Critical Concepts

ORESTES: Set me back upright, swivel me round—there’s no pleasing the sick! I hate being helpless ELEKTRA: Do you want to try putting your feet on the ground? It's been so long. But change is sweet O: Yes by all means. That will seem like good health. Sophocles on ICU mobility

🚨 Just had an absolute BLAST recording Episode 98 of @icuscenarios on RV failure in the ICU - with sepsis + renal failure making it extra brutal. We break down the real-world chaos: - Why POCUS can fool you - CVP trends - Why vasopressin is my PVR-sparing go-to pressor - Aggressive early diuresis guided by spot urine Na - Why intubating is like walking a tightrope - Avoid the killers that crank up PVR and doom the RV Huge thanks to the host for the deep dive. This stuff saves lives in the trenches every night. Listen now: icuscenarios.com/episode-98-rv-… And grab my new open-access review for the full framework: Acute Right Ventricular Failure in the Medical ICU (Lung 2025) → doi.org/10.1007/s00408… What’s your clutch move when the RV starts failing in mixed shock? Drop it below -> let’s talk shop #RVFailure #CriticalCare #MICU #FOAMed #RightHeart #PulmonaryHypertension #Noctensivist

@ross_prager icuscenarios.com/episode-72-cpr…

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)

#medtwitter #FOAMcc #FOAMed #meded

I'll be teaching with CHEST at a cool new procedural course Chicago in April. If you want to master central lines, art lines, chest tubes, paracentesis, thoracentesis, LPs, IOs, and more, check it out! High instructor ratios and it should be awesome. chestnet.org/store/products…

We explore mechanical circulatory support, including balloon pumps, Impella, and ECMO, in the new CCU lesson at icu101.com. #medtwitter #FOAMcc #ccu #pulmc

The basics of liver, kidney, and pancreas transplants and their post-ICU care. Now at icu101.com #medtwitter #FOAMcc #meded

Do you attend rapid responses? Aka the most chaotic place you're likely to experience outside of a natural disaster? Brandon and Bryan share some tips for organizing the scene, the case, and the team. #medtwitter #FOAMcc #FOAMed #meded icuscenarios.com/episode-98-run…

I’ll be speaking about the history of the HEARTSafe Communities program in the US and potential international applications in Dubai next week. See you all there! #medtwitter #FOAMcc #FOAMed

How do we handle ICP crisis in the neuro ICU? icuscenarios.com/episode-97-man… #medtwitter #FOAMcc #FOAMed #neurocrit

@EM_phile @nickmmark greater than unless there is a reason for a clear upper limit

@nickmmark Like you’d say “the floor is 60”?

General curiosity: When you’re communicating MAP goals in a generic hypotensive septic pt to the team, what do you specifically say? Something like:

How to approach a toxicology case - now in the MICU course at ICU101.com. #medtwitter #FOAMcc #FOAMed #meded #pulmcrit

Gastric bypass can cause steatosis and severe hyperammonemia. So can rituximab. Your joint effusion patient may have ureaplasma. Did you know all this? Listen to the show. #medtwitter #FOAMcc #FOAMed

So I'm looking for a better affirmation. How do I acknowledge without elevating myself above them? #medtwitter #FOAMed #meded

After a difficult shift or resus I will often thank a nurse for their help, or tell them they did well. But I now realize this creates a power dynamic of sorts; who am I to judge their work, and who says they were trying to help me?

One interesting lesson I learned as a parent: don't constantly praise your kid. It not only cheapens the words, it conveys a message of judgment and emphasis on success—I am the arbiter of worth and I deem your efforts worthy.

Caring for the post-op cardiac surgery patient - now at icu101.com.

Confused about steroids in the ICU? This week on the podcast, we talk to David Janz about who needs them, which ones to use, and which dose. icuscenarios.com/lightning-roun…

@jackdeliuc @icmteaching @IM_Crit_ @ross_prager @drtimothyli @ABsteward @PulmCrit @nickmmark @ThinkingCC @msiuba severity of illness and exposure history (healthcare setting etc)

@critconcepts @icmteaching @IM_Crit_ @ross_prager @drtimothyli @ABsteward @PulmCrit @nickmmark @ThinkingCC @msiuba Depending of which risk factors?

When are you used to cover MRSA in critically ill patients with pneumonia? @icmteaching @IM_Crit_ @ross_prager @drtimothyli @ABsteward @critconcepts @PulmCrit @nickmmark @ThinkingCC @msiuba