IMCrit

Nurse: Hey doc, can we feed this patient? He is npo for 5 days. Now on levo 0.2 mcg/kg/min Phil: Please let me know the capillary refill time, mottling score & diastolic BP. I will also perform a quick vascular occlusion test & decide Nurse: Let's wait another day @khaycock2 😂

In this retrospective cohort study, dexmedetomidine (DEX) exposure was associated w a HIGHER risk of clinically significant supraventricular tachycardia. Interesting, because I have used DEX thousands of times & I never recall this phenomenon (it happens only after stopping it)🤷‍♂️

@ThinkingCC @omarkandah Stay tuned…

@omarkandah @IM_Crit_ Yup ax is good

#CPR: EMS placing an arterial line (under US guidance) during CPR to guide resuscitation is a gangster move! Respect! #foamed #foamcc #meded #medtwitter

#foamed #foamcc #meded #medtwitter

@ThinkingCC I don't remember when it was the last time that in a really sick one, I went for a radial art line... 😉

@IM_Crit_ Absolutely! But especially in a high vasopressor situation, I would definitely want to be going Femoral.

A lot of clinical pearls here...

Five big ideas to improve the care of the critically ill patient (by Derek Angus) #foamed #foamcc #meded #medtwitter @PittCCM jamanetwork.com/journals/jama/…

The SOHO (Standard Oxygen versus High-Flow Oxygen Therapy in Acute Hypoxemic Respiratory Failure) is so bad. They compared HFNC to non-rebreather masks at 12 lpm - hardly “standard oxygen therapy.” They anticipated a 33% reduction in mortality, and by their own admission were wildly underpowered. Yet they did find a marked reduction in intubation + improved patient comfort with HFNC. The classic poorly designed “negative trial” that is actually positive and practice affirming (assuming you use HFNC…)

@sonorambler: This pic is from a case attended by the physician manned car in Oslo. It was taken more than 10 years ago of Dr Ottestad, consultant anaesthesiologist and HEMS physician. The arterial line was placed in a prolonged OHCA setting.

@SonoRambler Thanks for providing context!

@IM_Crit_ This pic is from a case attended by the physician manned car in Oslo. It was taken more than 10 years ago of Dr Ottestad, consultant anaesthesiologist and HEMS physician. The arterial line was placed in a prolonged OHCA setting.

@IM_Crit_ @saikatmitra05 @khaycock2 @BharatJagiasi @ross_prager @Drnasap

What do u think is going on? Post liver tx, complicated by hemorrhagic and septic shock, cardiac arrest with ROSC. ⁦@IM_Crit_⁩ feel free to repost

@msiuba Congrats, my friend!

@saikatmitra05 @khaycock2 @BharatJagiasi @ross_prager @Drnasap Thanks for sharing. I guess the rest of the team here will be more thorough but this monitor screenshot is so typical immediately postop that I don't do anything. I just tell the RN to find me when the patient is ready to be extubated (or something changes)...

#Haemodynamic A 72-year-old man is admitted to ICU 2 hours after CABG + MVR. He is mechanically ventilated and receiving noradrenaline 4 µg/min. Chest drain output is minimal. His observations as shown in multipara monitor. How would you troubleshoot his hemodynamic? Please poll below.