Colin McCloskey

Our Darkest Hour. Our civilization (being civilized at all) will die if our military commits Trump's stated war crimes. Then we would become a terrorist state. An outlaw state. Stop this crime before it happens! To the military: it is your duty to disobey these orders!! open.substack.com/pub/paulkrugma…

La portada del @TheEconomist de esta semana lo dice todo: Trump borroso en primer plano, Xi Jinping nítido al fondo, sonriendo. El título: “Nunca interrumpas a tu enemigo cuando está cometiendo un error.” China no disparó un solo misil. No necesitó hacerlo. Mientras Trump quema 850 Tomahawks, destroza su credibilidad con la OTAN y manda marines a una isla que no sabe cómo sostener, Beijing toma notas, firma contratos y espera la cumbre de mayo para negociar con un Trump debilitado. Lo que nadie está diciendo en voz alta es que esta guerra no la ganó ni EUA ni Irán, la está ganando Xi Jinping sin moverse de su silla. China controla el 70% de los paneles solares, baterías y vehículos eléctricos del mundo. Con el petróleo a 119 dólares el barril, todo ese inventario se vuelve oro. Los países del Golfo van a reconstruir con contratos chinos. Los europeos que querían frenar la avalancha de importaciones de Beijing ahora tienen otras prioridades. Y Trump, desesperado por cerrar un trato que no puede cerrar, va a llegar a esa cumbre con Xi en una posición que él mismo describió en su propio libro como la peor posible: oliendo a necesidad. El Economist lo plantea con una brutalidad elegante: el Trump de 2026 está ignorando los consejos del Trump de 1987. Su libro decía que lo peor en una negociación es parecer desesperado. Pues bien, Irán ya olió la sangre. La aprobación de Trump está en -20%. El 62% de los americanos rechaza una guerra terrestre. Y mientras Washington se enreda solo, China observa, planea y avanza. No es que China esté ganando la guerra. Es que está ganando el siglo — y lo está haciendo mientras su rival se destruye solo.

#ECLS for post-cardiotomy acute right ventricular failure: 🔍 multicenter, international, study including > 2K adults, 2000 - 2020 🫀12% patients had aRVF, 88% other indication for ECLS; similar demographics aRVF group: ⚖️ had higher pre-operative right-sided cardiac dysfunction, including pre-existing RV and biventricular failure 🫀more frequently underwent TV surgery and aortic root procedures ⏱️required longer run and longer #ICU stay 🚧 had more complications, including non-surgical bleeding and persistent right heart failure; anyway in-hospital and long-term survival comparable Patients requiring ECLS for post-cardiotomy aRVF, despite higher pre-operative risks and complex clinical courses, achieve survival rates comparable to other indications patients. 🔗 bit.ly/4tho1DB

The pattern is clear: ✅ Impella 𝗺𝗮𝘆 help in 𝗘𝗦𝗧𝗔𝗕𝗟𝗜𝗦𝗛𝗘𝗗 cardiogenic shock (DanGer-SHOCK) ❌ Prophylactic/elective Impella in high-risk PCI: NO benefit, possible harm ❌ Impella in STEMI without shock: NO benefit, significant bleeding risk

Great schema! But beware that *any* time you see a diagram like this, it assumes the patient has one disease process. Our patients are increasingly multimorbid so: ⚠️May have >1 cause of hypoNa ⚠️Fixing one cause may cause dominant physiology to shift (playing wack-a-mol)

“They got money for war, but can’t feed the poor.”

Fresh blog: STRATIFY trial for PE Peripheral tPA infusion is EQUALLY EFFECTIVE as compared to ultrasound-assisted thrombolysis Catheter-directed thrombolysis for PE is dead We can get the same benefits with peripheral tPA infusions (w/o procedural costs & complications)...#1/2

this right here is the reason China stays quiet on Iran everyone losing their mind asking where is Beijing while the US & Israel are bombing a major chinese energy partner and the answer is so brutal in its simplicity that most analysts miss it completely, the empire is eating itself alive and China is already building the replacementt America just dragged the entire Middle East into a war for Israel & now Saudi arabia, UAE, kuwait & qatar are sitting in a room discussing pulling out of US contracts & canceling investment commitments the Gulf states, the literal foundation of the petrodollar, the system that has kept the US dollar as world reserve currency since 1974 actively discussing the exit and Beijing did absolutely nothing to make that happen…Washington did it to itself but here's what people miss: china saw this coming years ago and already laid the tracks, literally the belt & road Initiative has quietly wired 150 countries into c’hinese infrastructure, ports, railways, highways, fiber optic cables, power grids…while the western media barely covered it Saudi Arabia started selling oil to China in yuan in 2023, that alone should have been front page news for a month, the BRICS just expanded to include Saudi arabia UAE and Iran in the samea bloc, China built CIPS as a direct alternative to SWIFT so the entire non western world can settle trade without ever touching the dollar, every single one of these moves was made before a single bomb fell on Iran and then there's Africa…the youngest continent on earth, median age 19, projected to reach 2.5 billion people by 2050, the largest workforce the planet has ever seen & China understood 20y ago that whoever builds Africa's infrastructure owns the 21st century, while the US was spending 4 trillion dollars destroying Iraq & Afghanistan China was building railways in Kenya, dams in Ethiopia, ports in Djibouti, highways in Nigeria, tech hubs in Rwanda, stadiums, hospitals, government buildings, telecom networks powered by Huawei across the entire continent.. & they did it without firing a single bullet, no regime change, no sanctions, no lectures on democracy, just concrete steel, fiber optic and longterm contracts so when people ask why China stays silent on Iran the answer is that silence is the strategy, every war America fights for Israel costs trillions, destabilizes energy markets, alienates Gulf partners and pushes the entire Global South closer to a system Beijing spent two decades building the gulf states pivoting right now has zero to do with ideology, Washington turned their entire neighborhood into a warzone to serve Tel Aviv's regional strategy & then asked them to keep buying treasury bonds with a straight face….the math just stopped working and when the math stops working loyalty stops too beijing's silencee on Iran is the most patient & most devastating move on the board, China is watching america dismantle its own hegemony in real time while quietly inheriting every alliance washington burns, it just has to keep building & keep quiet Napoleon said nver interrupt your enemy when he is making a mistake, Xi turned that into a 50y doctrine & right now it's paying off faster than even beijing expected

PS, It’s a difficult and painful realization that major societies often produce bad guidelines. As learners we used these guidelines as bedrock truth to help us grow. But the time comes to move on. learning medicine experienced doc believes guidelines realizes truth

Do you feed ICU patients on vasopressors? Evidence says it can be safe—and lifesaving when patients are adequately resuscitated. 🆕 New paper online today in @SurgicalClinics Key points 👇 • Vasopressors ≠ automatic contraindication to enteral nutrition • Dose, stability, and trends matter more than presence alone • Early trophic EN is reasonable once resuscitated • Close monitoring for intolerance is essential • PN remains critical when EN isn’t safe or feasible Not “feed everyone early” ❌ Feed the right patient, at the right time, the right way ✅ How do you approach feeding patients on pressors in your ICU? Protocol-driven or individualized? Read the full paper: authors.elsevier.com/a/1mate90QZ7Iga #ICUNutrition #FOAMcc #ICURehab #Dietitian #CriticalCare #SCCMSoMe

LENTZ EQUATION 🔥PEEP = BMI/3🔥 🙅‍♂️Stop under-PEEPing patients with high BMI 🙅‍♂️Stop trying to wean everyone down to a PEEP of 5 Patients with high BMI often need high PEEP as long as they are intubated & can be extubated *directly* off high levels of PEEP 😁

Remember when the troponin and BNP were going to be game changers for heart disease? #tropomania

Greatest academic medicine lie ever told: "...I have limited access to email"

Establishing expert consensus for psychomotor competency in percutaneous #ECMO cannulation: 🔍 modified Delphi study involving 32 experts in #ECLS management and percutaneous cannulation, representing 15 countries from 6 continents and 8 medical subspecialities as panelists 📋 consensus achieved for 77 unique core psychomotor skills and resource allocation steps for inclusion in a percutaneous cannulation (and related procedures) curriculum @JCardFail 🖇️ bit.ly/3MmJ3RJ Coming with editorial: ECMO cannulation training, a step forward in establishing essential safe practices 🖇️ bit.ly/4083Prg

ECPR patients are fundamentally DIFFERENT from other cardiac arrest patients! Listen to Ingrid Magnet and Michael Poppe tell about the data on reason why this is. edecmo.org/edecmo-102-ecp…

Expert recommendations for setting and adjusting airway pressure release ventilation based on clinical experience and basic science evidence CCR Journal Watch  criticalcarereviews.com/latest-evidenc…

Anyone justifying a woman being thrown to the ground like that by a man needs to be investigated‼️

If they call me a domestic terrorist, it is a badge of honor By Michael F. Dubois

2025 @ELSOOrg Consensus statement for provision & management of nutrition therapy in critically ill adult patients requiring #ECMO: 🍽️ should dietitians be included as part of critical care multidisciplinary team managing patients in #ECLS? 🍽️ should all patients receiving ECMO - receive nutrition assessment? - be considered for medical nutrition therapy - receive early EN? 🍽️ should GI intolerance be managed? 🍽️ under what circumstances should PN be used? 🍽️ how should - energy/protein targets be calculated & what dose should be achieved - non ventilated patients be managed? @asaiojournal 🔓 bit.ly/45BLRkq

Central lines placed under ultrasound guidance had the fewest complications when the subclavian vein was used, an observational study found. Read the context and comment from Michael E. Billington, MD: jwat.ch/3LBnYCr