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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#REBELEM #EMIMCC #FOAMed

#PeerReview #MedSky #EMSky #EMedSky #emimcc #ACEM
#ArtificalIntelligence

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...
#EMIMCC

#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...

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

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

A woman in her 90s seeks the ED because of jauneice. It came from nowhere a week ago and she is feeling fine otherwise. #POCUS shows a severly dilated common bile duct. CT without malignancy but a 4 cm obstructive duodenal diverticulum. This is (apparently) Lemmels syndrome. #EMIMCC

#emimcc

Polymorphic VT: Torsades vs Generic
-Torsades is polymorph VT w/ long QTc
Tx: electrical cardioversion (or defib if machine can’t sync) + Mg load

-Generic: almost always due to cardiac ischemia
Tx: Electrical cardioversion if unstable + often will need cath

youtube.com/shorts/YmDve...
#EMIMCC

Lightning rounds 63: How to be right, with Scott Weingart – Critical Care Scenarios

One of the most important questions of our time... how should we learn medicine in 2026? Does anyone still read papers? When everybody sounds convincing, how do we decide which experts are right? What do we do with AI? Scott Weingart weighs in

icuscenarios.com/lightning-ro...

#medsky #emimcc

kudos to ACEP for calling out the Surviving Sepsis Campaign 2026 guidelines and not joining in this madness.

ACEP is great at making evidence-based policies that actually *help* provide better patient care.

When ACEP is politely burning your guideline, you’re in trouble. #EMIMCC

🎙️ New Podcast!
💉 IO lines: Power & Pitfalls in the ED
⚡ Fast, reliable access in arrest & shock
🧭 Site matters: Sternum > Humerus > Tibia
⚠️ Labs unreliable, dislodgement common
👉 Listen now: https://wp.me/pdrP8b-5ph
#EMIMCC #FOAMed #MedSky

Surviving Sepsis 2026 is here & it's even more loony tunes than I was expecting.

They're promoting pre-hospital ABX & preemptive broad-spectrum IV antibiotics for intubated patients.

This insane fever dream is an antimicrobial stewardship nightmare.

Embarrassment for SCCM. #EMIMCC

Standard Geometry Blade Laryngoscope Grip Tips:
1) Grasp near blade to improve mechanical advantage
2) “3 finger” grip to facilitate gentle blade placement and serial advancement
3) “5 finger” grip once blade tip in vallecula + ready to lift

youtube.com/shorts/opthv...
#EMIMCC

🔥Just published🔥
SSC 2026
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 : Critical Care Medicine #IDsky #EMIMCC @pulmcrit.bsky.social
share.google/NbagT9xMBTgk...

Can we please stop referring to lactate as a perfusion marker? It’s no more so and no better than blood pressure. #emimcc #cccsky

a close up of a statue of yoda from star wars holding a sword . ALT: a close up of a statue of yoda from star wars holding a sword .

In the management of hemodynamics, you may have a different opinion but you can't have a different physiology

#foamed #foamcc #emimcc

The Impact of Aboriginal Health Liaison Officers and Culturally Safe Strategies on ED Leave Events

doi.org/10.1111/1742...

#OpenAccess

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