@emswami.bsky.socialCalcium doesn’t stabilize cardiac myocytes in hyperK
-Ca restores Ca dependent propagation
-Doesn’t matter clinically as Ca2+ will reverse hyperK induced ECG changes
-Ca2+ is still the treatment of choice in hyperK w/ significant ECG changes like QRS widening
@load-dependent.eurosky.socialI think this is turned upside down. There’s no reason to think the single center studies are credible, and try to find out what went wrong in the multi-center studies. Rather, the question is how the single center studies could be so consistently wrong. #emimcc
![What is known
Tachycardia is a feature of compensatory sympathetic stimulation (9, 10]. Sustained non-compensatory tachycardia may impair diastolic function, increase myocardial workload, and worsen ventriculo-arterial coupling [12-14). The potential to attenuate adrenergic toxicity while simultaneously allowing a compensatory adr-energic response has generated interest in the role of B-blockers. However, clinical studies have produced conflicting results [15-21]. In two multicentre randomised controlled trials (RTs) in septic shock, landiolol was associated with either an increased norepinephrine requirement and mortality (STRESS-L) [20] or no significant difference in vasopressor dose or mortality (Landi-SEP) [18]. These findings contrast with single-centre studies in which esmolol therapy was associated with reduced catecholamine requirements, fewer episodes of tachyarrhythmias, and improved mortality despite a significantly greater reduction in systemic oxygen delivery compared to the control group [21].
A limitation in some multicentre studies may have been the limited use of advanced hemodynamic monitoring capable of identifying clinically significant reductions in cardiac output and oxygen delivery after heart rate reduction [21, 22]. Moreover, a reduction of myocardial contractility may occur, but can pass undetected by conventional echocardiographic parameters 22).](https://cdn.bsky.app/img/feed_fullsize/plain/did:plc:wl5zwdwkg4kqg25gtxbepfh4/bafkreieqzwz264c7xezcqtlkgkuxmmenw4wearv2irat7qacpvk5kw36ha@jpeg)
@olofl-s.bsky.social
@schistosomnia.bsky.social
@drghem.bsky.socialwww.annemergmed.com/article/S019...
Hey #cardiology
Time to adjust some euristics
#EMIMCC
@emswami.bsky.socialLaryngoscope Grip
-Proper technique makes lifting easy
-Choke up on handle (fingers as close to where handle meets blade as possible)
-2 Fingers on for placement then 3rd + 4th applied when lifting
-This technique uses mechanical advantage to make lifting easy
@emajournal.bsky.social
@emajournal.bsky.social#OutOfHospitalCardiacArrest presentations to the Victorian Heart Hospital
#OHCA
doi.org/10.1111/1742...
@wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM
@emswami.bsky.socialCalling a Good Consult
-Introduce yourself/be polite
-Start with the end: diagnosis/clinical question 1st to frame conversation
-Close the loop: make it clear what you want (admission, ED consultation, follow up)
@emajournal.bsky.social
@hswapnil.medsky.socialJosh @pulmcrit.bsky.social tackles ICU management of DAH incl ANCA vasculitis
On PLEX: yes that doesn’t help DAH at all
However, in some patients, it helps save a few months off dialysis - small effect
@rebel-em.bsky.social🚨Do We Need a CT for Every Renal Colic? 🪨
🧍♂️ Young w/ classic sx? No CT
🧓 Older or unclear dx? CT w/ contrast.
🔍 Use POCUS to guide imaging
Stop the scan-everyone approach.
👉 Read more: https://loom.ly/AMw_hY0
Written by: Dr. Abbas Husain
#FOAMed #EMIMCC #MedSky
@olofl-s.bsky.social
@emswami.bsky.socialRelative Adrenal Insufficiency
-Key point: consider this diagnosis in every patient presenting w/ shock
-Typically occurs in patients on low dose daily steroid
-Chronic steroid use suppresses intrinsic steroid synthesis.
-Tx: hydrocortisone 100 mg IV
@rebel-em.bsky.social🚨 New Post Alert!
🔥 Pancreatitis Severity Made Simple:
Ranson’s Criteria vs BISAP Score — which predicts mortality better?
🩸 Compare the classic 48-hr model with the bedside-friendly BISAP.
➡️ https://wp.me/pdrP8b-5rG
#MedSky #FOAMed #EMIMCC
@emswami.bsky.socialFluid Load in Severe Asthma
-Intubation + mech vent switches pt from negative to positive pressure vent ➡️ ⬆️ intrathoracic pressure + drops preload
-In severe asthma, huge insensible losses due to ⬆️ work of breathing
-Consider early fluid load to avoid HD decomp
@imcrit.bsky.social@schistosomnia.bsky.social@imcrit.bsky.socialWhich of the following is the most likely diagnosis?
A. Acute ischemic thromboembolic stroke
B. Cerebral arterial vasospasm
C. Focal partial seizures
D. Posterior reversible encephalopathy syn.drome
@rebel-em.bsky.social🚨 REBEL EM Gear Available! 🚨
Show your love with our I Love EBM—REBEL EM Heart Logo collection! 🎉 T-shirts, hoodies, mugs, and stickers—perfect for the EBM community! 🫁💥
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