CriticalCareNow

Hyperangulated blades aren't intuitive
Mastering standard blades doesn't make you an expert here; it’s a different skill. Start with standard VL to learn anatomy, then transition to DL. Save hyperangulated for later—view is not the same as tube delivery. #FOAMed #Laryngoscopy

Driving pressure >15? What to do next.
A high driving pressure is a signal to act. You must either increase lung capacity through recruitment (PEEP) or reduce the demand on the lung by lowering tidal volume. Don't let the 6cc/kg rule override bedside physiology. Comment to discuss.

Comment to discuss.

BP climbing in a brain bleed?
Clinical Pearl: Pain is a primary driver of hypertension and increased ICP in neuro patients. Using fentanyl for gentle BP control addresses the root cause. Pair it with Precedex to blunt the sympathetic drive. What's your first-line analgesic in the Neuro ICU?

Are You Ready?

This conference is different. It's education reimagined. Come to Philly May 18-20, 2026 at the Punchline Comedy Club.

If the BP is tanking, you’re already too late
Don’t wait for a BP crash! SCAI SHOCK stages (A-E) predict mortality: Stage B (a 30-point systolic drop) carries a 34% risk, even if they look "fine." If you wait for cold, clammy Stage C signs, mortality hits 54%. Act early to save lives. #CriticalCare

Why you should start teaching airway with VL first
Start with video so mentors can actually coach what you see. Standard VL builds the same physical skills as DL but with a safety net. Master the tech first, then prep for "blackout" scenarios when batteries fail. 🔋 #MedEd #FOAMed #AirwayManagement

Do you prioritize recruitment or volume reduction? Comment to discuss.

Driving pressure >15? What to do next.
When driving pressure is high (DP 30), you're overdistending a small lung. Increasing PEEP can recruit alveoli, effectively increasing lung size and lowering DP. But if DP stays at 25, you still have work to do.

SAH? Don't forget the heart.
The catecholamine surge can cause significant cardiac stunning(think Takotsubo). Baseline echo is essential to differentiate new neurogenic dysfunction from baseline disease. How often are you finding LV dysfunction in your "bleeding brain" patients? Comment to discuss

Let's stop boring medical education

Ultrasound is great but…

…it can also cause harm

Ultrasound can be a powerful tool during cardiac arrest, helping identify reversible causes and guide treatment. However, its benefit is completely dependent on minimizing interruptions to high-quality chest compressions.

ScvO2 < 50%? It’s you vs. the clock!
If ScvO2 drops below 50, you're in a race against time! Start with a baseline, then use a fluid challenge; a 4% jump means they are fluid responsive. 💧 Remember: meds buy time, but they can't fix a surgical or structural heart emergency. #CriticalCare #MedEd

Which is better: standard or hyperangulated VL?
Don’t mistake a perfect view for an easy tube pass! While both VL types beat traditional DL, hyperangulated blades often make navigating the "corner" harder. Mastery of your blade’s physics matters more than the brand. 🚑 #FOAMed #AirwayManagement

High-yield vent pearl!
Compliance isn't just tissue elasticity; it's a measure of functional lung volume. Driving pressure tells you if your tidal volume is too much for the available "baby lung." Target a driving pressure under 15. Comment to discuss.

Is it vasospasm?
Clinical Pearl: The most important tool in the Neuro ICU isn't the TCD or the CTA—it's the hourly neuro exam. Vasospasm management is a 21-day art form. What’s your "must-check" at the bedside?
Comment to discuss.

You should be monitoring ScvO2
Stop ignoring ScvO2! It’s a direct window into oxygen delivery vs. consumption. If it’s under 50%, your patient is in deep trouble. Don't wait for BP to crash; use ScvO2 to catch tissue starvation early and address oxygen debt. #Shock #Resuscitation #FOAMed

VL isn’t cheating; It’s just better medicine
Using VL isn't lazy; it’s professional. Standard geometry moves the tongue while hyperangulated works around it, but both beat "old-school" DL. Don't let ego risk patient safety. Choose the best tech. 🚑 #FOAMed #Laryngoscopy

Why does 6cc/kg IBW often fail to protect the lung?
Because as disease severity increases, the aerated lung volume participating in ventilation decreases. Guesstimating vs. calculating matters less than the titration based on driving pressure. Comment to discuss.

Spontaneous ICH: What’s your BP goal?
High-yield neuro pearl: the target range is 130–150 mmHg, with a preference for < 140 mmHg. Regulating this is tough, but vital for outcomes.
Have you seen this present differently in your unit? Comment to discuss.

Cardiogenic shock? Pressors > Fluid Boluses
While fluids are the reflex for sepsis, 30 mL/kg can be a death sentence for a failing heart. 16% of shock is cardiogenic—pumping fluid here causes catastrophic pulmonary edema. Use pressors, not boluses. #EmergencyMedicine #FOAMed #Shock

Stop confusing VL with hyperangulated laryngoscopy

VL is the tech (camera + screen), while DL is the technique (line of sight). You can do both at once with standard blades. Hyperangulated blades are specialized tools, not a default upgrade. 🚑
#FOAMed #AirwayManagement

The use of steroids in septic shock has been debated for decades, but more recent data increasingly supports their benefit (PMID: 38250247), particularly for patients in refractory vasopressor shock.

Do This After A Code

Code Blues / Cardiac Arrests are incredibly demanding, both physically and emotionally, especially when they don't have the outcome we hoped for. As healthcare professionals, it's essential to have a routine for processing these intense moments.

The biggest resuscitation conference of 2026. Live in Philly or watch online. CME and CEU available

Why is the hyo-epiglottic ligament the "secret hack" for emergency airways? Advance into the vallecula and engage this ligament to mechanically lift the epiglottis for a superior view. 📸: Terren Trott (5-Minute Airway). Have you seen this presented in your unit?

Stop sedation-only protocols. 🛑

Vented patients are in pain even without trauma. Propofol is a blindfold, not a painkiller.

The Meat:
Pain meds first.
Lower sedative needs.
Better stability.

The "Don't": Assuming quiet = comfortable.

Fentanyl or Propofol first? 🏥

#ICU #Nursing #CriticalCare

Epi or Levo?

...so, you've just achieved ROSC in a hypotensive patient. Which vasopressor should you reach for: Epinephrine or Norepinephrine?

The answer, supported by data, is unequivocally Norepinephrine

Epi or Levo?

...so, you've just achieved ROSC in a hypotensive patient. Which vasopressor should you reach for: Epinephrine or Norepinephrine?

The answer, supported by data, is unequivocally Norepinephrine

Diuretic Resistance in Cardiorenal Syndrome (Part 4)