Daniel Negreanu

@NephroP @OrenFriedman Amazing answer, very clear. Thank you very much!

E/e’ correlates with mean LAP, which approximates the left ventricular pre–A-wave pressure in the absence of mitral stenosis. In contrast, LVEDP is typically slightly higher, as it reflects pressure after atrial contraction. Mean LAP represents the ambient pressure within the pulmonary venous circulation and is therefore more relevant when assessing the propensity for pulmonary edema, whereas LVEDP is better suited for evaluating left ventricular function. In addition, obtaining a reliable aortic regurgitation (AR) Doppler trace is not always feasible in practice. For these reasons, E/e’ tends to be more practical and clinically relevant in #POCUS settings.

#NephMadness #POCUS point of the day: You can estimate LVEDP on #echofirst using the aortic regurgitation jet. Measure the end-diastolic AR velocity on CW Doppler (right before QRS), then apply the modified Bernoulli: End-diastolic gradient = 4 × (AR velocity)² LVEDP = DBP - gradient As always with Doppler, this only works if the signal is clean and the Doppler cursor is well-aligned with the jet (sometimes apical 3-chamber view works better).

@NephroP @OrenFriedman Does it matter in your opinion that we are measuring slightly different things here? I.e. E/e' used to estimate *LAP* whereas your post using AR is estimating *LVEDP* ?

Both the E/e′ method and the aortic regurgitation method show moderate correlation with invasive filling pressures. In most practical settings, however, E/e′ is generally preferred. Based on what I could find, there do not appear to be any studies directly comparing the two methods. Also, E/e′ does not require the presence of aortic regurgitation, is less dependent on the accuracy of blood pressure measurement, and has been validated more extensively across a broader range of patient populations.

@aribindi @allisonoconn @SR_DeshpandeMD In Judaism, there is a principle called “Pikuach Nefesh” whereby preserving human life takes precedence over almost all other religious commandments. So this probably doesn’t matter.

@allisonoconn @SR_DeshpandeMD Jews also object to pork, some Hindus and Jains object to any animal, and many atheists are vegan and have strict moral views against using animal products. Why are you saying to ask Muslims instead of everyone?

Today my co-fellow @SR_DeshpandeMD taught me that since all heparin products are porcine-derived, all Muslim patients should be asked about/informed about heparin products prior to their use! Make sure you ask before starting that dvt prophylaxis!

@PulmCrit Fair enough!

@DanielNegz this does save them the work of having to come back and take another x-ray so it’s not the worst thing for them 🤷‍♂️

pro tip for swan insertion: 1) stat CXR 2) kindly ask Xray tech to leave the Xray plate behind the patient 3) shoot a film, eval swan position immediately on portable Xray machine 4) if malpositioned, reposition immediately and re-shoot CXR 5) repeat #3-4 til well positioned

@ThinkingCC Don’t just do something, stand there!

I think there are two important aspects where this is so true. The first is when to stop altogether, understandably, difficult, the second is when to stop aggressive, resuscitation, and just let time and the body continue the work.

@khaycock2 @ThinkingCC @PulmCrit @EMNerd_ @DoctorDaxon Got it, thank you. 🙏

@DanielNegz @ThinkingCC @PulmCrit @EMNerd_ @DoctorDaxon Yes PAT. To clarify, it doesn’t get shorter with a sudden decrease in PVR, what I meant is that it’s shorter than expected when you first measure it indicating more of an acute rather than chronic PH

thoracentesis as a pulmonary vasodilator 👀 if a substantial volume of lung is compressed/atelectatic due to an effusion, drainage may recruit that lung tissue, thereby reducing pulmonary vascular resistance

@khaycock2 @ThinkingCC @PulmCrit @EMNerd_ @DoctorDaxon By peak systolic velocity occurring sooner are you referring to the PAT? Why would that be shorter / occur sooner with sudden decrease in PVR?

@ThinkingCC @PulmCrit @EMNerd_ @DoctorDaxon Yeah it’s true. I think I do have one documented specific case of RVOT VTI notching turning into a non-notched VTI albeit with the peak systolic velocity occurring sooner than it should. All kinds of interesting things are happening if you just look.

To any health care institution or headhunter seeking world-class physicians and surgeons, the Quebec legistlature has passed a new special law severly impacting the civil and professional liberties of medical practitioners in our province, where average remuneration was already one of the lowest in North America, in a jursidiction with one of the highest tax rates in the world. You now have the opportunity to recruit top medical talent to your institution! Quebec medical professionals are accustomed to working in a resource limited setting, in high-volume practices for discounted rates. Now's your chance to recruit and you can thank @cdube_sante, @francoislegault and the @coalitionavenir for this health care fire sale!

@J_Equiza @neurocritical @TheNeuro_MNI @mcgillu Congratulations Jon!

Pleased to share our work at the @neurocritical Care Society Annual Meeting, reporting the largest cohort to date supporting lumbar drainage as an adjuvant therapy for severe bacterial meningitis. @TheNeuro_MNI @mcgillu #NCS2025

@J_Equiza @TheNeuro_MNI You will be missed Jon! Thanks for all your teaching on my MNI rotation!

It's been an absolute privilege to learn, train and work at the @TheNeuro_MNI ICU alongside an amazing team of professionals and human beings! Thank you for making me feel like home since the first day and for making everyday such an enjoyable experience! Forever grateful!

@DrToddLee @OFIDJournal Out of curiosity, do you know what our ED BCC rates are at MUHC?

@OFIDJournal This seems like a low cost high value recommendation if you use inexpensive diversion tubes. Or just draw the chem7 the patient is probably getting that day first. Also - I wish our contamination rates were only 2.9% :) I wish ours were even <5% in acute care areas.

Prospective Trial of a Passive Diversion Device to Reduce Blood Culture Contamination ✅ Just Accepted 🔗 bit.ly/3PjsbZS

@KiranRikhraj Great video Kiran! Very clear explanation

Oh Diastology. Trying to master the E, A and e' waves were the bane of my existence during fellowship. I've condensed their explanations in the video below to help you ace your echo exam. Please give it a watch! youtube.com/watch?v=bsAs20…

Surprising result: LLMs *did not* perform that well on this year's advent of code. More detail in my latest post 👇 jerpint.io/blog/advent-of…

Bedside assessment of left atrial pressure in critical care: a multifaceted gem. 🔗 Crit Care 26, 247 (2022). doi 10.1186/s13054-022-04115-9 #POCUS #FOAMed #FOAMcc

Presented at #CCCF2024: In the BALANCE randomized clinical trial, patients with bacteremia were assigned to 7 or 14 days of appropriate antimicrobial therapy, and 7 days of therapy was found to be noninferior to 14 days. Full trial results: nej.md/3Z5bTJD

@ThinkingCC @ross_prager @john_basmaji @KiranRikhraj Was there. Definitely did not sit well with the audience based on how chatty we were after the talk. No mention of fluid tolerance/intolerance 🤯

Just heard that at canadian ICU fellows’s meeting at CCCF were taught to - regardless of pt conditions, and in a pneumonia pt on hfnc, to go for 30ml/kg, followed by an FR strategy (🤦🏻‍♂️) and if FR, 2l more… @ross_prager @john_basmaji @KiranRikhraj u have some work to do!!!

I'm prescribing everyone a regular diet without restrictions on carbohydrates or sodium.

La création d'une association dédiée aux médecins spécialisés en soins intensifs au Québec représente un pas important vers la valorisation et la promotion de leur expertise unique. #Expertise #MedInterne @FMSQ

Great thread !