𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊

@natedefelice another trial will come out soon but for now there is this ahajournals.org/doi/10.1161/CI…

@PulmCrit Thanks for this. You say the Inari works. What is your evidence for this? I’ve been waiting for evidence! I have seen times when it seems to work but I’m reluctant given lack of data I’ve seen…and the history of pe treatments (as you point out here) is full of over promises…

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

If you missed this, read it before the HI-PEITHO trial comes out on 3/28 I think the STRATIFY trial will be integral to understanding and applying the results of the HI-PEITHO trial 😁🤞

@DrewMoghanaki Medical students have THREE TIMES the average rate of suicide compared to age-matched peers. Everyone's experience is unique, but big data indicate that medical school isn't a beautiful walk in the park.

This viral comment might apply to some medical schools, but not all. Many emphasize ethics, humanism, and teach students how to become lifelong learners. Also, more than half of the curriculum is still taught through the apprenticeship model. Thus, they are by no means just trade schools.

@gavinnixon7 Even in the diagnostic specialties (eg primary care), docs are so overwhelmed right now. If AI offloads a lot of the work there will still be loads of work left for doctors Many specialties are booking new appointments MONTHS in advance Don't think we'll be obsolete soon

This only applies to specialities where you have no skills other than diagnostics. In my world, I have to be able to manipulate 2D images and reconstruct them in my mind and navigate needles and trochars into bone tendons and muscles under fluoroscopy and ultrasound. We are so far away from any robot being able to handle the anatomical variability or translatable skill sets that this whole argument about AI replacing doctors is nonsense. It will replace diagnosis but medicine happens to people and doesn’t involve just prescribing a pill. The more procedural you are in the medicine the more protected you are. Not to mention treatments like PRP and stem cell which are highly personalized cannot be done with some algorithm and the procedures are highly variable in terms of targets pathology and treatment planning. Long story short don’t go into primary care. Go into procedural areas of medicine if you want to be relevant.

med school is trade school for physicians its extremely hard work but not very intellectually challenging (mostly college-level work) so going to med school and not doing clinical medicine makes little sense a thought experiment may help illustrate this… #1/2

@PulmPEEPs Like so many things in the PE world, the real question is: Is more stuff (more diagnostics, more therapeutic options, more tests, more echo findings, more classifications schemes) actually improving care, is it net neutral, or is it causing confusion? Only time will tell!

@PulmCrit I saw and I think it was a very thoughtful and insightful review. Regardless though I do think people will use this terminology now so will at least need to be familiar. But I think both reading the guidelines, and reading thoughtful criticism like your post are both important.

🚨 Guideline Alert!! 🚨 The 2026 Joint Committee Clinical Practice Guidelines on pulmonary embolism are here and they're all we can talk about! Check out its Top Take-Home Messages--first stop, the new Clinical Categories‼️

@gkirschh Med school doesn't make you a smarter or better person, or teach you anything magical. It's a train stop on the line to becoming a practicing physician. This is important to realize because, for example, an MD degree alone doesn't mean you should be the surgeon general.

@PulmCrit The longer I have been in medical training the more I analogize medical training to a guild

@seanluomdphd PS - Please note that I'm solely talking about medical school here. The act of being a practicing *physician* is an entirely different story.

@seanluomdphd I completed a combined degree program to earn both a bachelor's & masters degree in 4 years time (in biochemistry). So yes, I've been to grad school and I've written a master's thesis. My undergrad/masters work far more intellectually rigorous & challenging than medical school.

@seanluomdphd I don't think medical school is very intellectually challenging as compared to a good graduate program in one of the basic sciences. Medical school is largely memorization and pattern recognition. Original thought is often not rewarded (especially during preclinical MS3-MS4).

@PulmCrit It's pretty interesting if you enjoy the subject matter. I find medicine content to be more and more interesting the older I get! NEJM podcast every week. When you say "not intellectually challenging", there needs to be a "versus what?" question.

@adityajain_42 I don't think that attending medical school necessarily means that someone has a higher moral quality than, say, someone who majored in computer science.

@PulmCrit Thanks for engaging! I would argue that residency is the "trade school" for medicine. Med school is your scientific base and exposure. I think an MD is incredibly valuable for building in healthcare. I'd much rather healthcare be built by MDs than CSers for example :)

@IncognitoNewt I wish all the best for him. But I do think it would be useful for college students to recognize that if they're not really planning to do clinical medicine, they're better off getting a degree they're actually going to enjoy and use (e.g., JD/PhD/MBA).

@PulmCrit Would be interesting to see what that med student says in 10 years about not doing residency

have been consulted for this & can confirm that the team is drawn towards a serologic workup like salmon swimming upstream me: this is 2/2 cocaine, the tx is substance use disorder therapy not bronchoscopy team: well... let's see what the extractible nuclear antigen panel shows

👁️ Using the NPi hampers generalizability of research data across different locations that use different pupillometers. 👁️ Superior pupillary index formulations are likely coming soon that will render the NPi obsolete. Fresh blog here: emcrit.org/pulmcrit/npi/

Fresh blog: Six reasons to stop relying on the NPi (neurological pupil index) 👁️ NPi is based on a secret, proprietary formula used by one company 👁️ The neuroICU field was somehow convinced that we're too stupid to understand pupillometry tracings, so we need the NPi...(#1/2)

@IsaacLamb01 💯 Folks have no qualms about loading fosphenytoin anywhere, anytime, regardless of ECG or cardiac comorbidities (and yes - I've seen this go really sideways) Meanwhile, giving an IV load of lacosamide to a patient with PR of 220 ms in the ICU with telemetry causes panic

@PulmCrit A similar situation I see a lot is people freaking out about starting lacosamide without an EKG, but having no such reservations for (fos)phenytoin, which is way more dangerous in every dimension.

proposal: IV lacosamide loading in the ICU is safe in patients with asymptomatic 1st degree AV block (PR >200 ms) I encounter a lot of anxiety surrounding this, but the fear doesn't seem to be evidence-based Other drugs we use in ICU are much more likely to cause bradycardia

@shailinthomas TBH this makes me want to do an anesthesiology residency. I WANT THE PONY WITH THE LARYNGOSCOPE.