Himanshu Rawal MD

Great schema! But beware that *any* time you see a diagram like this, it assumes the patient has one disease process. Our patients are increasingly multimorbid so: ⚠️May have >1 cause of hypoNa ⚠️Fixing one cause may cause dominant physiology to shift (playing wack-a-mol)

Peripheral vasopressor administration in critically ill adults was associated with a low incidence of adverse events—major events were rare using short peripheral intravenous catheters, and use avoided central venous catheter placement in 60% of cases. ja.ma/4btNGSr

Defibrillation 2.0 by Dr. Corcoran #REVIVE2026 AP pad placement allows 🔺Better vector 🔺 Less impedence Dual sequential external defibrillation (DSED) AHA guidelines: Class 2b recom ILCOR: DSED suggested strategy for VF refractory to shocks @CardioNerds @OscarJMitchell

In the phase 3 TETON-2 trial involving patients with idiopathic pulmonary fibrosis, inhaled treprostinil was associated with a smaller decline in forced vital capacity and a lower risk of clinical worsening than placebo over 52 weeks. Full trial results: nejm.org/doi/full/10.10…

😵‍💫 Are you confused by Bayesian methods? Do you worry you’re alone? 🫢 Just in #journal_CHESTCritCare, B Malley et al eval how intensivists differently interpret results from Bayesian and frequentist trials… chestcc.org/article/S2949-… …I’m a bit unsettled by their findings 😉

Great to see this study in press where we show the utility of a sleep positioning device in managing GERD after lung transplant. Novel, safe and cost effective solution to a major problem in this population. Thankful to ACG for the research award! @ScottGabbardMD

Understanding lung physiology through ventilator screen 🫁 airway pressure waveform at a glance: respiratory system equation of motion, conductive pressure, stress index, driving pressure 🌊 flow waveform during pressure-controlled ventilation 💨 expiratory flow and the time constant of the respiratory system 🛌 dynamic bedside maneuvers: airway opening pressure, recruitability & recruitment-to-inflation ratio 🚧 the way forward #FOAMcc 🔓 rdcu.be/e6iG6

Right Ventricular Hemodynamics in Acute Respiratory Distress Syndrome: Monitoring and Implications for Clinical Management @atscommunity 🔗 tinyurl.com/4ea9hua2

The time of day for cancer immunotherapy is associated with major outcomes. Early is better. Results from a randomized trial of lung cancer, backs up the importance of our circadian rhythm and immune system nature.com/articles/s4159…

*Pulmonary embolism* versus *Acute myocardial infarction*: Above and below the pen: the size of the clots in each scenario I was looking for a picture like this and found it in a lecture by Dr Sripal Bangalore #foamed #foamcc #meded #MedTwitter

Alveolar gas equation and its clinical implications 🧮 derivation & application of AGE 💨 fraction of inspired O2 💨 atmospheric pressure 🩸PaCO2 & respiratory exchange ratio 🫁 PAO2 & A–a gradient in the approach of hypoxemia & pulmonary shunt #FOAMcc 🔓 rdcu.be/eZtD8

Post–intensive care syndrome (PICS) is a cluster of physical, cognitive, and psychological impairments that affect more than half of ICU survivors. 💡 Learn more about the diagnosis, treatment, and prevention of PICS in this JAMA Insights. ja.ma/4sy0ij4

1/ #POCUS pop quiz Elderly female with no PMHx presented with confusion, hypoxemia, rapid Afib and hypotension. Receives 3L of IVF and started on NE at 0.5ug/kg/min. This is her CXR:

From #pressor support to #impella support in #cardiogenicshock—how stable #pMCS enables #prehabilitation in the #ICU Gym and changes the trajectory. 💪

Big news: Results of the HIGHLY anticipated RSI trial: Ketamine vs Etomidate 🥁 Drumroll... n=2,365 pts 1° No difference in mortality (28.1 vs 29.1%) 2° Ketamine associated with WORSE hemodynamic outcomes (SBP <65, new/increased vasopressor requirement, or cardiac arrest): 17 vs 22% #CCRDownUnder

It's honestly hard to know how to interpret this data due to statistical power limitations. This is an important trial that should change practice. But I don't think we should all jump on the bandwagon that ketamine is a bad RSI drug. fresh blog: emcrit.org/pulmcrit/rsitr…

Mastering vasopressin in septic shock, pragmatic bedside guidance on its optimal use, emphasizing real-world constraints & evidence gaps: 💉 clinical pharmacology ⚖️ dosing ⏱️ timing 🩺 practical considerations #FOAMcc 🔓 rdcu.be/ePAno

(1/x) Andromeda-Shock 2 was just published in JAMA and is the most important septic shock trial in the past DECADE. They found that phenotyped resuscitation improves the composite outcome of mortality, vital support, and hospital LOS. Here's how you can apply this protocol to your practice 👇

A simplified ANDROMEDA- SHOCK-2 algorithm display by Jesus Nieves from Spain! As he said complex at first glance but quite easy when practicing!! Thanks Jesus😍😍

Dear all, unless you are already involved or practice or love the concept of physiology-oriented personalized resuscitation, I humbly but strongly 😍recommend reading before entering A2, several background articles to facilitate the flow: PMIDs 40999130, 40537864, 40163133,