The Once-Conventional 48-h Elective #Cardioversion Threshold for “Recent-Onset” #AtrialFibrillation Is No Longer Recommended
doi.org/10.1111/1742...
@wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM
@emajournal.bsky.social
@emajournal.bsky.socialThe Once-Conventional 48-h Elective #Cardioversion Threshold for “Recent-Onset” #AtrialFibrillation Is No Longer Recommended
doi.org/10.1111/1742...
@wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM
@emajournal.bsky.socialIntranasal #Dexmedetomidine for ED paediatric #ProceduralSedation
@wileyhealth.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM
@emajournal.bsky.social
@emswami.bsky.socialYEARS Algorithm in Active Cancer (PMID: 42437322)
-YEARS: If “No” to clinical signs of DVT, hemoptysis + PE, can double d-dimer upper limit
-RCT 700 patients w/ cancer showed 1.8% miss rate w/ YEARS (same as standard group)
-Potential reduced CTPA rate by 22%
@rebel-em.bsky.social🚨 New REBEL Core Cast! Ep 138: A Simple Bedside Approach to Shock💥 Start with the 4 L’s: Lucid, Limbs, Leak, Lactate
Pulse pressure = your shock type cheat code
🎧 Listen now: https://loom.ly/ntey1VU
#FOAMed #EMIMCC #MedSky
@load-dependent.eurosky.socialpH and lactate as predctors of survival in ECPR. Statiatically significant, clinically useless. Plus c’est grave, plus c’est grave #emimcc #cccsky www.sciencedirect.com/science/arti...
@emswami.bsky.socialLet’s Play Right Drug, Wrong Dose:
-Rocuronium
Wrong dose: 0.6 mg/kg
Right dose: 1.2 mg/kg (paralysis onset less than 60 sec)
-Epinephrine in Anaphylaxis
Wrong dose: 0.3 - 0.5 mg IM
Right dose: 0.5 mg IM - simplify decision in critical scenario
@imcrit.bsky.social@emswami.bsky.socialDo bougies incr risk of airway injury?
-Poor technique/blind placement of a bougie can cause airway injuries. Same is true of ETT + rigid stylets
-RCT data (PMID: 29800096 + 34879143): 2000 patients, no airway injuries
@imcrit.bsky.socialYour regularly scheduled reminder:
If you were on call Saturday night, Sunday is not a “day off.”
It’s a recovery day disguised as a day off.
Don’t be gaslit.
@load-dependent.eurosky.socialCorrelated, fluids are not good palliative care. If the patient is not a candidate for pressors and/or higher level care, volume is not less aggressive therapy, often rather more and can cause discomfort. #emimcc #crticaresky
@imcrit.bsky.social@emajournal.bsky.social
@emajournal.bsky.social
@emswami.bsky.socialBrisk trach bleeding = tracheoinnominate fistula
Initial Management
-Call vascular/CT surgery
-Overinflate trach balloon to tamponade innominate (works 85% of time)
-Intubate from above, remove trach + place finger into stoma to compress innominate anteriorly
@rebel-em.bsky.social🚨 Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
@emajournal.bsky.social
@load-dependent.eurosky.socialYou cannot assess safety nor efficacy in a single arm observational trial! I don't know how these things pass editorial and peer review. #emimcc #critcaresky #cccsky #cardiosky journal.chestnet.org/article/S001...
@rebel-em.bsky.social🦠 Sepsis antibiotics: Is 7 days enough?
The BALANCE Trial says yes
⚠️ But watch for spectrum & selection bias
💡 7d may work for most, but not all
📖Read full post here: https://loom.ly/rnrHxg8
#FOAMed #MedSky #EMIMCC
@emswami.bsky.socialAortic Dissection Management
Rally Consultants: CT surg, Cards, Vascular, IR
POCUS for tamponade
Anti-impulse therapy
-Analgesia 1st
-Anti-tachy tx: esmolol bolus + infusion w/ target HR 50-60
-AntiHTN tx: clevidipine/nicardipine w/ target SBP ~ 90-100 mm Hg