xenwan

1) acetazolamide for iatrogenic contraction alkalosis is standard tx IMHO (most drugs are "off label") along with K repletion etc

2) PO acetazolamide probably fine, great bioavailability

3) prevention with amiloride is great, I love amiloride

4) triamterene is maybe nephrotoxic so less of a fan

🔍 Notable mimics of cellulitis include (but are not limited to):
- Stasis dermatitis
- Lymphedema
- Contact dermatitis
- Lipodermatosclerosis
- Eosinophilic cellulitis
- Deep vein thrombosis

There is nothing magical about formal ultrasounds for appendicitis. We EM docs can do it too! 32 y old male with a classic history, CRP 94. #POCUS shows an appendicolith and an inflamed appendix. Surgeon moves up the operation because of risk of perforation. #EMIMCC

it's wild how badly people dose hypertonic therapy

60 ml of 23% is equivalent to ~500 ml 3%, so this article makes no coherent sense

best approach: figure out the sodium change you want and calculate the hypertonic dose

math sets you free from dozens of contradictory consensus statements #EMIMCC

#PaperinaPic summarizing the Queen of Hearts artificial intelligence study to read ECGs by the Queen of Infographics, @kirstychallen.bsky.social #MedSky
thesgem.com/2026/02/sgem...

Among patients with acute ischemic #stroke due to non–large vessel occlusion, #tenecteplase administered 4.5 to 24 hours after symptom onset increased excellent outcomes but raised the risk of intracranial #hemorrhage. #ISC26

📽️ Watch the video & read the full study: bit.ly/4kgH1yQ

Daily Pearl:

Type B lactic acidosis should be considered in patients receiving high doses of beta 2 agonists (albuterol) which can cause a dramatic non-hypoxic rise in lactate.

Source: CPS - November 26, 2025 VMR with Sharmin & Rahul - SOB, cough, malaise

CANADA NEWS: University of Toronto Family Medicine Chair and basic income advocate Dr. Danielle Martin has been nominated to replace former Deputy PM Chrystia Freeland in upcoming Toronto by-election (University-Rosedale)

The healthcare case for guaranteed income security is overwhelming.

The New England Journal of Medicine Olezarsen for Managing Severe Hypertriglyceridemia A Research Summary based on Marston NA et al. | 10.1056/NEJMoa2512761 | Published on November 8, 2025 Visual representations of the patients in the trial and the treatments they were assigned. Read the full Research Summary at NEJM.org.

In the phase 3 CORE-TIMI 72a and CORE2-TIMI 72b trials involving patients with severe hypertriglyceridemia, olezarsen led to a significantly greater reduction in the triglyceride level and in acute pancreatitis events than placebo. Full results and Research Summary: nej.md/491XG5V

#MedSky

When managing patients with ischemic #stroke, can we please adopt a single BP target? Currently, BP should be <185/110 mmHg prior to thrombolysis & <180/105 after, which feels unnecessarily complicated. Wouldn't it be simpler to use one target, such as <180/100 mmHg, for both?

Black-and-white satirical movie poster. Melania Trump is in a tailored black suit and high heels sits sideways on a white toilet, legs crossed, staring coolly at the camera against a stark white background. Large bold title at the top reads “MELAENA,” with the subtitle “Telltale sign of GI bleed.” At the bottom, bold text states: “If you don’t have an ulcer, this movie will give you one.” A parody studio logo in the lower right reads “BROWNNOSE STUDIOS.”

I'd consider watching this if it counted as CPD points.

#medsky #FOAMed #GIbleed #EmergencyMedicine #IfInDoubtScopeIt

Why aren’t you prescribing fish oil to your dialysis patients? PISCES showed a striking cardiovascular benefit with fish oil in hemodialysis. Lovaza closely matches the trial’s ethyl-ester formulation, is FDA regulated, EHR friendly, and offers a practical, re…

PBFluids▶️PISCES showed a striking cardiovascular benefit with fish oil in hemodialysis. Lovaza closely matches the trial’s ethyl-ester formulation, is FDA regulated, EHR friendly, and offers a practical option while we wait for the exact formulation pbfluids.com/2026/01/why-...

‘It’s the sovereignty of the country’: Guinea-Bissau says US vaccine study suspended Despite US pushback, officials in west Africa say controversial hepatitis B study on pause amid ethics concerns

“Africans want to solve Africa’s problems, not satisfy the curiosity of the funders.”
www.theguardian.com/world/2026/j... @dennisrenmd.bsky.social @kaymd.bsky.social

Tirzepatide on obstructive sleep apnea-related cardiometabolic risk: secondary outcomes of the SURMOUNT-OSA randomized trial - Nature Medicine In a prespecified secondary analysis of the SURMOUNT-OSA trial, tirzepatide improved cardiometabolic outcomes in patients with moderate-to-severe obstructive sleep apnea and obesity.

Tirzepatide significantly improves cardiometabolic risk in obese patients with obstructive sleep apnea, targeting both weight and apnea metrics.

by Malhotra A, Grunstein R (...) Bednarik J et 9 al. in Nat Med #MedSky

👉 get more here

📖 read the article:

Ultrasound machine was critical during astronaut medical crisis at space station The astronauts gave public remarks for the first time Wednesday since being evacuated from the International Space Station

If they learned how to use #POCUS, why can't we?

www.independent.co.uk/space/nasa-a...

hi, intesivist here.

we dont use sepsis screens.

sepsis screens use us.

#foamcc #emimcc

Do you administer non indicated medications if the family wants to? Same for intubation as far as I’m concerned. No indication for ICU admittance hence no intubation for a 97 yo pt with dementia. My perspective from Italy in a (dying?) public healthcare.

The Story Behind My Most Famous Blog Post The origins of "How to Figure Out the Length of Antibiotic Therapy"

Revisiting "How to Figure Out the Length of Antibiotic Therapy", and how it came to be. Sobering that my greatest claim to writing fame is now over 15 years old, implying a subsequent lack of inspiration. 🤷‍♂️ #IDsky #medsky paulsaxmd.substack.com/p/the-story-...

I had the pleasure of interviewing Noah Wyle on the Skeptics' Guide to Emergency Medicine. Consider listening & sharing the SGEM episode.
thesgem.com/2025/05/sgem... #MedSky

Daily Pearl:

Severe hypomagnesemia can independently cause both hypokalemia (by affecting the ROMK channel in the kidneys) and hypocalcemia (by inducing PTH resistance).

Long-term PPI use can lead to profound hypomagnesemia.

Source: CPS - Episode 431: The Clinical Unknown Series

🦠 Tamiflu: Worth It?
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed

Daily Pearl:

In aspiration PNA, elderly patients may present with atypical signs of infection, such as functional decline, confusion, or tachypnea, in the absence of fever due to immunosenescence.

Guidance: Be comfortable with short-term eGFR swings.

Act only on *sustained* changes. Otherwise you are treating biological variability, not disease.

*And always correlate with the clinical picture *

Statistically significant does not mean clinically significant. In the latest Stats, Stat! animated video from 𝘕𝘌𝘑𝘔 𝘌𝘷𝘪𝘥𝘦𝘯𝘤𝘦, Nigam and colleagues explain the minimal clinically important difference.

Watch “How the Minimal Clinically Important Difference Works”: youtu.be/rStW1rBjURc

#MedSky

❄️ Winter is coming… and so are the pneumonia admits.
CURB-65, PSI/PORT, SMART-COP — they’re not answering the same question. One guides admit vs discharge, another predicts mortality, and one spots who’s about to crash.
New on @REBEL_EM 👉 https://loom.ly/pUrda8w

Daily Pearl:

Postpartum heart failure is not always peripartum cardiomyopathy. Also consider thyrotoxicosis, as pregnancy can trigger or unmask Graves disease.

🦠 Tamiflu: Worth It?
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed

Using the Comparing Oral versus Parenteral Antimicrobial Therapy (COPAT) Clinical Trial to Influence Institutional Practice Transformation Towards Earlier Transition to Oral Antibiotics Early IV to oral transition improves antibiotic treatment safety across many serious infections. In a rural health system, implementation of the COPAT Tria

Early IV→oral switch works—and safer. In the pragmatic COPAT RCT (5 hospitals), early oral therapy cut adverse events vs IV-only (3.2% vs 6.5%; HR 0.24) with equivalent efficacy. #AntimicrobialStewardship

academic.oup.com/cid/advance-...

@blepiro.bsky.social