Critical Care
68 Threads
...🧵This is a thread about 8.4% sodium bicarbonate (aka bicarb amp) in critical care. This the first part in a series of three about sodium bicarbonate 🧂in critical care: 🧐I will...
👉🏻 🧵This is a thread about Hypercalcemia in critical care. 🚨 Rare but always a medical urgency 👉🏻 severe and symptomatic hyperCa (ionized Ca > 3 mM/L): ⚠️ usually with acute ons...
(1/x) Intubating a critically ill patients is the most dangerous procedure we do in the ICU (3.1% cardiac arrest rate) not because of hypoxia or tube placement, but hemodynamic co...
(1/x) In the #ICU, problem based vs. system based #rounding is commonly discussed (sometimes heatedly) between intensivists. I prefer one over the other (I will share below), but...
(1/x) Can you use BIPAP for patients with neuromuscular weakness (e.g. myasthenia) instead of intubating them?🧠🧠 Most textbook answers to when to intubate (20-30-40 rule etc.) are...
The Case of the Mysterious Masquerader. Let us delve into this enigma. 1st ever experience for us. a 🧵 (1/13) #neurotwitter #NeuroX #MedTwitter #MedX #Neurology #FOAMmed #Parkins...
(1/x) Massive GI Bleed patients are among the hardest to manage in the ICU as they often have multiple competing priorities: airway management, transfusion, diagnosis, & interventi...
(1/x) We often talk about source control in sepsis, but what does this actually look like for a patient with septic shock in the ICU? Some are obvious (e.g. perforated bowel = OR)...
(1/x) Intubating critically ill patients in the ICU has some important differences to the ED or OR. It also carries with it a 3% chance of cardiac arrest. Yes, THREE percent (PMID...
ICU Stories: While walking around the ICU at the beginning of your night shift, you notice that the respiratory therapist increased the FiO2 from 90 to 100% in a mechanically vent...
#Tweetorial 🚨 Team asked about Train of Four #TOF testing during #ICUrounds this weekend. So here’s a quick review! HOW: Stimulator delivers 4 consecutive electrical impulses (...
ICU Hemodynamic Secrets: You have probably seen this excellent study by @siddharth_dugar @AbhiDuggalMD (retrospective cohort study comprising all 3,151 adult patients admitted to...
Most patients with sepsis don't need anti-anaerobic antibiotics. But most get them anyway. Why not, what's the harm? I worry the harm is considerable. Our new study in @JAMAInte...
Although I haven’t placed an NGT in over a decade, this article provides numerous tips and tricks on how to increase success. 🎩 tip to the authors. https://t.co/4Ise540F2X https:...
10 waveforms (besides electrocardiogram) every intensivist should be familiar with: 1. Arterial line waveform Obviously, we need an arterial line. Besides the SBP/DBP/MAP/HR data,...
New @IM_Crit_ series: ICU dirty secrets: 1. The deeper thought behind giving only 20 mg of iv furosemide to a patient with rising creatinine (let’s say: 2.5 mg/dl), massive flui...
A🧵 on alkali therapy. First a Question❓️ A patient of diabetic ketoacidosis presented in a stupourous state with hypotension. ABG ➡️ pH -7, HCO3 - 9 mEq/L, K-5mmol/L. Along...
ICU pearls: This is the monthly reminder that “maximum dose pressors” is a stupid concept...🤐 I took care of a patient last night that needed up to 0.55 mcg/kg/min of norepinephrin...
Fluid Therapy for Critically Ill Adults With Sepsis: A review @JAMA_current #MedEd #MedTwitter https://t.co/4XUCZ6LxDD
Drug of choice for ANAPHYLAXIS in a patient with no response to Epinephrine? Patient is on Propranolol 60 mg BD for essential tremors. #MedTwitter #emergencymedicine #CriticalCar...
In part 1, I talked renal physiology to warm you all up!😉😂 In part 2, we are talking pharmacology and how we combine💊 See 🧵 below I’m presenting the whole talk at the fabulous...
ICU milestones: It was 23 years ago today, May 4th 2000, when @NEJM published one of the most influential studies in Critical Care (CC): the Acute Respiratory Distress Syndrome Net...
🫠 Approach to Hypotension 🫠 Recent ICU shifts = newfound appreciation for this clinical dilemma. The traditional breakdown of hypotension/shock is very classic: my schema aims to...
ICU stories: Diabetic ketoacidosis (DKA) is another "bread-and-butter" ICU case. The typical scenario is one of a patient who presents to the ED w nausea/vomiting/weakness, receive...