Marcelo D

Tired of 2 AM deep dives or trying to CTRL+F your way through massive guidelines? 🏥🧠 Try foamcortex.com It’s like having EMCrit, LITFL, and the best EM blogs synthesized into a single brain. Here are 5 recent questions users threw at it 🧵👇

El café no causa fibrilación auricular, al contrario, podría protegerte #AventhoAnestesia #Aventho #SMMCE #SAML El ensayo clínico DECAF (“Does Eliminating Coffee Avoid Fibrillation”) randomizó a 200 pacientes con FA luego de cardioversión: mitad tomaba café, mitad debía abstenerse de todo lo que los hacía felices durante 6 meses (cafeina) Para sorpresa de todos, los cafeteros tuvieron menos recurrencias de FA o flutter (47% vs 64%; HR 0.61; p = 0.01). Ni propafenona, ni sotalol, ni yoga: el héroe fue el espresso Durante años se culpó al café de cada palpitación, y miles de pacientes recibieron el consejo de “mejor evítelo”. La ciencia viene a decirnos que el verdadero riesgo era vivir sin él Los autores sugieren que la cafeína bloquea los receptores de adenosina (ese pequeño demonio proarrítmico) = café podría ser antiarrítmico. Y no, no hubo más infartos, accidente cerebrovascular ni muertes… solo más aroma jamanetwork.com/journals/jama/…

@OrlandoRPN @grok explícame esto

Pero cómo que la Guía 2025 de Monitoreo Hemodinámico de Pacientes Críticos NO incluye el Gasto Cardiaco medido por 2 Gasometrías? Porque en México la usan muchos sonsos todos los días en sedes de UCI de $10 pesos y también incluyen el monitoreo de la volemia por la resequedad de boca… #LIVES2025 🇩🇪

🫁 ADVANCED THORACIC #POCUS 🫁 🅰️-Line: Physiologic reflection of pleural line 🅱️-Line: Vertical comet tail artifacts 🦓 Z-line: ill defined artifacts shorter in depth that look like B-lines but arent 🆎Lung profiles can help w/diagnoses #FOAMed #MedEd @POCUS_Society @srrezaie

From Dr. @amalmattu at #ICEM2025 💡 Acute heart failure? Don’t reach for furosemide first. 🚫 50% aren’t volume overloaded ✅ Start with: 1️⃣ NIV 2️⃣ SL nitro q5min 3️⃣ High-dose IV nitro 4️⃣ THEN furosemide (~30min in) Redistribute, don’t just diurese. #FOAMed #ICEM2025 #EMConf

Por alguna razón, el calcular el calcio corregido con albúmina es una práctica que se lleva a cabo de manera indiscriminada (y errónea) Mejor el Ca ionizado o en su defecto el calcio total sin corregir 🔗 jamanetwork.com/journals/jaman…

Mastering the Suprasternal View in Echocardiography The suprasternal view is a crucial but often underutilized echocardiographic window that provides key insights into aortic pathology and great vessel abnormalities. 📌 How to Obtain: - Place the probe in the suprasternal notch with the marker directed towards the chin. - Apply gentle downward pressure while angling slightly posterior to visualize the aortic arch. - Optimize gain & depth to enhance image clarity. - Use Color Doppler to assess flow abnormalities in the great vessels. Patient Positioning: - Supine with neck extended (placing a small pillow under the shoulders helps). Structures Visualized: ✅ Aortic Arch & its branches (Brachiocephalic, Left Common Carotid, Left Subclavian) ✅ Descending Thoracic Aorta ✅ Right & Left Pulmonary Arteries ✅ Superior Vena Cava (SVC) ✅ Left Atrium Key Pathologies Detected: 📌 Aortic Coarctation – Look for narrowing of the aorta with post-stenotic turbulence on Doppler. 📌 Aortic Dissection – Identify an intimal flap separating true & false lumens. 📌 Patent Ductus Arteriosus (PDA) – Color Doppler reveals continuous left-to-right shunting. 📌 Aortic Aneurysms – Assess dilation & wall abnormalities to detect aneurysmal changes. 📌 Aortic Thrombi & Emboli – Visualizing thrombi can help assess embolic risk. Why is the Suprasternal View Important? This view is critical in pediatric & adult echocardiography, especially in suspected congenital heart disease, unexplained hypertension, and aortic syndromes. Its role in screening for aortic dissection, PDA, and coarctation makes it invaluable in emergency and routine cardiac assessments. Do you routinely use the suprasternal view in your echo practice? #CardioTwitter #Echofirst #POCUS #MedX

Nmixx para el Festival de Viña 2026 #Viña2025 #NmixxFestivalDeViña

What is the data on family presence during resuscitation/CPR? There’s been multiple RCTs performed on this topic with subsequent systematic review’s including a Cochrane review. One cluster RCT even included 1-year follow-up with family that were present during the resuscitation. Here’s the gist of what these studies demonstrate: -There appears to be no impact on patient mortality (IOW it does not degrade the quality of resuscitation) -Family members report lower PTSD, anxiety, and depression (this data is from prehospital setting) -Qualitative data suggests that it helps to ease into cessation of resuscitation -Several studies have highlighted the need for a dedicated team member to address the family during the resuscitation -One study assessing patient survivors found that 9 of them reported awareness of family presence without any negative effects -Assessments of staff members found no increased sense of stress My two cents is that there probably needs to be some preparation including notifying staff that the family will present so they are aware along with a dedicated staff member to prepare the family for what they are about to witness. pmc.ncbi.nlm.nih.gov/articles/PMC73… pubmed.ncbi.nlm.nih.gov/34167849/ jintensivecare.biomedcentral.com/articles/10.11… #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #ems #prehospital #ambulance #family #death #medx #medtwitter

Ya es Tiempo de adoptar una estrategia de Fluidoterapia Restrictiva en Choque Séptico❓ 💦🚫❌ Olvidémonos de los 30 ml/kg en Bolo de Cristaloide 💦 ❌ y mejor pensemos -juiciosamente- si nuestro paciente séptico en particular requiere fluidos sciencedirect.com/science/articl… Ante un Choque Séptico, iniciar Norepinefrina tempranamente y evaluar la respuesta a Fluidos antes de iniciarlos podría ser una mejor opción ✔️ @Fluid_Academy #SMMCE #AVENTHO

It can be hard to not carry the weight.

Using AI to improve scientific literature search results #FOAMed buff.ly/4cxXER7

Estimados amigos Imagenólogos y técnicos radiólogos, la Lesión Renal Aguda por Contraste NO EXISTE desde hace décadas, favor de No negar los estudios contrastados ni pedir Cr sérico obligatoria o firma de algún incauto responsable. Al contrario, se asocia a menor mortalidad de los pacientes, tal vez porque puedes hacer un diagnóstico importante y dar tratamiento. Estudio de >140,000 pacientes en un servicio de Emergencias: journals.lww.com/ccejournal/ful…

mdpi.com/2077-0383/13/1… @MartiolaKola

I think this case will break EP and IC Twitter... 61m presenting with chest pain. Diagnoses?

#POCUS guided IV @Pocus101 #FOAMed #FOAMcc pocus101.com/ultrasound-gui…

The PREOXI Trial: Pre-Oxygenation with NIV vs Facemask rebelem.com/the-preoxi-tri… #REBELEM #Preoxygenation #Intubation #NoninvasiveVentilation #PREOXItrial

Lung point and disappearance of B lines An old man with severe ILD presented with chest pain. Lung US showed extensive B lines that disappeared at one point and then the appearance of an A-line with the absence of pleural sliding, indicating pneumothorax

Tuesday shift ⁦@UMEmergencyMed⁩ ⁦@UMEMresidency⁩ #foamed #WhiteBoardTeaching

If you intubate you need to read the #PREOXI trial! -n=1301 people requiring intubation in ED/ ICU were randomized to preoxygenation with oxygen mask vs non-invasive ventilation (NIV) -NIV HALVED the risk of hypoxemia: 9 vs 18% -NIV reduced mortality: 0.2% vs 1.1% #CCR24 🧵 1/