the EMCrit Crew

Airway Triage Debate: Today, a debate with an anesthesiologist [@airwaymxacademy] on the use of his airway triage app and whether it is applicable to resus airways... emcrit.org/425

EMCrit Wee - 2026 PE Update F/u with @pulmcrit & Justin Morgenstern [#FOAMed for just a bit] emcrit.org/k173

@DrGermanov I said 16 mg over 6 in my discussion—may be even lower in future

@emcrit Btw great update, thanks! One question I keep thinking about: HI-PEITHO used 9-18 mg, STRATIFY – 20 mg alteplase. Given OPTALYSE and the apparent efficacy/safety balance with lower-dose USAT regimens, do you think 18-20 mg is optimal?

AHA PE Guidelines 2026 are here, so are STRATIFY and HI-PEITHO. I have new takeaways, updated risk stratification, treatment recs, and much more... emcrit.org/424

COHb of 32% — should you dive this patient? The answer is more complicated than your tox textbook lets on. New EMCrit with Dave Juurlink unpacking why it is not the slam dunk you were taught. [#FOAMed for a bit] emcrit.org/423

EMCrit Wee - You Don't Understand Dizziness and Vertigo - But You Need To!!! -Why the Sudbury Risk Score is fairly useless -Why STANDING is pretty good, but could be improved -What you should use instead [#FOAMed for a bit] emcrit.org/dizzy

EMCrit RACC-Lit Review - April 2026 All of the Resus and Acute Critical Care Goodness! emcrit.org/c72a

EMCrit 422 - SSC 2026 Guidelines: The good, the Bad, and the UGLY - a discussion with lead author, Hallie Prescott A fantastic interview on how the SSC guideline sausage was made and the areas I found contentious [#FOAMed for now] emcrit.org/422

If the data in the paper is correct, it would be because acidosis leads to decreased insulin sensitivity and the argument would be that we need to normalize hyperchloremic acidosis to avoid patient slipping back into DKA. If instead the contention is that anion gap misses plasma ketones, but serum bicarb would pick it up; that is specious. If you are documenting significant BHB with a normal anion gap then the issue is likely low albumin. A normal bicarb will be just as insensitive to this issue as a normal AG--they are measuring the same thing.

@EMNerd_ There’s some data that a persistent non-gapped acidosis leads to reopening of the anion gap. pubmed.ncbi.nlm.nih.gov/37133440/ we have Bhb readily available and there are group of patients with “closed gap” but positive BHB.

Okay got in a discussion with Endo at work about the management of DKA on following the AG vs the serum Bicarb to assess for resolution. They cited the following guideline which recommends using the serum bicarb because the AG can be affected by the hyperchloremic acidosis.

EMCrit 1:1 Nursing 008 – The Stroke Show. We're back from break with our standard fare of crucial info for Resus and Acute Critical Care Nursing. [#FOAMed for now] emcrit.org/1to1-008

EMCrit 421 - A Friendly Debate on the Role of ED Pharmacists - I want their minds, not their hands! with @MeganARech #EMPharmacy #EMRX Listen and then tell us what you think! emcrit.org/421

EMCrit Wee - An Airway Discussion with Jonathan St George of the Protected Airway Collaborative Informal chat on the DAS guidelines and a bunch of other airway stuff. emcrit.org/y6ud

EMCrit 420 - #CVEMCrit - Nuanced Presentations of Dynamic Left Ventricular Outflow Tract Obstruction (LVOTO): When It’s a “Two-Ventricle” Problem — and So Much More @TrinaAugustinMD Have you diagnosed dLVOTO in the past 3 months? If not, then you missed it! [#FOAMed for now] emcrit.org/420

EMCrit 419 – Questions and Answers (Members Q&A Episode 003) Finishing up the stack of questions from the past few months!! Some good stuff in here. emcrit.org/419

EMCrit 418 - Questions and Answers (Members Q&A Episode 002) I answered 1 hour worth of questions--when I recover, I will do the rest! emcrit.org/418

EMCrit Wee - ECGs in Acute Pulmonary Embolism - Death Threats in Little Squiggly Lines. I bring @PendellM on the show to discuss the ECG in acute PE emcrit.org/ecg-pe

EMCrit 417 - The Antibiotics Show - Community Edition with David Talan. Choices of ABX for Sepsis and Septic Shock [#FOAMed for now] emcrit.org/417

CV-EMCrit Wee - Electrical Storm: Surviving the Storm Part II - Storm on VA-ECMO This one is really of particular interest to CV intensivists, though of course, everyone is welcome. [#FOAMed] @TrinaAugustinMD emcrit.org/storm-va

@AirwayMxAcademy would you like to come on the show to discuss or not—either way is fine. I have no desire for a back and forth on twitter.

I don’t mind that you do not fully agree, but would like to understand why you keep teaching and promoting something that doesn’t work? And cannot be explained. That does not make sense to me. It is only 10% of the assessment and risk stratification equation. It was already shown 10 years ago by Nørskov et al. so imho it is indeed rather “outdated”😎. 🥊 📖 …-publications.onlinelibrary.wiley.com/doi/10.1111/an…

EMCrit 416 - JanuAIRWAY - State of the Airway 2026 -Difficult Airway Assessment -PreOx -Med Choices -eFONA Let's reestablish our intubation foundations by using the new DAS guidelines as a guide to discussion... emcrit.org/416

1. Very aware of your work and had already read your editorial 2. My disagreement doesn't imply that my thoughts are outdated, simply that they are not fully in agreement with yours 3. Most fruitful way to hash this out would be you coming on the show to discuss 4. A good prompt for one's internal AI IMHO, please delete anything I have said in the sentence or clause preceding, "just saying."

@emcrit Thanks for sharing but your airway assessment section is outdated. Just saying 📖 pubmed.ncbi.nlm.nih.gov/38508944/