Jerónimo Xavier Cassanello

Mi papi. Nino Antonio Cassanello Layana. Mi ídolo, mi vida, mi todo. El era la medicina. Por el soy médico. El arte de la semiología médica. Internista. Sin temor a nada, ni nadie. Sembró en todos aquellos que lo rodearon. Hoy recibo esos afectos.

Variadito

Un comandante de avión planteó una comparación necesaria: en la aviación, los tiempos de trabajo у descanso están estrictamente regulados para garantizar la seguridad. Sin embargo, en el sistema de salud, se naturalizan jornadas que van en contra de ese mismo principio. Guardias de 24 horas, seguidas de otros turnos, en contextos donde se espera tomar decisiones críticas. El problema no es solo laboral, es estructural: un profesional agotado difícilmente pueda rendir al máximo. La seguridad del paciente también empieza por algo básico: que quien lo atiende esté en condiciones de hacerlo.

97 años de un sentimiento eterno. 🔵⚡️ De generación en generación, el orgullo sigue intacto. ¡Feliz aniversario, Club Sport Emelec! #VolviendoASerEmelec 🔵 #MesDelEmelecismo

🔝I presented on my TOP 10 LIFESAVING PAPERS in critical care at @CC_Symposium last week! 🎖️Which papers made it in? Why? What did they change for ICU care? #FOAMed #POCUS #FOAMcc @veerappan91050 Lets take you on a little journey!

La escuela pública nació para que el hijo de un barrendero pudiera llegar a ser neurocirujano. Hoy, ese ascensor está averiado. Hemos sustituido el conocimiento exigente por dinámicas que solo benefician a quien ya trae una mochila llena de una casa con recursos. 🧵va...

I sat down with my mentor Dr. Eugene Braunwald for a 3 part series about his life. In part 1 we talk about his early years: "Everything changed on March 12, 1938 when Hitler marched in with the Nazis & my father was arrested" Hear how they escaped here For better video quality view here: clinicaltrialresults.org/interview-seri…

"Señores, estoy hasta los cojones de todos nosotros". (Estanislao Figueras, presidente de la I República, antes de irse a Francia sin avisar a nadie). "Pruebe usted a gobernar rodeado de imbéciles". (Manuel Azaña, presidente de la II República, antes de irse al exilio).

The American Heart Association mourns the passing of the legendary cardiologist Eugene Braunwald, M.D., widely recognized as one of the most influential figures in the history of cardiovascular medicine. Over seven decades, his work reshaped the understanding and treatment of heart disease, leading many to call him the father of modern cardiology. Braunwald was a lifelong contributor to the American Heart Association, helping advance its research and scientific mission, and was honored with some of the Association’s highest honors for his lasting influence on cardiovascular care and research. His influence extended well beyond his own discoveries, as generations of Association‑supported investigators, clinicians and academic leaders were trained by Braunwald or guided by the clinical trial standards and mentorship models he helped establish. newsroom.heart.org/news/american-…

From: Current Anesthesiology Reports (2024) 14: 446-57. doi.org/10.1007/s40140… Just one of the personalized peri-intubation resuscitation approaches:

"Hospitals cost $1 to $2 million per bed to build. A single hospital can routinely exceed $1-2 billion. Their floor plans are rigid, fixed for decades. AI is about to make those floor plans obsolete." Having now been on the front line of clinical care delivery, designing hospitals and building agentic AI infrastructure -- the collision is hard to ignore. We're spending $70B a year on hospitals with designs that may be obsolete before construction is done. linkedin.com/pulse/hospital…

Nuevo libro

Does anyone know who these 2 legendary players are?

Today in 1970, feuding Houston surgeons Denton Cooley and Michael DeBakey appear on the cover of Life Magazine.

💊 ¿Es obligatorio tomar la levotiroxina en ayunas? Clásicamente sí. Pero un nuevo RCT en JCEM (2026) plantea algo interesante que puede cambiar la práctica clínica 👇

We should be moving to ketamine faster for refractory status. In this meta-analysis 1. Response rate was 64% 2. Median maintenance dose 2.5 mg/kg/hr, 3. Dose was the same between responders and non-responders. But... responders were started on KET earlier (3.2 vs 4.3 days) 4. Avg duration of KET 5 days 5. Minimal complications (<1%) #curingcoma neurology.org/doi/10.1212/CP…

El Gran Garríncha!!

AKI guidelines hadn’t been updated since 2012. The KDIGO 2026 AKI/AKD Public Review Draft just dropped and it changes how we define, diagnose, and follow up after acute kidney injury. Here’s what every nephrologist, intensivist, and internist needs to know 🧵 ⚠️ Public review draft only · Not yet final guidelines

💉🩺Rapid sequence intubation in 2026: we are no longer “protecting the airway.” We are managing physiology under extreme stress. The latest evidence challenges one of the oldest dogmas in critical care. RSI was designed to prevent aspiration. But today, the real enemy is often hypoxemia and cardiovascular collapse. 1. Aspiration is no longer the central problem For decades, RSI was built around one fear: aspiration. But emerging data suggest: RSI may not significantly reduce aspiration It may increase hypoxemia and hemodynamic instability The paradigm is shifting: 👉 From aspiration avoidance → to physiologic optimization 2. First-pass success is everything Every additional attempt increases: Hypoxia Hemodynamic collapse Mortality Modern RSI is built around one goal: Get it right the first time. That means: Videolaryngoscopy first-line Stylet routinely Team choreography, not improvisation 3. Preoxygenation is now a therapeutic intervention Not just a step—a determinant of survival NIV > face mask HFNO as adjunct Semi-upright positioning And one key shift: 👉 Gentle ventilation is no longer taboo Done correctly, it reduces hypoxemia without increasing aspiration risk. 4. Hemodynamics matter more than ever Up to 40–50% of patients experience peri-intubation instability. The modern approach: Avoid propofol in unstable patients Favor etomidate or ketamine Consider prophylactic vasopressors Fluid loading? Not routinely beneficial. 5. Cricoid pressure: from dogma to doubt No clear benefit in preventing aspiration May worsen laryngoscopy and ventilation Current thinking: 👉 Use selectively, or not at all 6. RSI is no longer a rigid protocol It is now: Patient-specific Physiology-driven Team-dependent With tools like: Gastric ultrasound POCUS-guided decisions Structured airway protocols 7. The real determinant of success: human factors Preparation, communication, and coordination matter as much as drugs. Because in critical care: The airway is not just anatomy. It is a moment of systemic vulnerability. 🤓Final message RSI has evolved: From speed → to precision From protocol → to physiology From individual skill → to team performance And ultimately: The goal is no longer just to intubate. It is to intubate without killing the patient. 📃Reference Boulos NM et al. Anaesth Crit Care Pain Med. 2026. doi.org/10.1016/j.accp…

🔥⚠️We are fighting fever… when we should be using it 🤓 Every day in ICU...Paracetamol, Cooling blankets, Aggressive temperature control But what if fever is not the problem 🤔 *Fever is not a failure of physiology It is an adaptive response Driven by cytokines and Controlled by the hypothalamus 🫀 Clinical implication Fever is not noise...It is a signal *Heat boosts immunity At 38–41°C: • ↑ Neutrophil activation • ↑ NK cell activity • ↑ Antigen presentation • ↑ T-cell interaction 🫀 Clinical implication You are suppressing immune function when you suppress fever *Bacteria don’t like heat Most pathogens: • Optimal growth ~37°C • Growth impairment near 40°C Even more interesting β-lactams work better at higher temperatures 🫀 Clinical implication Fever may act as a natural antibiotic enhancer *The paradox: treating fever may worsen outcomes Observational data show: • Higher fever → lower mortality • Hypothermia → worse outcomes And even more concerning Antipyretics in sepsis → ↑ mortality 🫀 Clinical implication We may be harming patients with “routine care” *The myth of temperature control Antipyretics reduce temperature by 0.3–0.5°C No mortality benefit Sometimes harm 🫀 Clinical implication We are treating a number, not a patient *The real strategy: permissive hyperthermia Target: ~38–40°C Not normothermia Not aggressive cooling 🫀 Clinical implication Fever should be tolerated, not eliminated *When should we treat fever? ✔ Extreme hyperthermia (>40°C) ✔ Patient discomfort ✔ Cardiovascular stress ❌ Routine suppression in sepsis 🫀 Clinical implication Treat symptoms, not physiology *The uncomfortable truth We were trained that fever is dangerous, but evidence suggests that Fever is PROTECTIVE and its suppression may be HARMFUL 🫨 🤓Final reflection In sepsis, the goal is not comfort alone. The goal is survival, and sometimes survival requires heat😎🔥 📚 Tilanus A, Villamil W. Open Forum Infectious Diseases, 2025 “Fever in Sepsis Revisited: Is a Little Heat What We Need?” doi.org/10.1093/ofid/o…

By 1968, the psychedelic movement had seeped into every corner of pop culture - music, film, art, and even cartoons. One of the strangest and most delightful examples was “Psychedelic Pink”, the 39th episode of the Pink Panther series.