Derek Smith

@DrToddLee @zacroBID @IdVilchez @JulianVentres @ABsteward Here another study. Cool thing is that at the 1 gm dose of cefadroxil renal clearance appears to be saturated so AUC increases. Very impressive CMax of 35 mcg/ml, so T>MIC should be >90% in blood for susceptible pathogens. pmc.ncbi.nlm.nih.gov/articles/PMC18…

@JimC386110 @DavidJuurlink @MakisMedicine @PLOSMedicine @husam247 @DrJeffKwong

@DavidJuurlink @MakisMedicine @PLOSMedicine @husam247 @DrJeffKwong Hey Jerklink, this is coming from a US citizen in a language the left and liberals like you understand “Fuck you”. Cheers Jim C

Have you heard about young people dying suddenly after COVID-19 vaccination? Our new study in @PLOSMedicine shows there's absolutely nothing to that. If anything, the opposite is true. With @husam247 and @DrJeffKwong journals.plos.org/plosmedicine/a…

@bpherg @DavidJuurlink @MakisMedicine @PLOSMedicine @husam247 @DrJeffKwong

@DavidJuurlink @MakisMedicine @PLOSMedicine @husam247 @DrJeffKwong I pity you on judgement day, when you stand before God. He sees through the lies. You will not get away with it. Hell is a horrible place to spend eternity. If I were you, I would find Jesus, repent, and be saved. Do not ignore the young or others, who have died from the evil vax

Getting an important point across at today’s ⁦@resuscitology⁩ course

@allisonoconn @SR_DeshpandeMD Fondaparinux - synthetically made, no porcine products.

Today my co-fellow @SR_DeshpandeMD taught me that since all heparin products are porcine-derived, all Muslim patients should be asked about/informed about heparin products prior to their use! Make sure you ask before starting that dvt prophylaxis!

@ACEPNation 9/ Lactate: elevations in lactate should not be considered evidence of tissue hypo perfusion, but rather the presence of possible physiologic stress, iatrogenic B2 agonist administration, or impaired lactate metabolism (severe liver disease or thiamine deficiency)

@chandra_ri64999 @dr_kush_s @KartikBSonawane @KalagaraHari @DaraEsra @esra @AoraIndia @IJA_web @BJAJournals @SGSocAnaes @CASUpdate What do you personally use for sedation in these cases?

Laproscopic repair of Inguinal hernia with combo of hyper plus isobaric drugs ..no major tilt needed like GA .sedated but arousable patient throughout ..surgeon used IAP 6 -8mm Hg ..again showing relaxed field n less need of sedation.

doxy + ceftriaxone (CAP) linezolid + piptaz (sepsis, nec fas) roc + ketamine (RSI) amio + mg (AF) nicardipine + mg (eclampsia) ketamine + dexmed (analgosed) bipap + dexmed (asthma, copd) midaz + 200 J (VT) loop + thiazide (diuresis) LEV + lacosamide (refrac sz)

@BradSpellberg @ABsteward @DrToddLee @jasonroberts_pk @PulmCrit Need to get cultures before antibiotics. But wait, you can give antibiotics prehospital, so cultures schmulters. Then give alot of fluids. And after large volume fluids, you can give more large volume fluids. Or small volume fluids. Because....guidelines.

The framing for this has always seemed strange to me. Surgery has a 0% failure rate at preventing recurrent appendicitis (yes if done well) and antibiotics a 44% failure rate. Unless surgery is strongly contraindicated, appendectomy seems like the right choice.

In other words: #diedsuddenly is bullshit

@Hragy Canada - family members most certainly out of room. Can return back once stabilized.

In The Pitt they allow patients relatives to stay in ER by bedside while tracheal endotubation is done, is this usual? I usually ask relatives to stay outside, it aborts many problems including people fainting. The rules in your hospital/country?

Clopidogrel is superior to aspirin for cardiac outcomes beyond 1-year up to 5-years. Results from the STOPDAPT-2 ACS and STOPDAPT-2 Total Cohort. Should it be a lifelong maintenance therapy? @HirotWatanabeMD @MNatsuaki @KoYamamoto7 ahajrnls.org/3PlxLhD

🫀 Rethinking shock: why MAP is not enough. One of the most persistent paradoxes in critical care is the patient with “adequate” mean arterial pressure (MAP) but ongoing tissue hypoperfusion. This review provides a compelling physiological explanation: arteriolar collapse and haemodynamic incoherence. Key concept: Critical Closing Pressure (CCP) is not a continuous downstream pressure, but a threshold phenomenon. When vascular tone exceeds intraluminal pressure, vessels collapse—interrupting flow regardless of upstream pressure. Implications: • Perfusion becomes heterogeneous across vascular beds • Macro-hemodynamic targets (MAP, SVR) may appear normal • Microcirculatory flow remains impaired Why this matters clinically: • MAP-centered resuscitation may fail • “Normal numbers” can be misleading • Shock should be understood as a failure of flow distribution and vascular recruitment Therapeutic perspective: The goal is not simply to increase pressure, but to: • Reduce excessive vasoconstriction • Relieve external vascular compression • Improve effective arterial inflow 🤓My perspective: This work reinforces a critical transition in ICU medicine: → From pressure-based resuscitation → To physiology-guided perfusion management When combined with concepts like microcirculatory coherence and precision medicine, this provides a more complete framework for understanding shock. 📄 Miller et al. Journal of Personalized Medicine (2026) DOI: 10.3390/jpm16020078 #CriticalCare #Hemodynamics #Shock #Microcirculation #IntensiveCare #PrecisionMedicine #ClinicalResearch #MedicalEducation

Good oral hygiene is associated with a 51% reduction in risk of cardiovascular death (18 year study) (Turns out the mouth might be more important than we doctors thought) Janket et al 2023 pmc.ncbi.nlm.nih.gov/articles/PMC98…

If you've had a kidney stone, you've been advised that the most important thing to prevent another bout is to increase hydration. Now a randomized trial of hydration in over 1600 participants showed no benefit, despite evidence of increase during volume. thelancet.com/journals/lance…

Spinal hypotension prevention. How do you prevent spinal hypotension in your practice? I’ve done phenylephrine infusions for all of my career but have recently moved to norepinephrine and am tentatively a big fan! @ruthi_landau @SafePartum

Phenomenal lecture on cesarean delivery with @ruthi_landau at @SafePartum #OBShock #OBAnes

Atrial fibrillation and heart failure with preserved ejection fraction: diagnostic challenges and therapeutic opportunities heart.bmj.com/content/early/…