I use the standing algorithm

This is a great way to use LLMs in medicine. Simply letting the LLM do all the work will invariably lead to numerous issues but a "triple-threat" approach makes a lot of sense @pulmcrit.bsky.social emcrit.org/pulmcrit/tri...

Andexanet alfa increases VTE w/o offering improved clinical outcomes bit.ly/41oy4vm -660 patients AA or 4FPCC -No mortality benefit for andexanet -9% increase in VTE (NNH = 11) Not perfect data but mounting evidence that this massively expensive drug offers no benefit w/ incr complications

Occult VF in Cardiac Arrest: 5.3% of patients with cardiac arrest showed VF on echo but ECG w/ PEA/asystole Study does not show improved outcomes but not powered to do so Strong argument for intra-arrest echo as it can dramatically change management #EMIMCC

Ketamine in peds PSA (PMID: 40481829) - Registry of 12,780 ED PSAs -0.016% (2 patients) w/ critical events (1 suspected aspiration, 1 anaphylaxis) -0.52% high-risk events -7 laryngospasms Bottom line: ketamine is exquisitely safe in peds PSA in the ED

Stable VT Treatment -Electricity is the best option (safest, highest success rate) -If you're going for a med, procainamide far superior to amiodarone: lower SE profile, higher success rate #EMIMCC #MedSky

Steroids in pharyngitis #MedSky #EMIMCC

#MedSky #EMIMCC

Resuscitation relies on rapid access. Don’t delay: 1, 2, IO #MedSky #EMIMCC

Epi can be life-saving in the crashing asthmatic patient. This is a must know med dose #MedSky #EMIMCC

Clinical Conundrum: Should We Always Treat Fever in Sepsis?: bit.ly/3BwUEbq TL;DR: No. No incr mortality/morbidity + possible protective effects #MedSky #EMIMCC

Insulin is a critical med in severe hyperkalemia but, 5 units is probably more than enough Data shows just as effective in lowering K w/ reduced risk of hypoglycemia #MedSky #EMIMCC

Shock refractory to 1st pressors? Consider occult causes of shock. Patient's BP won't improve until you address Central idea: the cognitive response to shock should not simply be to reach for pressors but rather to identify + treat the underlying cause #MedSky #EMIMCC

REBEL Core Cast 132.0 - Recent Onset AF: bit.ly/4f0zRe4 - ED cardioversion safe in low risk (CHADS-VASC < 2 for men, < 3 for women) up to 48 hours from onset - Restrict cardioversion to < 12 hours in high risk - Electricity >>>>> Procainamide > Amiodarone #MedSky #EMIMCC #FOAMed

Just a quick reminder #MedSky #EMIMCC

To all the #MedSky folks. Thankful to have a new place to engage in #MedEd

#MedSky

Give prophylactic abx post-tube thoracostomy in trauma Best evidence (2022 SRMA bit.ly/4cHLCpE) shows decreased rates of empyema w/ abx particularly in patients with penetrating trauma #MedSky Insta Reel: bit.ly/3OoGtIh

Paralytic 1st RSI assoc w/ improved 1st pass success bit.ly/4eDjt2Y Key is understanding onset of action of meds: - Roc 1.2 mg/kg onset ~ 45-60 sec - Ketamine ~ 30 sec - Etomidate ~ 30 sec Paralytic 1st aligns onset + reduces chance for apneic but not paralyzed #MedSky

Flu season is here. Reminder that tamiflu (oseltamivir) is pretty worthless: bit.ly/3p2HFYD High-quality SRMA shows: No ⬇️ in 🏥 overall No ⬇️ 🏥In older or at higher risk ⬆️In adverse events (nausea, vomiting) Echoes what we've been saying for years bit.ly/3XetvR2 #MedSky