🚨 Intermediate-high risk PE: RV strain + troponin. Stable for now, but will they crash?

​HI-PEITHO (NEJM 2026) finally gives us RCT data for Catheter-Directed Lysis (USCDT). Is this the new standard for the "sickest of the stable"? 🧵👇
#MedSky #CritCare #FOAMed #emimcc

Polymyxin B haemoadsorption in endotoxic septic shock (Tigris): a multicentre, open-label, Bayesian, randomised, controlled, phase 3 trial In patients with endotoxic septic shock defined by high endotoxin activity and multiorgan failure, polymyxin B haemoadsorption was associated with a high probability of lower mortality at 28 days and ...

​🚨 New Trial: TIGRIS 🚨

Polymyxin B Hemoadsorption (PMX) in endotoxic septic shock.

✅ 99.4% probability of benefit for 90-day survival.
✅ 15.5% absolute risk reduction in mortality.
✅ NNT of 6.5

​Interesting step towards endotyping shock and immune mediated management.🧬
#FOAMed #emimcc #critcare

Patient with cardiogenic shock, EF <10%. Micro axial flow device is placed. Is there loss of the Windkessel effect due to the micro axial device?

#emimcc #critcare #FOAMed #Physiology

Following up on the HD-CPR post: here is Per Olav Berve at Big Sick 2018 explaining exactly why monitors lie to us during mechanical CPR. If you want to understand "pre-tidal" CO2 and true diastolic pressure, watch this.

​ #CritCare #FOAMed #emimcc

The association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest The optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood p...

Hemodynamic-directed CPR question for everyone:

If you have an A-line during arrest and compressions are generating a dBP >30-40 mmHg, do you consider holding ACLS epi pushes? Curious who is individualizing CPR here. #CritCare

Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation The resuscitation of a patient in shock is a highly complex endeavor that should go beyond normalizing mean arterial pressure and protocolized fluid loading. We propose a holistic, four-interface conceptual model of shock that we believe can benefit ...

We are moving more and more into an individualized shock management era and POCUS is leading the way. I've been working on incorporating the interfaces model and estimating Ea/Ees for ventricular arterial uncoupling.

#FOAMED #CritCare #POCUSsky

🫁 Persistent air leak (PAL) is more than a bubbling chest drain. In critically ill patients it can severely affect oxygenation, ventilation, and lung expansion and may require bronchoscopy, surgery, or even ECMO.
Read more in the #BJAEd: www.bjaed.org/article/S205...
#CritCare #ICU #Anaesthesia

🚨 Septic shock, AKI, pH 7.15. Do you start a Bicarb drip? Does it save kidneys or just treat a number?

I built an open-access "Landmark ICU Trials" cheat sheet/reference for rounds. Let's look at a new addition: BICARICU-2. 👇
#MedSky #CritCare #Nephrology #FOAMed #MedEd

A new infographic from the CHEST Critical Care Network describes the clinical implications of late cycle dyssynchrony and how to achieve optimal synchrony by adjusting cycling settings. Learn more: www.chestnet.org/guidelines-a...
#CritCare #MedSky

Graphical abstract showing summaries of the demographic data (M 71%, HIV 57%, SOT 18%, autoimmune disease 16%), sites of infection (CNS 91%, fungemia 60%, lung 40%), ICU management (mech ventilation 55%, pressers 34%, RRT 18%), and outcome (ICU mortality 42%, 90d mortality 50%)

Presentation and prognosis of cryptococcosis requiring intensive care unit admission in France: the CRYPTO-ICU study

Retrospective study of 151 patients admitted to 30 French ICUs with cryptococcosis over 23 years

academic.oup.com/cid/advance-... #IDSky #TxID #CritCare #MedMycoSky

A new infographic from the CHEST Critical Care Network describes the clinical implications of late cycle #dyssynchrony and how to achieve optimal synchrony by adjusting cycling settings. Learn more: www.chestnet.org/guidelines-a...
#CritCare #MedSky

#Anesthesiology #CritCare #ICUnurse #ICUMedicine #FOAMcc #FOAMed #Medicine #Medical #MedEd #EmergencyMedicine #Resuscitation

November is National Hospice and Palliative Care Month.
*Familiarize yourself with the latest in Palliative Care
*Download supplemental materials specific to the ATS Community
*Earn CME credits
#PalliativeCare #Pulmonary #CritCare #medsky

The clock’s ticking in septic shock.. but does it actually make a difference?

Read more in Annals of EM. www.annemergmed.com
Or check out the 🔗: doi.org/10.1016/j.an...

#EM #EmergencyMedicine #ERDoc #CriticalCare #CritCare #Pharmacy #Medicine #MedicalEducation #MedED #FOAMed #EBM

Glad to share I passed the NBE Advanced Peri-op transesophageal #echofirst exam.
For #Nephrology fellows, I’m excited to teach TEE (sim) in addition to TTE #POCUS - a great way to deepen understanding of cardiac #anatomy and prepare for #CritCare fellowship.

Plasma proteomics identifies molecular subtypes in sepsis - Critical Care Background The heterogeneity of sepsis represents a significant challenge to the development of personalized sepsis therapies. Sepsis subtyping has therefore emerged as an important approach to this p...

Plasma proteomics identifies molecular subtypes in sepsis #CritCare #MassSpec ccforum.biomedcentral.com/articles/10....

A Modified Delphi Consensus-based Comprehensive Checklist and Angoff Standard for Assessment of Competency in Brain Death/Death by Neurologic Criteria Determination Objective: To develop a comprehensive checklist, define critical actions, and establish a minimal passing standard for adult and pediatric critical care clinicians as well as other providers to facili...

New preprint - A Modified Delphi Consensus-based Comprehensive Checklist and Angoff Standard for Assessment of Competency in Brain Death/Death by Neurologic Criteria Determination. Thanks to co-authors, especially @namorrismd.bsky.social! www.medrxiv.org/content/10.1... #neurology #critcare #MedEd

From running effective rounds in the #ICU to the latest in managing #ARDS, the #CHEST2025 critical care program will provide exciting sessions for everyone. chestnet.org/newsroom/blo...
#CritCare

#CRRT #nephcrit #emimcc #nephsky #nephrology #ccsky #critcare #criticalcare #ICU #intensivecare #meded #medsky

At #LACTIC25 we have the one person that can do both a stroke thrombectomy and a decompressive craniectomy talking about their perspective on stroke. Don't miss out!
Register here 👉 clockworkmedical.com/meeting/lactic…

#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference

🩺 For APPs in critical care, the CHEST Critical Care APP Certification Exam offers a valuable way to validate your ICU knowledge and expertise.

🔗 More details in CHEST Physician: www.chestphysician.org/chest-to-off...
#MedSky #APPs #CritCare

Medical and surgical perspectives on empyema at #lactic25 tickets selling fast, register here 👉 clockworkmedical.com/meeting/lactic…

#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference #leeds #LTHT #leedshospitals #yorkshire

Tickets for #lactic25 are selling fast! Check out the programme below. Including the legendary
@dogicuma.bsky.social

Register here👉 clockworkmedical.com/meeting/lact...

#ICU #critcare #AIM #EM #emergencymedicine #CPD #FOAMed #medicalconference #leeds #LTHT #leedshospitals #yorkshire

Explore a CHEST guideline on the transfusion of fresh frozen plasma and platelets in critically ill adults. A panel of experts has developed multimedia resources to help you apply the guideline in your day-to-day practice. Read the guideline and learn more: www.chestnet.org/guidelines-a...
#CritCare

Do you see what I see? 👀

Tag someone you think may know the answer!

Learn more in this month’s issue of Annals of Emergency Medicine
🔗 www.annemergmed.com/current

#emergencymedicine #em #criticalcare #critcare #POCUS #Ultrasound #cardiology #radiology

New CHEST guidelines recommend a more restrictive approach to platelet and fresh frozen plasma use in the #ICU. What do critical care teams need to know?

🔗 Read the full article: www.chestphysician.org/platelet-and...
#MedSky #CritCare

Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial - PubMe... French Ministry of Social Affairs and Health.

#icm #critcare folk does anywhere routinely single stat dose acute brain injuries to reduce VAP? pubmed.ncbi.nlm.nih.gov/38262428/

Brilliant recent Nature publication on steroid adjusted mortality in varying sepsis phenotypes - those who are rapidly improving do worse if treated with steroids and those rapidly worsening do better #icm #critcare #ansky

#Diuretics play a key role in critical care management of fluid overload. This narrative review provides an overview of their mechanisms of action, indications during critical illness and side effects #CritCare

Grand Rounds 05/01/2025
Join the Pro-Con Debate on Steroid Use in ARDS.
Pro: Drs. Orr & McGuire
Con: Drs. Sweeney & Pierce
Moderator: Dr. Malhotra
A critical discussion on a vital topic. #ARDS #Pulmonary #CritCare #Steroids