Sam Ainslie

Infants presenting to ED, only 50% will be given ANY pain relief, let alone those admitted to the wards/NICU... & sucrose doesn’t count as a pain medication. Give them something else & help prevent our peads from being under-treated. #SMACCmini #SMACC #controversial

Only one chance in this lifetime… Like watching sunset at the beach from the most foreign seat in the cosmos, I couldn’t resist a cell phone video of Earthset. You can hear the shutter on the Nikon as @Astro_Christina is hammering away on 3-shot brackets and capturing those exceptional Earthset photos through the 400mm lens. @AstroVicGlover was in window 3 watching with @Astro_Jeremy next to him. I could barely see the Moon through the docking hatch window but the iPhone was the perfect size to catch the view…this is uncropped, uncut with 8x zoom which is quite comparable to the view of the human eye. Enjoy.

This is Molly. She was finally found a week after her human fell down a 180-foot waterfall while hiking together in New Zealand. Her human was badly injured and rescued by helicopter, but Molly was missing. A week later, Molly was found at the base of the waterfall and reunited with her human. 14/10

Happy Easter week everybody. 😅

@Just_DrAnya @BrandonLuuMD Unsure what kind of doctor you are @Just_DrAnya but this is false information. Drinking water will not make you more dehydrated.

The statistics are staggering, but the mainstream solution is biologically flawed. When women feel this fatigue and brain fog, they usually respond by chugging gallons of plain, filtered water. This actually flushes out your essential blood minerals and can worsen cellular dehydration. True hydration isn't about how much liquid you swallow; it’s about how much water actually enters your cells to produce energy. To pull water into the cell, you need an electrical charge. Stop drinking "dead" water. Adding a pinch of high-quality sea salt or a proper electrolyte blend to your morning glass is the quickest way to stabilize your mood and banish the headaches.

Stay hydrated. Research shows even 1.36% dehydration is enough to cause significant mood decline in women: ↑ Anger-hostility 8% ↑ Fatigue 17% ↓ Vigor 12% ↑ Mood disturbance 19% ↑ Task difficulty perception 58% ↓ Concentration 45% ↑ Headaches 2x

💉The 2026 Anaphylaxis Guidelines highlight something uncomfortable for all of us in acute care: we do not fail because we lack knowledge, but because we fail to act on what we already know. Across 12 international guidelines, there is almost perfect agreement on one point: intramuscular epinephrine is the first and most important intervention⚠️. Yet in real practice, it remains significantly underused, often replaced or delayed by antihistamines or corticosteroids, therapies with no evidence for acute life saving benefit This gap between evidence and behavior is the central clinical problem. From a bedside perspective, three insights are particularly relevant: First, diagnosis remains the main bottleneck, not treatment. The guidelines clearly show that variability in diagnostic criteria, especially in patients without skin manifestations or in infants, leads to hesitation. Clinically, this reinforces a key principle: -> anaphylaxis is a clinical diagnosis driven by physiology, not by complete textbook criteria. Waiting for skin signs or full multisystem involvement delays epinephrine and worsens outcomes. Second, the document reframes management from a pharmacologic problem to a systems and education problem. Underrecognition by clinicians, lack of training in schools and community settings, and poor patient education all contribute to undertreatment. In reality, the success of anaphylaxis management depends less on ICU level interventions and more on early recognition and immediate action in prehospital environments. Third, there is a clear shift toward proactive risk management rather than reactive treatment. Modern guidelines emphasize emergency action plans, patient carried epinephrine, and structured education programs. This aligns with a broader trend in critical care: outcomes improve when interventions occur before physiological collapse, not after. An important nuance for critical care physicians is the role of adjunctive therapies. Antihistamines and corticosteroids are consistently positioned as SECONDARY, non life saving treatments. Their continued overuse reflects a cognitive bias toward treating visible symptoms rather than addressing the underlying hemodynamic and airway threat. Clinically, this is equivalent to treating hypotension in septic shock with paracetamol. 🤓Bottom line: Anaphylaxis is one of the clearest examples in medicine where the evidence is simple, but implementation fails. The priority is not new drugs or devices, but closing the gap between recognition and immediate epinephrine administration. 📃Reference Wallace DV, Immunol Allergy Clin N Am ▪ (2026) doi.org/10.1016/j.iac.…

@PulmCrit @gokpocus @VACAR_AV I don’t read this as a “every ?sepsis gets ABx” but rather “if it’s likely septic shock AND it’s gonna be a hot minute til ED can do anything about it, AND the patient is/has required intubation, give some ABx because things are dire.” Can always 📞 ED consultant before you push?

@PulmCrit @gokpocus Currently @VACAR_AV has data proving paramedics can consistently obtain uncontaminated bloods for the lab. If a patient needs a pre-hospital RSI “2° sepsis” (in Australia), they’re incredibly sick, likely multiple pressors etc. Seems the right time to give a broad spectrum AB?🤷🏼‍♂️

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.

Disney launched a new ad where a dad and son share a night time walk on a cruise ship, across an entire lifetime. Every parent needs to hear this: the moments feel small until they’re gone. Put down the phone. Spend the time. It’s the only thing they’ll remember.

This is wild. 143 million people thought they were catching Pokémon. They were actually building one of the largest real-world visual datasets in AI history. Niantic just disclosed that photos and AR scans collected through Pokémon Go have produced a dataset of over 30 billion real-world images. The company is now using that data to power visual navigation AI for delivery robots. Players didn't just walk around with their phones. They scanned landmarks, storefronts, parks, and sidewalks from every angle, at every time of day, in lighting and weather conditions that staged photography would never capture. They documented the physical world at a scale no mapping company with a fleet of vehicles could have replicated on the same timeline or budget. Niantic collected this systematically, data point by data point, across eight years, while users thought the only thing at stake was catching a rare Charizard. The most valuable AI training datasets in the world aren't being assembled in data centers. They're being built by people who have no idea they're building them.

Regular exercise is linked to slower biological aging - but only in people sleeping 7+ hours. People who slept under 6 hours and exercised actually aged faster.

Delivering bad news as an ICU doctor is one of the harder parts of the job. Here are some lessons I've learned along the way👇 1. Always sit down 2. Don't just jump into it. Spend the first couple of minutes with introductions to yourself, your team (if present), but more importantly who all is in the room (patient, family etc.) 3. If you will be needing consent for something (procedure, palliation etc.) as part of the discussion, ensure you know who the decision maker(s) are. 4. Preface the bad news "I have to share something that might be hard to hear" 5. Clearly in <30 seconds deliver the bad news then STOP TALKING. The biggest mistake I see is people give the news and keep going. It takes time to process what may be the worst news they've ever received. Silence is the solution here. They will talk or ask questions when they are ready... it could be 10 seconds, 1 minute, or 10minutes. Give them the time they need before you proceed. 6. Ask if they have any questions about what you have delivered. 7. Be prepared to answer 'what comes next' .. 8. Ask about spirtual / religious beliefs when appropriate and offer support if that is available. 9. Let them know you or someone from your team will be available to answer questions that might come to mind... often in the moment, questions slip people's mind but come to them minutes after you leave. Make sure they know how they can have them clarified. Just some thoughts here... any others? Bonus: Don't construe family members becoming angry as them being angry at you or the team. Anger when faced with this news is common, normalize it and realize it likely isn't directed at you!

Milennials (noun): A legendary tribe of 30-40 years old who look 25 but feel 65 who fueled by iced coffee, nostalgia, and mild panic

Shared medical decision making doesn’t mean listing a menu of options and asking the patient to choose

Pacemaker Mediated Tachycardia initiated SVT (likely AVNRT) I am not sure if what I am saying in the title is correct but here I will post the strips. The PMT was initiated by NSVT. Notice the retrograde P wave after the 4th wide QRS (NSVT). It was followed by a VP>retro P>VP =PMT

Here are the top 5 myths about volume status in medicine. Thinking about asking @netflix to turn this into a mini-series (or maybe )@MythBusters Episode outline below, share to get the producers ready.

Wanna understand the Andromeda Shock trial? We did a @CritCareTime episode about those topic with @ross_prager! Check it out: 🎧 AUDIO Apple podcasts.apple.com/us/podcast/cri… Spotify open.spotify.com/episode/704KOK… 📺 VIDEO YouTube youtu.be/oHljHxlNve4?si… 📖 NOTES criticalcaretime.com/episodes/decon…

@Aidan_Baron journals.sagepub.com/doi/abs/10.117… Someone tried ketamine. 🤷🏼‍♂️😅

Hello #MedTwitter Hive mind Does anyone have suggestions for treating patients with severe Cannabinoid Hyperemesis Syndrome (with abdominal pain as one of the predominant symptoms alongside N+V) Who is also allergic to Droperidol, Haloperidol, Metoclopramide, and most anti-H1

@FLTDOC1 Tail rotor separation… mechanical failure? Glad everyone’s okay. 🙏🏼

nb.. This is a 45 year old aircraft flightaware.com/resources/regi…

A 60-year-old man wanted to change his diet to improve his health. Like millions of other people, he turned to ChatGPT for advice. "What can I use as a substitute for table salt?" he asked it.

I saw this video this morning on my feed and I think it so eloquently explains what Charlie Kirk was put on this earth to do. “When people stop talking, that’s when you get violence, that is when civil war happens”