Zack Singer

@PulmCrit @ross_prager Best medical resource I’ve ever used. Reference is regularly and recommend it to everyone. You and the team have a lot to be proud of, and patients everywhere are benefiting from your efforts

@ross_prager Thanks so much Ross 🙏🙏 I’ve basically given up on publication and academic promotion, so I hope you’re right about the IBCC 😂

end-stage academia: how to game the system to score more grants and publications this is ultimately a zero-sum rat race that doesn't help patients or science

🧵 What drives blood flow – the heart or the vessels? Eminent physiologists have argued this for decades. The disagreement survives because of imprecise causality. Here’s the resolution 👇

@vanrstvc @stanfordanes Congrats Vanja that's awesome

I’m beyond excited to share that I’m joining the most amazing group @stanfordanes as a Cardiac Anesthesiologist and Intensivist. I'm honored to be able to continue to work with such a talented and supportive department and division! Excited for the next stage of my career.

💫@SCC_CCS Members, we are launching a mentorship program & are looking for cardiovascular specialists, researchers & allied health professionals to helps us build the future of 🇨🇦 cardiovascular community. 👆Lead with heart & become a mentor! surveymonkey.com/r/75NRQN5

@MichaelMwachu @NedadurRashmi @SchulichMedDent @LHSCCanada Welcome @NedadurRashmi! I remember working with you as a medical student many years ago. You were a great role model. Looking forward to working together in London

It is with great pleasure that we welcome Dr. @NedadurRashmi as Assistant Professor of Surgery and Consultant Cardiac Surgeon to the Division of Cardiac Surgery, @SchulichMedDent @LHSCCanada. Rashmi brings great cardiac skills & excellence in AI/ML in CV medicine!

@drjohnm Yeah I really don’t understand this study design. All patients had a hx of HF (SGLT2i indicated) and a risk enhancer that was itself an indication for SGLT2i (DM, CKD, low EF). What does this study add?

Two questions for #ACC25: If you add an SGLT2i after any cardiac procedure. And study it against placebo, would it not show a reduction in HHF? Why do we allow investigators to not tell us total hospitalizations? <-

@ross_prager @eddyjoemd Recent paper exploring the mechanism of benefit of calcium in hyperkalemia pubmed.ncbi.nlm.nih.gov/39046789/

I commend the authors on the work but please everyone STILL GIVE CALCIUM for SEVERE HYPERKALEMIA Absence of trial evidence supporting does not mean lack of clinical utility! Vasopressors have never been randomized (vasopressors vs withholding) and shown to benefit patients yet clearly work. Ventilators have never been randomized for patients with profound respiratory failure, yet when implemented appropriately clearly help. Please give calcium stil.

Hyperkalemia management: No supporting clinical effect was identified for calcium or bicarbonate. Is it time to rewrite all the order sets? 🎩 tip to the authors. eddyjoemd.com/foamed

Incidence of sudden cardiovascular incapacitation (SCI) after STEMI declines after 15 days: recommendations on age-based driving restrictions #DRIVE-STEMI Study @YbarraLuiz @zacksinger26 @hwijeysundera ahajournals.org/doi/full/10.11…

@luke_crit @ross_prager @PulmCrit @ottawaheartrob @uOttawamwoo @CardioNerds As long as the local anesthetic lasts - benefit may be like a threshold effect where you knock down the sympathetics and then things stay settled. Not everyone responds. Unilateral usually sufficient. Risks include (transient) vocal cord paresis. B/l riskier if not intubated

@ross_prager @PulmCrit @ottawaheartrob @uOttawamwoo @zacksinger26 @CardioNerds Very interesting. How long does a block last for? Do you have to perform it bilaterally?

(3/x) #2: Arterial Line monitoring of CPR quality This is a bit of a double edge sword. Having arterial pressure monitoring for CPR is fantastic for: 1. Monitoring for ROSC --> reduce pulse check duration 2. Monitoring CPR quality --> diastolic BP (DBP) less than 30mmHg may be less correlated with ROSC 3. Theoretically can be used to titrate vasoactive medications 4. Distinguish between PEA and pseudoPEA Out of these, number 1 and 4 are the most useful for me. Manually checking for pulses in cardiac arrest is notoriously inaccurate (even among skilled providers). The problem? Placing arterial lines in cardiac arrest is hard (even for experienced clinicians!). Here are some tips: 1. Best operator available 2. Make sure you are going for common femoral (people sometimes go too low in cardiac arrest) 3. Have someone stabilize the pelvis manually (this reduces motion of the legs) **** 4. Ultrasound guided is a must (you will likely be venous blind because the vein is huge and artery is small in cardiac arrest) Biggest error is becoming task focused on the access. Placing an arterial line is great when there are lots of skilled hands around, but when I'm a solo code team leader don't have the bandwidth to do myself. PMID: 27107688 (animals although human data for this too)

@Bhanu2405 Thanks very much ☺️

@zacksinger26 Wow! Congratulations Zach

Glad to share our paper examining driving restrictions after STEMI (DRIVE-STEMI), published in Circulation ahajournals.org/doi/epub/10.11…

DRIVE-STEMI Supports Less Restrictive Driving Guidance After Acute MI tctmd.com/news/drive-ste…

@SCC_CCS @CircAHA @ICESWesternSD

Special thanks to all my co-authors, especially my supervisor and friend @YbarraLuiz for his mentorship and to @hwijeysundera for his expertise and guidance. @Dr_ChrisSimpson @ICESOntario @WesternU

@ross_prager @CardioNerds @CardioCrit @amalmattu @American_Heart @benhibbertMDPhD AP pad placement should be standard of care. There is data about consistent reduction in impedance of ~30% with AP vs AL which results in more current delivered to heart and greater success with defib. No reason to use AL over AP!

(5/x) #4: Vector change defibrillation Normal pad placement for defibrillation is typically anterior-lateral. Turns out that simply changing the pads to be anterior -posterior (think cardioversion) will improve survival to hospital discharge! (DOSE-VF RCT!) Dual sequential defibrillation (two defibs) also improved survival but logistically is so much harder to coordinate in many centers. I try to go anterior-posterior whenever I have the chance! Study below is DOSE-VF RCT in @NEJM

@IM_Crit_ We do therapeutic normothermia (as per TTM2 trial) @CritCareWestern. Eagerly awaiting STEPCARE (planned n = 3900, 2x2x2 factorial design - treat fever vs no tx, deep sedation vs minimal, MAP 65 vs 85). I expect no fever tx, min sedation & MAP65 to be noninferior #zentensivism

Are you cooling patients? Speaking about temperature control post-arrest: