From China, in @jama.com

Finally a role for dobutamine?

jamanetwork.com/journals/jam...

Adding dobutamine to norepi- in patients undergoing surgery for sepsis control periop reduces AKI 🤔

Very specific group to study!

#nephsky #emimcc

An 8 y old has fallen 3m from a tree straight on the abdomen. Complains of belly pain. Primary survey unremarkable otherwise. #POCUS shows a small amount of free fluid above the bladder. Surgeon wants a CT that doesn’t show source of bleeding. Patient did fine. CT really necessary? #EMIMCC

One final thought:
I wish we had more participation from Chinese clinicians/researchers on social media. China produces important clinical research; discussions like this would be better if the investigators themselves could join us. We are missing valuable perspectives.

#emimcc #FOAMed #FOAMcc

Apply pelvic binder indiscriminately in significant blunt trauma w/ HD instability

Don’t “rock the pelvis” - dislodges clots, increases bleeding + pain

Place binder on gurney + transfer pt directly from EMS stretcher onto binder. Reduces time to binder placement
youtube.com/shorts/aslSz...
#EMIMCC

Is immobilisation really the primary cause of post critical illness weakness? #emimcc #critcare

Severe Met Acidosis w/ Compensatory Resp Alkalosis
-Want to avoid intubating as vent can’t do as good a job compensating as pt can
-But, if pt tiring (either by gestalt, taking lower TV on NIV or rising CO2 on blood gas), time to step in + start mech vent

youtube.com/shorts/25GBz...
#EMIMCC

Lactate is NOT a specific marker of hypoperfusion since in most cases it is increased du to adrenergic stimulation and mitochondrial dysfunction, not tissue hypoxia. #emimcc

Patient on citrate CVVHDF. Raised tCa/iCa but not hypocalcaemia or acidotic. Do I need to worry?
#emimcc

I don’t think you need a team to decide the management for PE anymore than you need a team for myocardial infarction, on occasion you have the time and the case is complex enough for a heart team but that’s the exception. #emimcc #cardiosky

New Zealand National Poisons Centre consultations about antidotes to treat poisonings

doi.org/10.1111/1742...

#OpenAccess

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

Pain-Related Re-Presentation Following ED Discharge

doi.org/10.1111/1742...

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

ED Intubation for #Sepsis

doi.org/10.1111/1742...

#OpenAccess

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

Best way to improve outcomes in cardiac arrest is w/ early defib + high-quality CPR
-Key: max your compression fraction
-Poor defib coordination can eat at hands on time
-Precharging defib reduces hands off time + incr compression fraction ➡️ improved rate of ROSC

youtube.com/shorts/LmXvN...
#EMIMCC

Of course, a normal BP doesn't exclude ongoing bleeding or compensated shock. Context matters. But often, this is a gradual Hb drop that the body has had time to adapt to.

The Hb tells us how severe the anemia is. The patient tells us whether they need the ICU.

#FOAMcc #FOAMed #emimcc

Man in his 60s with ongoing chemotherapy is brought to the ED by ambulance for resp distress. Sat 92 % on 6L Ox, temp 38.2, BP 100/65, pulse 105. Treating phys thought sepsis, but one of my learners wanted #POCUS for diff diagnoses. It showed a clot in the right ventricle. So proud. #EMIMCC

Cremasteric Reflex in testicular torsion
-Sensitivity ranges from 21-100% (PMID: 40537283)
-Clearly, inadequate to rule out the diagnosis of torsion

youtube.com/shorts/_lB3m...
#EMIMCC

Optimal ETT Shape w/ standard geometry blade (DL or VL) is 25-35 degrees (PMID: 17079788)
-Straight to cuff w/ 25-35 degree angulation
-Anything beyond that increased the risk of difficult or impossible tube delivery

youtube.com/shorts/aDtpx...
#EMIMCC

Why the increased thrombotic events? Less use of antithrombotics/anticoagulants? #emimcc #critcaresky

🔟 The core ICU rule.

Treat the physiology, not the monitor prompt.

"Suction" tells us what the machine is feeling. It is our job is to figure out what is happening.

#emimcc #foamed #foamcc

An Embedded Low-Acuity Pathway Should Be Judged Beyond Throughput
#LetterToTheEditor

doi.org/10.1111/1742...

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