More highlights from our most recent episode on the new PE guidelines. Follow up care for PE is essential; see what testing and evaluation is recommended and when.

Full episode wherever you get podcasts or on YouTube!

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#pulmsky
#criticalcare

Patient on unfractionated heparin infusion. APTT > 180, anti Xa 0.6.
Which one should I believe?

#emimcc

Preplanned and pushed tPA on the CT gantry. Unfortunately no significant improvement, iEPO ineffective. After 90min of tpa the patient succumbed. Is anyone out there also calling IR in this setting? Would have maybe used ECMO but wasn't within his stated wishes prior to intubation. #emimcc #icusky

Acetylcisteine for ischaemic liver - yes or no?
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The effect of radiology vetting on CTPA yield

doi.org/10.1111/1742...

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Differences in time to analgesia based on biological sex for patients with abdominal pain
#OpenAccess
doi.org/10.1111/1742...

@wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM

Pet peeve: Research on pupillometry that only reports the neural pupil index (NPi) is worthless & will wind up in the ash heap of history.

NPi is *proprietary* & calculated with a *secret* formula by *one* company's product.

Does this seem like ideal scientific practice?...#1/2 #EMIMCC

#cardiosky #echosky #emimcc

🚨 Follow up post to my review of HI-PEITHO.

​Does catheter directed Thrombolysis actually work? STRATIFY Trial suggests CDT doesn't work. 🧵👇
#MedSky #CritCare #FOAMed #emimcc

A woman in her 60s seeks the ED for CP starting 2 h ago. ECG concerning for ST elevation in anterior leads. #POCUS shows hypokinesis septally. Gets transferred for urgent cath which shows a 100% LAD stenosis. Succesfully stented. Repeat echo normal. #EMIMCC

🚨 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

Lightning rounds 64: The new Surviving Sepsis guidelines with Hallie Prescott – Critical Care Scenarios

We explore the latest Surviving Sepsis guidelines with lead author Hallie Prescott, including the controversies pertinent to US-based practice

icuscenarios.com/lightning-ro...

#medsky #emimcc

Lightning rounds 64: The new Surviving Sepsis guidelines with Hallie Prescott – Critical Care Scenarios

If you are interested in the new surviving #sepsis #guidelines and the controversy around them, you may find useful this podcast with Hallie Prescott, the guideline co-chair

icuscenarios.com/lightning-ro...

#foamed #foamcc #meded #medsky #emimcc

Fresh blog on the HI-PEITHO trial 😁

🔊 ~18 mg alteplase over 7 hrs is safe (no ICH, no difference in bleeding rates)

🔊 Alteplase reduces the risk of cardiopulmonary decompensation and poor functional outcomes

#1/2 #EMIMCC

Looking at the PMHx of a pt with seizures, noted they’d been thrombolysed for a stroke recently. The subsequent MRI was entitely normal.

Ladies and gents, we thrombolise non-strokes…and “minor” strokes in 90yr olds

Yet same dose tPA in PE, we need them to be peri-dead.

Make it make sense.
#emimcc

#emimcc #ccc

#PeerReview #ArtificialIntelligence @wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM

Guys help! My boss today says there's evidence that noradrenaline has better outcomes than metaraminol in septic shock, but I can't find the evidence!
#emimcc

homer simpson from the simpsons is standing in front of a green bush . ALT: homer simpson from the simpsons is standing in front of a green bush .

He is a good friend but he intubates with midazolam & fentanyl...

#foamed #foamcc #meded #medsky #emimcc

#emimcc

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Orthostatics worthless in assessing volume status
-50% > 65 + 44% teens orthostatic at baseline(PMID 9109468, 12006955)
-Perform poorly in known volume loss(PMID 8198307)
-Useless in assessing those w/ fluid depletion from vomiting, diarrhea (PMID 10086438)

youtube.com/shorts/Dvq5R...
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#emimcc

TIGRIS, the new Xigris?
#emimcc

Oh boy Eddie and Todd are not going to like this acronym
#emimcc
@icucast.bsky.social

#PeerReview and #AI

doi.org/10.1111/1742...

@thesgem.bsky.social
@wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM
#ArtificalIntelligence

#PeerReview

doi.org/10.1111/1742...

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@wileyhealth.bsky.social
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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

The most dangerous thing you can have is a non-septic shock misclassified as septic shock. #emimcc