Razvan Azamfirei 🦋 @razvanazamfirei.bsky.social

Surviving Sepsis 2026 is here & it's even more loony tunes than I was expecting. They're promoting pre-hospital ABX & preemptive broad-spectrum IV antibiotics for intubated patients. This insane fever dream is an antimicrobial stewardship nightmare. Embarrassment for SCCM.

I had patient in cardiac arrest who was receiving CPR and was mouthing "stop" only to have us stop and find he was asystolic but then wake up when we re-started compressions. Has anyone else encountered this? (We gave him sedation)

Pan CT following cardiac arrest has become my routine practice for the past 6 years. Why? 1. Their heart stopped --> we need to figure out why. CT can identify unexpected or difficult to diagnose causes. e.g. PE, pancreatitis, abdominal catastrophe 2. They were just assaulted for X min with CPR . I've seen flail chest, hemothorax + liver/spleen lacerations. They have thoracoabdominal trauma. 3. CT head identifies catastrophic brain injuries (not early gray-white loss or edema which doesn't mean much if done right post ROSC) but rather massive bleeds or sometimes even strokes. I operationalize it as a CT head non-contrast, CT chest with PE protocol, and then CT abdomen with whatever phase they can get after everything else. Of course, I do not delay transfer to cath lab or OR if there is a specific indication (e.g. STEMI vs. bleeding) but will get a CT after the cause has been reversed in those cases.

12/ If gradients were causes, then simply increasing a gradient would reliably increase flow. But in physiology: • gradients often rise while flow falls • congestion can coexist with poor perfusion • pressure can be high when throughput is low That alone tells you gradients are reports, not drivers.

Tip 1: Just go see the patient. When somebody is calling the intensive care unit in the hospital, they are calling for help. We are the 911 for hospitalized patients. Even if there may not be a clear ICU indication based on your initial phone call with the referring physician or nurse, just go see the patient. Often I find that we can still improve patient care for those patients even if they don't need vasopressors, ventilator, or inotropes. Often they are quite sick, and our expertise managing sick patients can be very useful. In 2025, we need to move away from the restricted notion that the intensive care unit expertise only pertains to ventilators, vasopressors, and inotropes. We are experts in managing acutely unwell patients even before they require ICU, so we should lend our expertise to help patients anywhere in the hospital.

Can somebody point me towards literature looking at pre-operative fasting and aspiration/patient outcomes? ASA Practice Guidelines use residual gastric volume as a surrogate for aspiration risk, but I can't find evidence supporting the RGV >25mL & pH <2.5 threshold.

Important point re indirects: Unlike other Trump moves, this is arguably GOOD news for researchers! If the NIH budget is unchanged (a big if), this allocates more money to researchers; if you go from an indirect of 75% to 15% it means you can fund 3 grants instead of 2.