Ian Seppelt

@Peter_Fitz Follow the cricket example. Aside from obvious howlers, VAR only if one team requests it and they only have a certain no of requests per game. Referee makes a decision before the VAR and that only changes if very obviously wrong.

That's the entire point. For the sake of a few technically wrong calls, let the game flow!

@Peter_Fitz That's one way of putting it.🤔

@skdoctorgov @DocPriyamMD @DrSargeTakhar Yes. Not ‘BiPAP’ (which is a trade name) unless the patient is also hypercarbic. CPAP is what you need to help the failing heart (by decreasing the transmural pressure gradient - Laplace’s law)

@DocPriyamMD @DrSargeTakhar Can we use CPAP as we lack BIPAP

A 1st-year resident ran up to me during my night shift, looking completely pale. "Sir, we have a problem in Bed 4. I don’t know what to give first." The Patient: 1. Known Case of Heart Failure. 2. Gasping for air, lungs full of crepitations. 3. JVP hitting the jawline. 4. Grade 4 pitting edema (legs look like they are about to burst). The Catch: I looked at the monitor. BP was 70/40 mmHg. The junior whispered: "Sir, the textbooks say Diurese the 'Wet' patients, but the ACLS says Fluid bolus for Hypotension. If I give Lasix, his BP hits zero. If I give Fluids, he drowns in front of us. What do I do?" I replied....

Attention CICM Fellows and FANZCAs! Tick off your Airway/CICO CPD CCAM Essentials Course - Nepean ICET Centre 5th May 2026 Book NOW!

@Peter_Fitz Agree. Why wouldn’t Hastie wait until after the next election, and leave Taylor to make a mess of things in the meantime? They have no chance at all of winning the next election so it would be smarter to be strategic.

Again, I am surprised at the speed of this. It feels like the mob is circling when Taylor hasn't even been in the gig for mor than a month or so!

@Peter_Fitz Not just former leader of Nara but former Deputy PM! Definitely a few barnabies loose in the top paddock now.

This, from a former leader of the Nats. Gobsmacking.

@Russell19674643 @MikeCarlton01 Very nice pension, if you can get it.

@MikeCarlton01 Ley has fucked off with her $300,000 a year.

Happy and content - serene, even - I have not read a word about Taylor, Hume and the Opposition rabble today. Nor will I. They are a ship of fools, irrelevant, and life is too short to bother with ‘em.

@Paul_Wischmeyer E. All of the above. The trial data are not robust enough nor convincing enough to make any firm recommendation. We do know that feeding is better than not feeding, however.

What’s the optimal protein dose in ICU for best recovery of physical function & quality of life? A. <1.2 g/kg/d B. 1.2–1.5 g/kg/d C. 1.5–2.0 g/kg/d D. >2.0 g/kg/d #ASPEN26 #ICURehab #ICUNutrition

@Peter_Fitz An oldie but a goodie and still just as applicable!!

That clip, Dan, is the gift that keeps on giving. How many times have you trotted it out since first airing?

EU leaders say they are "watching the situation". They cannot even bring themselves to condemn strikes on a sovereign nation in flagrant violation of international law.  Absolutely craven and pathetic.

@Peter_Fitz I’m appalled by the carnage on Sunday. And completely disgusted by Howard and Frydenburg trying to politicize it. Cathy Wilcox today was spot on, as usual. @cathywilcox1

Me too. The last time Australia faced that level of vicious barbarism as we saw at Bondi - Port Arthur - Howard had his finest time as PM, and showed real leadership.

@Josh_S_Davis ‘Mean SOFA’ is a flawed concept. SOFA is a multi domain ordinal scale. A mean score is mathematically nonsense.

Watching results presentaiton of #IMMUNOSEPTRIAL at #CCRDownUnder Strengths: Best proof of concept thus far for precision medicine in sepsis Weaknesses: Primary outcome not patient centred, used arbitrary dichotomisation of delta SOFA

I think Van sounds sincere.

@ross_prager Step one is to get the diagnosis right. ‘Sepsis’ is not a diagnosis, it is a syndrome and too much time, money and effort have been spent looking for magic bullets for a syndrome rather than identifying and treating a diagnosis. Hence your point 1 - early source control.

With the publication of Andromeda-Shock 2, an ICU fellow asked me "are there any interventions in septic shock that you think would reduce mortality if studied in a RCT?" Great question: I think the following interventions could conceivably reduce mortality in septic shock. 1. Ultra-early source control --> e.g. if septic with a source (e.g. stone, intra-abdominal etc.) gets intervention done within 1 hour. Sometimes there are delays in source control based on real-life considerations (e.g. surgeon availability, OR availability, anesthesia, delay to diagnosis). If we could reduce these delays I suspect we could improve outcomes. Not easy to study though and often the decision for source control is not as a binary as we would hope. 2. A new drug that can improve endothelial dysfunction in sepsis... what that is, who knows. 3. Creating / implementing a micro-circulatory non-invasive monitor that let's you know tissue perfusion across multiple organs. Cap refill time is the scalable, non-invasive surrogate for this, but I think that understanding each organs micro-circulation (not just 1 surrogate) and then implementing physiologically informed interventions could further improve outcomes. 4. Removing maintenance fluids entirely from the care of septic patients. If done at a huge scale (e.g. Mega-ROX style) I suspect that removing all maintenance fluids and only allowing physiologically considered boluses could improve outcomes. Will it help all patients? No. Could we see a mortality reduction from reducing volume overload for ICU patients, conceivably. 5. Prognostic enrichment and sub-phenotyping of septic patients to those with hyperinflammatory states (e.g. biomarkers, imaging) and then trialing new anti-inflammatory agents. 6. New advances in antimicrobial therapy (e.g. new drug or dosing or timing) regimes --> I think that some of the continuous beta-lactam infusion literature is interesting and there are probably more pharmicokinetic/pharmicodynamic considerations that could help patients. 7. At a population level, increased awareness surrounding sepsis to patients, healthcare providers, and public in general with systems of care dedicated to improving them. Hard to study in RCT but probably where gains could be made. What other ideas do people have here? @john_basmaji @nickmmark @icmteaching @KiranRikhraj

@Peter_Fitz 🤔

@SenatorCash Rudd has done an excellent job. The exchange with Trump was hilarious, but well handled. Albanese did incredibly well negotiating that meeting. You would have a lot more credibility if you reserved your criticism for when there is actually something to criticise.

A regrettable moment in Washington. When the ambassador becomes a laughing stock, confidence in the role suffers. The responsible step now is to recall Kevin Rudd and reset.

@Peter_Fitz @AusRepublic I want an Australia that is Australian! One that has an Aussie as our head of state and not an entitled Englishman and his heirs and one without the Union Jack in our national flag. #KingCharlesIII #GodSaveTheKing #auspol #AusRepublic #NotMyKing

@AnishJayJain @DGlaucomflecken @OpNotes @StanfordGenSurg @StanfordSurgery @StanfordMed Please take your dirty masks off before a photo!!😬

Casually running into the man, the myth, the legend @DGlaucomflecken between cases…..priceless