Xenwan

61yo M from Ghana. Complaining CP since 3 hours.

This ECG looks tasty. Could mislead a lot of physicians.
@drghem.bsky.social @emcrit.bsky.social @eusem.bsky.social @criticalcarenow.bsky.social
(My first Bluesky post💙)

🚨 NEW POST: MDCalc Wars 🛑💥
Are you using PERC and Wells correctly?

✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!

👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky

a man wearing sunglasses and a green shirt with breaking bobby bones on the bottom ALT: a man wearing sunglasses and a green shirt with breaking bobby bones on the bottom

rapidly pushing IV calcium may cause:

😦 vasodilation, bradycardia, hypotension
😦 nausea/vomiting, flushing

if patients are conscious, this can make them feel horrible

if the patient is obtunded & not intubated, emesis can be a big problem

whenever possible, give IV Ca slowly #EMIMCC

the distinction between “bactericidal” vs “bacterostatic” antibiotics is some irrelevant BS.

this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC

Chronicles of Chronotherapy in Controlling Cardiovascular Complications — NephJC Dr Hiremath gives the chronotherapy literature a Swap.

That’s exactly our point - the Spanish data made no sense www.nephjc.com/news/chronot...

IMO use long acting meds once a day and timing does not matter

Good question! #idsky #microsky
🪡
Co-amoxiclav is generally dosed in the UK as follows:

PO: 500mg Amox / 125mg Clavulanate
IV: 1000mg Amox / 200mg Clavulanate
Both 8-hourly.

This gives you differing ratios of Amox to Clav (4:1 for PO, 5:1 for IV). What gives?

NephJC Shorts: The end of the Fluid Wars? — NephJC N Engl J Med . 2025 Jun 12. doi: 10.1056/NEJMoa2416761. Online ahead of print. A Crossover Trial of Hospital-Wide Lactated Ringer's Solution versus Normal Saline Lauralyn McIntyre , Dean Fergus...

Another #NephJCshorts, by @hswapnil.medsky.social

✍️Edited by @kidneyboy.bsky.social

🎨VA by @nephroseeker.medsky.social

🌊The long discussions mirror the old FLUID war. Despite the nuances, the conclusion is firm: Ringer's lactate offers no benefit over NS

www.nephjc.com/news/fluid-t...

Ceftriaxone Is a Narrow Antibiotic Now — and Other Musings In no particular order, 20 things I’ve found interesting lately — a mix of ID (mostly), language quirks, clinical stuff, even tennis, and an apology (#21) at the very end. Bonus videos embedded becaus...

Ceftriaxone is a narrow antibiotic now.
Plus: ID binomials, BCID magic, linezolid price madness, a Novak Djokovic apology (!), and more.
20 musings, mostly ID-related, bonus videos included. #IDSky
blogs.jwatch.org/hiv-id-obser...

BRB, I just need to file a patent real quick for a combination of droperidol plus magnesium (dropnesium) as the ideal drug for everything.

migraine? dropnesium.

nausea/vomiting with low Mg? dropnesium.

agitation with unknown QT? dropnesium.

#EMIMCC

One of the most mature and intelligent things a human can do is say, "I don't know enough right now to have a well-informed opinion on that."
#medsky

Hypophagia and body weight loss by tirzepatide are accompanied by fewer GI adverse events compared to semaglutide in preclinical models Tirzepatide exhibits a greater therapeutic index compared to semaglutide in preclinical models of nausea and emesis.

More preclinical data extending the anti-aversive actions of GIP through studies of Tirzepatide www.science.org/doi/10.1126/...

Lauralyn McIntyre & Monica Taljaard summarise the FLUID trial presented yesterday at the Critical Care Reviews Meeting 2025 and simultaneously published in the @nejm.org
www.nejm.org/doi/full/10....

Lactate infusion improves cardiac function in a porcine model of ischemic cardiogenic shock Critical Care

Lactate infusion enhances cardiac output and peripheral perfusion in ischemic cardiogenic shock without affecting heart rate or systemic blood pressure, finds a study published in Critical Care.

#MedSky

And live at NEJM

www.nejm.org/doi/full/10....

Trial from Ottawa at #CCR25

Really, who still cares about balanced versus normal saline arguments! (Beyond some nerdy nephrons and Josh)

Same vibe.

h/t @darrencullen.bsky.social

Things We Do for No Reason™: Avoiding intravenous iodinated contrast material in patients with acute kidney injury or chronic kidney disease Click on the article title to read more.

This was a fun article to work on. Hope you enjoy it.

Things We Do for No Reason™: Avoiding IV iodinated contrast material in patients with acute kidney injury or chronic kidney disease Journal of Hospital Medicine
shmpublications.onlinelibrary.wiley.com/doi/10.1002/...

A former Columbia University professor of pediatrics and attending pediatrician at Columbia-Presbyterian Medical Center has been charged with submitting false vouchers for supplies and pocketing thousands of dollars in reimbursements from the medical center, authorities said yesterday. The physician - Dr. Robert W. Winters, who resigned both posts last fall after more than 20 years with the medical center and the faculty of the Columbia College of Physicians and Surgeons - surrendered to District Attorney Robert M. Morgenthau of Manhattan last Thursday. After waiving a grand jury indictment, he was charged with second-degree grand larceny. He was released in his own recognizance after an arraignment in Criminal Court. The charge carries up to seven years in prison.

If you have trouble remembering Winters Formula (pCO2 = HCO x 1.5 +8±2), tell your attendings that you refuse to support the work of a thief:

www.nytimes.com/1982/05/16/n...

full text in the alt

We endorse this statement. For our users, please be assured that recommendations in The Sanford Guide will always be evidence-based, derived from science and supported with references to the most relevant source literature. —Jeb C. Sanford, Managing Editor, on behalf of our Editorial Board

I use high dose MRA (IV canrenone 200mg for 3 days) in acute decompensated heart failure in case of high dose furosemide (>125 mg/24h). Should prevent excessive RAAS activation and hypokalemia (both by furosemide and acetazolamide) and metabolic alkalosis driving diuretic resistance.

Interactive Medical Case Plight on the Pickleball Court An illustration of a woman coughing

A new interactive feature describes a 68-year-old woman who presented to the ED with dizziness and shortness of breath on exertion that abated with the use of an albuterol inhaler. She reported a 4-day history of cough, sore throat, and nasal congestion. Test your skills: nej.md/4kcdPIe

🌟 ABX Pearl of the Day: Positive UCx but unable to verbalize UTI symptoms

❓ Q: My elderly patient had a fall with altered mental status, and UCx is growing pan-S E. coli (>100K CFU/mL). They are unable to verbalize UTI symptoms. Should I treat for UTI?

#IDsky #medsky #meded #pharmsky #skyRX

Wonderful essay. If you’re not in medicine (or if you live outside the US), you may want to sit down before reading this explainer on reimbursement for care provided by #InfectiousDiseases physicians

In this Core Curriculum, Nayan Arora and Sarah F. Sanghavi discuss disorders of volume, which are typically identified clinically as changes in the extracellular space, and management strategies through a series of clinical vignettes:

bit.ly/Arora24CC (FREE)

Figure of survival curve showing no difference

There you have it: BEDMED published in @jama.com

jamanetwork.com/journals/jam...

h/t @drjmluther.bsky.social

No difference in bedtime versus morning BP meds - as expected

#NephSky #Hypertension
1/

scientific illustration of a virus

Have you been a good prescriber this past influenza season?

As little oseltamivir as feasible?

And you didn't hand out Xofluza, did you? 😡
#medsky #IDsky

www.acepnow.com/article/have...

#MedSky

thesgem.com/2025/05/sgem...

Yeah they seem unrelated, plus the atrial activity is too slow to be a flutter if paper speed is 25 mm/sec. There seem to be A-V dissociation in the second half as well, having a better look.

Yeah they seem unrelated, plus the atrial activity is too slow to be a flutter if paper speed is 25 mm/sec. There seem to be A-V dissociation in the second half as well, having a better look.

I assumed 50 mm/sec 🙇‍♂️