It’s amazing how much good will and great discussions that come out of simply saying «are there any other patients you would like my input on?» when finishing a consult in the ICU. #emimcc #cardiosky

Cardiology has two strong examples for why we should not mistake predictors of negative outcomes for causal variables we can intervene on. 🧵👇 #emimcc #cardiosky #metascience

RIP Rinaldo Bellomo www.thelancet.com/journals/lan... #EMIMCC #NephSky

Is there any reason to think vasopressin is more effective than noradrenaline as a vasopressor in the presence of acidosis? #emimcc #pharmsky

We should never be to busy to tell patients and their loved ones it might be the last time they get to speak. Hard earned lessons😔 #emimcc

Nice overview. Given the predominant Beta1 effect, watch the HR. If a patient is already tachycardic, they are unlikely to benefit. #emimcc

RE: https://bsky.app/profile/did:plc:4ksjksy2f4pg3wuipo6jji7u/post/3lu6yoh7ilk2h

Very interesting physiological study of the hemodynamic effect of nitroprusside infusion in HFpEF vs HFrEF. I think this is equally relevant both for the interaction with EF seen with most heart failure therapies, as in the disparate effects seen with IABP in cardiogenic shock 🧵 #cardiosky #emimcc

Effects of Vasodilation in Hea...

Ghastly images - look at panel C www.nejm.org/doi/full/10.... @nejm.org #NephSky #EMIMCC

#EMIMCC

The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc

Absolutely fascinating! We know the heart switches to lactate as energy substrate in shock, could there be a clinical benefit from lactate infusion in human cardiogenic shock? #emimcc #cccsky

RE: https://bsky.app/profile/did:plc:gjh4hswdpahgwosaktvp6tx7/post/3lkt6cu357j2z

Is it reasonable to have the same empirical MAP target in cardiogenic and septic shock? It’s not really the MAP that matters but the perfusion pressure, and that means taking CVP into account. #emimcc #cccsky

The Australians with a clear recommendation to use balanced solutions (they don’t specify Plasmalyte) in kidney transplant www.kireports.org/article/S246... in @kireports.bsky.social #NephSky #Transplant #EMIMCC

Could not agree more! The problem with pulmonary embolism is the lack of clear ownership (at least in my part of the world). #emimcc #cardiosky

RE: https://bsky.app/profile/did:plc:44b5u35ozfocrnqzge5xsohp/post/3lpygmruln22i

On paper, there's a strict distinction between type 1 and type 2 infarctions. In practice I wonder how many cases classified and coded as type 1 NSTEMIs are really type 2. #cardiosky #emimcc

Fascinating that the U-shaped relationship seen between LVEF and outcomes is not seen for RVEF #echosky #emimcc #cardiosky academic.oup.com/eurheartj/ar...

RE: https://bsky.app/profile/did:plc:livhihcevy3t7frqotqojazw/post/3lorg7otqxs22

Routinely reported ejection fr...

I have seen quite a few tamponades. I think I’ve seen electrical alternans once. It requires a large effusion and a swinging heart #emimcc

RE: https://bsky.app/profile/did:plc:23kyc35kxpg4b3fmejeicxm4/post/3lo4obm6grc26

I’m obviously a bit biased, but I believe there is greater danger in misclassification of non-septic shock (especially cardiogenic) as septic shock than from delayed recognition of septic shock. #emimcc #cccsky

Keep recommending this excellent paper on principles and practical use of Bayesian statistical methods for clinicians #emimcc #cardiosky www.atsjournals.org/doi/10.1164/... @fgzamp.bsky.social @f2harrell.bsky.social

Using Bayesian Methods to Augm...

Less volume loading, earlier vasopressor use in sepsis potentially an explanation for both less mechanical ventilation and more vasopressor use? #emimcc

RE: https://bsky.app/profile/did:plc:q5ogl3twkcqyhvz4zebonw3z/post/3lmrvl4ayl227