JD Landon, MD

These guys are legends! Very cool YouTube Channel.

@SayedAhmad_MD @djarlarnbah @ross_prager @ResusTEEproject The resusTEE protocols are typically only 4 limited views, not comprehensive. Minimal complications have been reported. Credentialing for limited use is often not an issue and easy to get proctored exams during routine elective procedures.

@djarlarnbah @ross_prager I am not aware of routine TEE use in post arrest in the United States . It would be difficult to implement as only cardiologists , some anesthesiologists and very few intensivists are trained to perform TEEs.

A patient brought into the ED with out of hospital cardiac arrest and 30 minutes of CPR. You drop the TEE probe and see this. What's the finding and what would you do?

2025 Intubation guideline and the education package das.uk.com/new-das-2025-i…

A simplified ANDROMEDA- SHOCK-2 algorithm display by Jesus Nieves from Spain! As he said complex at first glance but quite easy when practicing!! Thanks Jesus😍😍

Amazing work by these centers and teams!

@nickmmark I love this comment. After tramadol, my biggest pet peeve in the ED is Norco and Percocet. Makes little sense to mix these meds.

Honestly if the FDA wanted to do something beneficial with acetaminophen they would outlaw combination products with it, limit package size, & mandate packaging in blister packs. They did this in the UK and it reduced deaths from Tylenol overdose by 22% pmc.ncbi.nlm.nih.gov/articles/PMC31…

As a new Emergency Medicine attending 10 years ago I was asked to write about my insights into what it's like to be an ER Doctor. I just randomly came across it and after all these years I'm amazed by how much this all still rings true in my heart today. So I wanted to share it with you guys. Here's what I wrote: MAKE THINGS HAPPEN, SAVE LIVES, ALLEVIATE SUFFERING My Emergency Department is a battlefield. Volumes are high and the pace is fast. To succeed as an Emergency Physician I must be an expert of efficiency. I also must be an expert of triage. I am constantly triaging and re-triaging as things evolve. The ED is highly unpredictable. My entire shift I am on guard and ready for any emergency to come flying through the doors at any moment. In the meantime I am either taking care of or seeking out other emergencies. My job is not to be expert in all of medicine. My job is to be jack of all trades and master of diagnosing and treating what can and will kill you. If I cannot provide the definitive care you need, my job does not end until I have gotten you there. The more I practice Emergency Medicine, the more I realize that what I do more than anything else is - make things happen. Cliff Reid (@cliffreid) delivered an excellent SMACC talk on making things happen in the resuscitation bay. (If you haven’t yet heard it I recommend you do). I’ve come to realize that this concept extends beyond the resus bay and pervades all aspects of my job. So what does it mean to make things happen? Making things happen means putting my visions of what needs to happen into motion and making them reality. In order to make things happen, I must first appreciate that my ED is equipped with an army of highly skilled staff that are the heart and soul of the department – and that without them I could make very little happen. Making things happen means identifying a sick patient and getting them quickly moved to a critical bed; it means getting my suspected head bleed patient expeditiously to the CT scanner with least possible delay; it means mobilizing help to intervene on my flash pulmonary edema patient in hypertensive crisis and getting her on CPAP & Nitro immediately to pull her out of the water and prevent intubation; it means convincing my adamant patient who is ready to walk out the door but is clearly not well enough to go home not to sign out against medical advice, but rather to stay in the hospital where he/she is safe and taken care of; making things happen means advocating for my patients and convincing my consultants to take them emergently to the cath lab or operating room at 3 AM when it otherwise would not have happened until morning. Making things happen means constantly thinking two steps ahead. Making things happen is an art. I have learned that to excel in Emergency Medicine I must master the art of making things happen. If my goal is to save lives, I must first recognize that a life needs to be saved – that is, I must be an expert at diagnosing life-threatening processes. The 75-year-old clutching his chest with tombstones on his ECG – that’s easy. The problem is that most of my patients are not truly sick. Some are here because they are afraid that they are sick, and just need reassurance. Some are here just for pain medications. Most of my patients are undifferentiated. Sickness is a spectrum. Truly sick patients often look sick, but often they do not. I must be expert at sifting through the crowd and identifying which patients are harboring a life-threatening diagnosis. This is not always an easy task, but it’s up to me to figure it out. It’s my job to figure out that the 45-year-old gentleman who looks comfortable sitting up in bed watching television and texting on his phone has a Type A Aortic Dissection. If I simply get two sets of cardiac enzymes, repeat an ECG and discharge him home since these are normal – there is a good chance he will die. It’s my job to figure out that the 60-year-old lady with chest pain who was transferred to me for “NSTEMI” actually has a huge saddle pulmonary embolus. It’s not enough to just admit her to the hospital floor only for her to sit up there, decompensate, and have a bad outcome. I have to do better than that. In the Emergency Department, there are landmines scattered everywhere. It’s my job to find the landmines. I can’t talk about saving lives without talking about Resuscitation. This is an entire topic in and of itself and I could write all day about it – but I won’t do that here. I will simply say that if I want to save lives, I must be an expert at Resuscitation. I believe that as an Emergency Physician, if I am not expert at Resuscitation – my purpose is lost and my mission is in vain. Resuscitation encapsulates those moments that matter most; the moments that often determine my patients’ fates, and define Emergency Medicine as a specialty. Resuscitation is the essence of Emergency Medicine. In the end, Emergency Medicine is all about the patients. While patients are under my care, I consider them family. When I walk into a room, I shake hands with each patient and all their friends and family members who have come to support them. I look my patients in the eyes. I listen to them. I try my best to put myself in their shoes and empathize with them. I know that communication is vital and I make sure we are on the same page, and that all of their questions have been answered. I make a point to ensure that they know to let me know if they need anything. If my patients are not comfortable, I am not comfortable. Some humble advice I have to offer for success in Emergency Medicine: 1. Never stop learning. There’s too much out there to know, and knowledge is the foundation for the care we provide. Your eyes won’t see what your mind doesn’t know. Never get complacent in your knowledge. 2. Trust your instincts. Gestalt is at the heart of what we do. Without it we are merely computers and robots. Gestalt trumps any clinical decision rule any day. Even if you don’t know exactly what’s wrong with your patient, but you have a feeling something bad is going on – trust it and pursue it. 3. Be decisive. I’ve seen too many times patients crash while “decisions were being made”. If you choose not to intervene that’s fine, but not intervening should never be the default decision, as a result of indecision. That is unacceptable. First do no harm, does not mean do nothing. Don’t fall victim to being more comfortable with the devil you know than the devil you don’t. Understand that sometimes not taking a risk can be extremely risky. 4. Learn to control your mind in stressful situations. Adrenalinization is normal. While it’s a natural reaction and will enhance your performance, too much will impair your thought process and technical skills. Learn to recognize when you’re becoming over-adrenalized, and learn whatever it is that works for you to be able to relax, stay calm, and temper your sympathetics. 5. Be cognizant of human factors. So much of what we do is psychological. Be aware of your susceptibility to cognitive bias. The key to conquering cognitive errors is to be aware of their existence. 6. Debrief after codes or tough cases and take time to reflect back after shifts. I do this routinely and I find it to be invaluable. Some of the greatest things I have picked up on have been via this process. 7. Learn Emergency Ultrasound.Believe me when I tell you that Emergency Ultrasound will transcend your practice. If you don’t learn EM ultrasound, at least learn the critical care stuff. If you don’t learn the critical care stuff, at least learn basic Echo – it has the greatest impact. 8. Follow up on your patients. I can’t express how much of my learning is through following up on my patients. If you don’t do it already – start! You will be amazed by how much you will learn. 9. Accept and embrace that some of your patients will have bad outcomes or die no matter what you do – but never, ever let this be an excuse to provide anything less than the best care you possibly can. 10. Be kind and compassionate. When it’s all said and done our patients may not remember details of their ED stay during what might very well have been the worst day of their lives – but they will remember how we made them feel.

Another publication demonstrating the cost effectiveness of ECPR. Lots of heterogeneity but this demonstrates ECPR is the future of OHCA for selected patients. Requires strength, leadership and the pursuit of better outcomes for patients to deliver resuscitationjournal.com/article/S0300-…

@ThinkingCC @IM_Crit_ Similar stories at my shop.

@IM_Crit_ These are the ones I lose sleep over. Knowing it’s people behind a desk, preventing me from giving them a fighting chance. Makes me sick.

My current project. So much resistance, so much inertia. A lot of large fragile egos involved. preprints.org/manuscript/202…

@DanielJafari @ThinkingCC @HofstraU @ZuckerSoM @ResusJournal @NSLIJ_EM @Northwell_EM Love that paper. It’s what I teach our residents.

@emdocjd @ThinkingCC @HofstraU @ZuckerSoM @ResusJournal @NSLIJ_EM @Northwell_EM It's not evidence based by if SBP is <60 I treat it as non perfusing and do a round of comprehension and start epi/norepi drip. We studied the Doppler PSV and found it to correlate well with SBP share.google/qLcltjbsinlwgU…

Arterial line placement during cardiac arrest in Emergency Department is feasible and highly successful! Very proud of our star MS1 @HofstraU @ZuckerSoM Michelle Akerman, leading author on our letter to editor @ResusJournal reporting our experience @NSLIJ_EM @Northwell_EM

A lines in cardiac arrest… feasible and helpful. Why not guide your resus with precision rather than guesswork!

@ThinkingCC @DanielJafari @HofstraU @ZuckerSoM @ResusJournal @NSLIJ_EM @Northwell_EM Do you guys have a threshold A line SBP/DBP that you target for so called “pseudo-PEA” for when to continue compressions or withhold?

@DanielJafari @HofstraU @ZuckerSoM @ResusJournal @NSLIJ_EM @Northwell_EM Absolutely. We’ve been doing this for years, it offers the need for pulse checks, and enables a lot more granularity, and also raises questions as to what thresholds one should use for chest compressions when there is cardiac activity.

(0/5) Here are five of the commonest cognitive traps in medicine (and forcing strategies to avoid each)👇

If you are doing literature searches and systematic reviews, below are 10 AI tools that can help automate this process 👇 Most of them have free plans to try them out.

Let’s go !! @EVMSEM #Sonogames25 @EVMSedu #saem2025

This needs to happen!

🚨New study of pre-hospital #TEE in cardiac arrest. ~90% of CPR pre-TEE was in the wrong place! (not over the LV) Study Overview: Retrospective. OHCA. Performed by specialist MDs in Australia. N = 19 (small). Results: 1) Changed management or confirmed diagnosis in 17/19 2) Improved CPR location in 13/17 pts. 3) 17/19 patients CPR was not over LV. TEE resulted in improved location of CPR being performed (see figure below!) This is the sort of innovation we need in pre-hospital CPR. Huge hats off to the authors. Now question is how to scale to more providers (through technology, education, or other). @EM_RESUS @EMCases @IM_Crit_

TEE in Cardiac Arrest in the prehospital world. It is feasible. It will save lives.

Incorporation of prehospital TOE in cardiac arrest resuscitation is feasible. Identifying the area of maximal compression early in the resuscitation may improve OHCA outcome and aid in the ECPR decision making tree. Larger trials are needed #resuscitation #OHCA #ECPR #prehospital

Take home messages on neuroprognostication after cardiac arrest from #ISICEM25 @ISICEM