#emimcc — Public Fediverse posts
Live and recent posts from across the Fediverse tagged #emimcc, aggregated by home.social.
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Never seen it. I joke that for each decaden of practice, you can drain 250ml more and hour. Once by accident drained 3l in an hour, patient was so satisified😅 #emimcc
RE: https://bsky.app/profile/did:plc:23kyc35kxpg4b3fmejeicxm4/post/3mlvhdwvdmk2d -
RCTs have shown no benefit from IABP in acute ischemic cardiogenic shock, an observatiobal trial isn’t even hypothesis generating. No grounds for new IABP trials in this population in my opinion. #cardiosky #cccsky #emimcc
Intra-aortic balloon pump vers... -
Agree with this
All formulae for corrected calcium are imperfect
Just measure ionized calcium
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Agree with this All formulae for corrected calcium are imperfect Just measure ionized calcium pubmed.ncbi.nlm.nih.gov/42035248/ #EMIMCC
Albumin-adjusted ("corrected")... -
Observational studies suggests higher mortality but lower thrombosis risk with VKA vs DOACs in CTEPH. What do people do? Personally I want a trial before switching to DOACs as standard of care here #emimcc #cardiosky
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Bayesian reanalysis can be a great way to assess a contested trial, by showing how strong a prior you need to nullify or inverse the results. I don't understand why they did not include a pessimistic prior here though (even as I see a sceptical one more realistic). #emimcc #cardiosky #cccsky #stats
RE: https://bsky.app/profile/did:plc:77cp7kgakti2uthqnkkdaqum/post/3mkpw474mis2q -
REBOARREST by friends and colleagues is out! No benefit of Reboa in non-traumatic OOHCA #cardiosky #emimcc #critcaresky link.springer.com/article/10.1...
Prehospital resuscitative endo... -
Single arm pulmonary embolism intervention studies are useless for anything than assessing adverse events, perhaps even more so than the registry studies. Just look at the discrepancy in mortality between RCTs and observational data without inclusion criteria. #emimcc #cardiosky
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Good example that diastolic flattening is much more common than systolic in acute PE. #echosky #emimcc #pocusky
RE: https://bsky.app/profile/did:plc:ypl3l3efpmvo25klknwnoevj/post/3mk65dbbkfc2r -
Do PPIs cause kidney damage? Read an update at the bottom of our summary www.nephjc.com/news/compass... #MedSky #NephSky #EMIMCC
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Cool study - an amp of sodium bicarbonate (50 ml 8.4%) raises sodium similar to a boils of 3% - as expected of course!
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In heterogeneous syndromes like ARDS and sepsis, I believe we generally are more likely to be able to find what causes iatrogenic harm than actual therapies. #emimcc #critcaresky
RE: https://bsky.app/profile/did:plc:q5ogl3twkcqyhvz4zebonw3z/post/3migjy6ta5z2u -
Precision medicine in sepsis = correct antimicrobial coverage, source control and tailored haemodynamic support. #emimcc
RE: https://bsky.app/profile/did:plc:u6ai4u2rvrdb5xjk62y2jpci/post/3mjflldtrf52m -
In a patient with high-risk pulmonary embolism, but no sign of hypoperfusion, would you start LMWH or UFH? #emimcc #cardisky #cccsky #critcaresky
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On the other hand, if you use PICCO just to get the ABP value, you may become wiser #emimcc
RE: https://bsky.app/profile/did:plc:pdj5upxe4ocjvjltlkdai7b4/post/3miyx7rlbyc2r -
TIGRIS, the new Xigris? #emimcc
RE: https://bsky.app/profile/did:plc:mciolqc63d6o6pveql6t6s2t/post/3mhycedhdyk22 -
The most dangerous thing you can have is a non-septic shock misclassified as septic shock. #emimcc
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One point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working: Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number! #emimcc #cccsky
RE: https://bsky.app/profile/did:plc:vmwckmxogx3lipqxlmn76mbe/post/3mh67jqfw3z2h -
The end of the road for rivaroxaban? Shows how important direct comparative trials among drugs within the same pharmacologic class are. #emimcc #cardiosky www.nejm.org/doi/full/10....
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One thing that strikes me from these guidelines (which do have many good parts) is how many of the interventions have strong Ia recommendations based on purely observational evidence. Putting the cart before the horse #emimcc #cardiosky
RE: https://bsky.app/profile/did:plc:pdj5upxe4ocjvjltlkdai7b4/post/3mfi3rdpwyc2t -
You have a patient with a subclavian CVC, and you discover a large clot on it. You start anticoagulation of course, but when do you dare remove it? Will you wait until the clot is resolved? #emimcc #critcaresky #ansky
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Another trial!
Albumin 20% for septic shock
Does not work - JAMA NO
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2845268
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Another trial! Albumin 20% for septic shock Does not work - JAMA NO jamanetwork.com/journals/jam... #EMIMCC
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What is worse, digital ischemia or atrial fibrillation? #emimcc #cccsky link.springer.com/article/10.1...
Vasopressin in septic shock: a... -
as a pedant, it's chloride depletion alkalosis and not contraction alkalosis (pendrin etc), right? and proactively fixing potassium is so much better - I find amiloride is underused (start when K is ~ 4?) while diuresing? #EMIMCC
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There are few absolute rules in medicine but «never treat sinus tachycardia, treat the cause» has extremely few exceptions. #emimcc #cardiosky #medsky
RE: https://bsky.app/profile/did:plc:kgfqlfzek5twmq7ahzc5ws46/post/3megnwoheqs2q -
funny retraction in @[email protected] journal ICM link.springer.com/article/10.1... LLM made real citations into fake ones? 😂 (dunno what the editors mean by improper peer review) #emimcc #AIinMedicine #AISlop
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To write a "state-of-the-art review" of diastolic dysfunction in acute and critical illness with an emphasis on SGLT2-inhibition and not mention the DEFENDER trial is quite something. #cardisky #emimcc #cccsky www.jacc.org/doi/10.1016/...
Diastolic Dysfunction in Acute... -
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Wow - excellent discussion of the totally underwhelming BICAR-ICU2 trial podcasts.apple.com/ca/podcast/f... @[email protected] fighting a line fight against the unimpressed nephrons with guest @[email protected] #NephSky #EMIMCC
FF 88 BICARICU-2, Bicarbonate ... -
Levosimendan is quite often seen as a "safe" inodilator with respect to ventricular arrhythmias. I don't think it is, and this trial in my view supports that. Also, drugs with very long half lives are generally not a good idea in the critically ill #cardiosky #emimcc #cccsky
Levosimendan to Facilitate Wea... -
New results from DanGer Shock ,shows it's those with the lower systolic pressure (the sicker patients) that benefit from Impella. #emimcc #cardiosky #cccsky jamanetwork.com/journals/jam...
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One of my strong pet peeves: never start vasopressin based on a fixed cutoff for noradrenaline and never without an echo. I strongly oppose the algorithm proposed here #emimcc #cccsky
RE: https://bsky.app/profile/did:plc:oaaejshh5ta7u2zzmczevuyi/post/3m5hfnacyps2y -
Fascinating paper suggesting the assumption that there is a sigmoid dose response relationship and threshold effect ( "all-or-nothing") for loop diuretics rests on repeated misinterpretation of original studies from the 70s and 80s. #nephsky #cardiosky #emimcc academic.oup.com/ehjcvp/artic...
What are the pharmacodynamics ... -
Hypokalemia caused by loop diuretics, I wonder if chloride loss and ensuing metabolic alkalosis is more important than potassium loss itself? #cardiosky #nephsky #emimcc
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Reupping this question as I’m seeing the same, often because it is assumed to be better tolerated hemodynamically (myth?). #cardiosky #emimcc #kidneysky
RE: https://bsky.app/profile/did:plc:kibuncmmpq2nfezzxd22ircj/post/3ljzxz4q6rk2s -
Likewise, low blood pressure is a reliable sign of shock and malperfusion in sepsis/distributive shock, but not in other, especially cardiogenic shock. #emimcc #cccsky
RE: https://bsky.app/profile/did:plc:kgfqlfzek5twmq7ahzc5ws46/post/3m2pk6yahlk23 -
Is it really true that LUS predicts worsening renal function, while measures of venous congestion and right heart function do not? Unlikely. Rather, this is a good teaching example of P-fracking and unfair competition. Follow for my thoughts 👇 #pocusky #cardiosky #emimcc
RE: https://bsky.app/profile/did:plc:k44cfm5gdmshrleo3aghl2ko/post/3lyx7q5pdmc2h -
Granted, few patients where still available after 4 years, but still odd to have 0 mortality from 4 to 10 years in a population that has had cardiogneic shock #cccsky #cardiosky #emimcc
RE: https://bsky.app/profile/did:plc:pqur3apsmhyw756zvruofulp/post/3lxp2qv4ttc2c -
Extremely striking difference in utilisation of Impella in the US vs UK and Canada. #cardiosky #cccsky #emimcc jamanetwork.com/journals/jam...
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Great thread! The one thing I will disagree on is the value of EF. It is misused and misunderstood but far from useless. It is a measure of ventriculoarterial coupling and used in conjunction with stroke volume truly informstive of the balamce between LV function and afterload. #emimcc #cccsky
RE: https://bsky.app/profile/did:plc:pdj5upxe4ocjvjltlkdai7b4/post/3lwjyglqvrc2l -
The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc