos to @pulmcrit.bsky.social for the convertion model emcrit.org/pulmcrit/val... and PMID: 37989791 #EMIMCC #FOAMed