Critical Concepts @critconcepts Twitter profile | Pikagi

Pikagi

Critical Concepts

@critconcepts

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Critical care PA, FCCM. Proprietor of , cohost of , former EMT. #FOAMcc #FOAMed

https://t.co/RTVkhC1sgb

Joined February 2014

Don't wanna be here? Send us removal request.

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@critconcepts

Critical Concepts

1 year

ORESTES: Set me back upright, swivel me round—there’s no pleasing the sick! I hate being helpless ELEKTRA: Do you want to try putting your feet on the ground? It's been so long. But change is sweet O: Yes by all means. That will seem like good health. Sophocles on ICU mobility

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@critconcepts

Critical Concepts

2 years

hmm spicy #medtwitter

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@critconcepts

Critical Concepts

2 years

A patient suffers STEMI causing biventricular failure, including severe RV infarct. An Impella is placed, and they arrive in the ICU from the cath lab. You see the following. (This arterial line is functioning.) What do you know about the hemodynamics? 🧵 #FOAMcc #medtwitter

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@critconcepts

Critical Concepts

4 years

#covid19FOAM #coronavirus updates from the CCM-L list. Troubling reports from Italy, as this sounds like a rather sicker population than described in other settings. Note the high prevalence of shock and fairly young age bracket. (shared with permission)

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@critconcepts

Critical Concepts

2 years

@ebtapper this would give me great respect for the journal's processes

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@critconcepts

Critical Concepts

3 years

@DGlaucomflecken there’s no vaccination against rounding, buddy. We’re coming for you.

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@critconcepts

Critical Concepts

4 years

This differential needs a differential.

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@critconcepts

Critical Concepts

6 years

@DGlaucomflecken K, but... Na.

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@critconcepts

Critical Concepts

9 months

@DxRxEdu Elevated ICP It is slightly hypotonic and can promote cerebral edema

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@critconcepts

Critical Concepts

4 years

"Worth a try" drugs for #covid19 seem to have filtered into three camps: 1. Remdesevir 2. Lopinavir-ritonavir (aka Kaletra), possible with ribavirin 3. Chloroquin or hydrochloroquine There was also talk of ciclesonide but this seems to have died down #covid19FOAM

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@critconcepts

Critical Concepts

4 years

@sargsyanz Never outrun your ability to make good decisions. Medical emergencies happen at the pace of a brisk walk. If you ever see me running, *I* am in danger and you probably are too. Catch up.

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@critconcepts

Critical Concepts

6 years

*admit w/dementia & CHF* Me: *ready to deftly pivot to goals of care, feeling good about the process* How does she sleep? Flat in bed? Husband: She usually falls asleep with her head on my shoulder while I rub her back. Me: 😟😟 Can't seem to forget her now. @thosewecarry

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@critconcepts

Critical Concepts

2 years

"Vasopressin can be used at lower doses (0.01–0.03 U/min) [in pulmonary hypertension], where it causes pulmonary vasodilation via the NO pathway" 🤔🤔 #medtwitter

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@critconcepts

Critical Concepts

2 years

@FLTDOC1 we do not

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@critconcepts

Critical Concepts

4 months

By age 35, every critical care clinician should have six PowerPoint presentations about basic clinical topics with no animations, a set of scrubs stolen from a minimum of three hospitals, and an iPhone video of a SonoSite screen showing cardiac tamponade. #medtwitter

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@critconcepts

Critical Concepts

5 years

Friends: I'm EXTREMELY excited to announce a new project, the ICU Point of View video series. These are "first person" procedural tutorials filmed from a GoPro camera on my head, on live (consenting/anonymous) patients, and narrated in detail.

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@critconcepts

Critical Concepts

2 years

@leach_md proceed to the OR where you will stand in one spot on cement for the next 6 hours either yelling or getting yelled at

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@critconcepts

Critical Concepts

2 years

Big new RCT on APRV vs ARDSnet lung-protective ventilation for ARDS (mostly COVID patients) 🧵of take-home points: #medtwitter #FOAMcc #FOAMed #pulmcc #COVID19 #SoMe4MV

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Use of Airway Pressure Release Ventilation in Patients With ... : Critical Care Medicine

ould be associated with improved outcomes in patients with acute respiratory distress syndrome. The aim of this study was to compare the outcomes between airway pressure release ventilation and...

journals.lww.com

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@critconcepts

Critical Concepts

2 years

An echo case. 75m dialysis patient with bowel perforation. Ex-lap, resection, and extubated. 2L fluid given. Arrives in ICU on escalating norepinephrine doses. #POCUS shows the below. 1. What are the most key abnormalities? 2. How will you manage hemodynamics? #FOAMcc #FOAMus

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@critconcepts

Critical Concepts

3 years

An area of much interest to me. How often do you have a patient in the ICU where you don’t know what’s wrong with them? Here’s an early attempt at an approach or algorithm to unpacking mystery cases. #FOAMcc #FOAMed #medtwitter #pulmcc

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Difficult diagnoses in the ICU

The majority of patients admitted to the ICU have common diseases. The presentation may be severe, but the pathology is bread-and-butter: sepsis, heart failure, pneumonia, GI bleeding, and so on. H…

www.critcon.org

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@critconcepts

Critical Concepts

1 year

Quick tips on mastering your procedural guidewire! #medtwitter #FOAMcc #FOAMed #meded Part 1

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@critconcepts

Critical Concepts

2 years

Allan Walkey on atrial fibrillation in ICU ( #SCCM2023 ) Arrigo 2015: cardioversion for secondary A-fib in ICU rarely works (43% remains sinus at 1hr, 23% at 24hr). Diltiazem was more effective at rate control than amio or digoxin.

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@critconcepts

Critical Concepts

1 year

Yesterday I placed a fully sterile subclavian line and arterial line in 22 minutes from scrub to walking out - sites dressed, room clean, rails up. Lines routinely take over an hour even for experts. What's the secret? 🧵 #medtwitter #FOAMcc #FOAMed #meded

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@critconcepts

Critical Concepts

3 years

"We switched to pressure control because the peak pressures were high"

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@critconcepts

Critical Concepts

2 years

@norfolk_tim Lean all the way in and embrace nihilism. “Oh, you gave 4 liters. That’s fine. Nothing matters. We’re all just a collection of shifting, decaying particles, moments from eternal silence. Send them up. Do we have a bed? Who cares. Do we have a nurse? Of course not.”

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@critconcepts

Critical Concepts

2 years

Adult male, hypoxemic with suspected aspiration pneumonia. CXR raises another suspicion, so POCUS performed. Make a prediction before viewing replies. #medtwitter #FOAMcc #FOAMed #POCUS #cardtwitter

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@critconcepts

Critical Concepts

4 years

It's Pedantic Saturday! Remember: - The P in PCO2 is capitalized, but in pH is lowercase (the latter suggests a logarithmic process) - Diminished amplitude in waveforms (e.g. arterial lines) are "damped," not "dampened" - Breathing is "stridulous," not "stridorous" #medtwitter

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@critconcepts

Critical Concepts

2 years

@joshmcgoo “so just for my own learning: why are you the way you are?”

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@critconcepts

Critical Concepts

6 years

Critical care simplified: 1. Put oxygen into blood. 2. Get blood into tissues. 3. Annihilate bugs that ain’t from these parts. 4. When in doubt, stick something in. 5. Liberate your humans ASAP. 6. Comfort always. Not just when 1-5 fail.

@santalum_aurum

Chandana Sri

@santalum_aurum

6 years

Surgery, simplified: 1. If it festers, lay it open 2. If it is gaping, sew it shut 3. If it is cancer, cut it out 4. If it bleeds, tie it up 5. If it doesn't, check the plumbing 6. If there are stones, take them out 7. Keep radio, anaesthesia and patho happy

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@critconcepts

Critical Concepts

3 years

@Caulimovirus you need one of those sodium channels I keep hearing about

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@critconcepts

Critical Concepts

7 years

@medicalaxioms I open blinds in nearly every patient room as I round in the ICU and will until I can convince nursing that sleep/wake cycles matter

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@critconcepts

Critical Concepts

7 years

Things Heisenberg taught me about the ICU: 1. Cycling the cuff enough makes the BP rise. 2. If you monitor it sternly you can force an uptrending temperature to lose confidence before it becomes a fever. 3. Pulmonary toilet consists 99% of saying "pulmonary toilet" often enough.

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@critconcepts

Critical Concepts

4 years

@DGlaucomflecken Brother, they might start cancelling your cases soon. Your playlist may be “All By Myself.”

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@critconcepts

Critical Concepts

3 years

Interesting oximetry tracing, looked almost venous. PaO2 was actually 400. Hypothesis: volume overload -> venous pulsatility sufficient to make the PULSE oximeter read venous blood as arterial. Arguments? #medtwitter #FOAMcc

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@critconcepts

Critical Concepts

1 year

I've been listening to medical podcasts for a long time. Many have come and gone. But I've seen enough... here's my top three from the current roster. #medtwitter #FOAMed #meded #FOAMcc

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@critconcepts

Critical Concepts

2 years

the downside of using nifedipine over amlodipine for routine ICU hypertension is that it’s long-acting the upside is that it actually lowers the blood pressure

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@critconcepts

Critical Concepts

3 years

Great summary of PEEP trials by Daniel Talmor ( #CCC50 )

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@critconcepts

Critical Concepts

3 years

New review on vent dyssynchrony! This is a tough topic to understand clinically, and many pieces are more "academic," so we tried to take a practical approach with tons of images (simulated and in-vivo) and bedside strategies. #FOAMcc #pulmcc #medtwitter

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Patient–ventilator dyssynchrony in the intensive care unit: A practical approach to diagnosis and...

Patient–ventilator dyssynchrony or asynchrony occurs when, for any parameter of respiration, discordance exists between the patient’s spontaneous effort and the...

journals.sagepub.com

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@critconcepts

Critical Concepts

6 years

The Wong-Baker FACES scale is a patient-indicated visual analog scale, not an objective chart for comparing little sample faces to the patient's face. I Can Not Comprehend how people get confused about this.

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@critconcepts

Critical Concepts

6 years

One phenomenon I have consistently noticed is that as intelligent people advance through formal medical training/experience, they become less certain, more humble, more willing to be wrong. They've been tested and erred too many times to remain passionately arrogantly positive.

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@critconcepts

Critical Concepts

1 year

What is it with people using normal saline in DKA? Tradition? Habit? Potassium phobia? #medtwitter

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@critconcepts

Critical Concepts

3 years

@Caulimovirus what’s your stance on nephrotoxins

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@critconcepts

Critical Concepts

1 year

An ICU #POCUS case... 65m hx Afib, HFpEF, off meds, feeling weak. In ED found with AF+RVR and hypotension. Receives amiodarone, comes to ICU. Intubated for worsening shock and AMS. POCUS shows:

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@critconcepts

Critical Concepts

10 months

No joke, the Hospitalist and Resuscitationist conference this year was maybe the best conference I've ever attended (and I only went virtually). Incredible density of high-yield clinical material. If you do any critical care I HIGHLY recommend checking out the recorded talks...

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@critconcepts

Critical Concepts

2 years

@soupmd_ Double down. “My attending wants it gone.”

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@critconcepts

Critical Concepts

2 years

Richard Branson on bronchodilators ( #SCCM2023 ) clear standard of care for bronchoconstriction, but mostly used for hypoxemic disease because it "can't hurt". Ehrmann 2013 European survey found 95% used them routinely in mechanically ventilated

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@critconcepts

Critical Concepts

4 years

Diuresis baffled me when I first got out of school, but it's pure bread and butter for critical care. When should you start? How do you dose furosemide? What if it's not working? An overview of these basics, and more... #medtwitter #FOAMcc #pulmcc

The art of diuresis

[A caveat: some of the numbers discussed below are specific to the US, and may not apply internationally.] Most ICU patients initially receive a lot of fluid. Later, they need to get rid of a lot o…

www.critcon.org

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@critconcepts

Critical Concepts

2 years

me holding all the organ failures together until change of shift #medtwitter

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@critconcepts

Critical Concepts

2 years

Hi everyone. This is Riyan. He’s 7lb 1oz and an obvious athlete. We may be busy for a bit.

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@critconcepts

Critical Concepts

2 years

Aww man I wanted to do this study

@avkwong

Adrian Wong

2 years

Radial artery cannulation in intensive care unit patients: Does distance from wrist joint increase catheter durability and functionality? #WINFOCUS22

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Critical Concepts

1 year

@DrCasteelEM Oto's Corollary: Simultaneous diagnoses are usually explained by one acute process triggering or unmasking another pre-existing or at-risk condition

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@critconcepts

Critical Concepts

9 months

Mind has been exploded by this concept. Amazing how you can keep learning. My questions: 1. If the real gradient is MAP to Pcc (not MAP to CVP), is venous congestion irrelevant to perfusion? Unless edema is severe enough to raise Pcc? @ZPutowski #medtwitter #FOAMcc

@ZPutowski

Zbigniew Putowski

9 months

1/24 Recently, I started reading a lot about vascular waterfall (VW) and its importance in cardiovascular physiology. It seemed confusing at first, but the more I read about it, the more it fascinated me. 🧵 about physiology!

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@critconcepts

Critical Concepts

6 years

A beginner's guide to the ICU: Simple answers to (mostly) simple problems. How to get through your day in the ICU without killing a patient or yourself. #FOAMcc

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A beginner’s guide to the ICU

Newcomers to the ICU are often overwhelmed by the sheer volume of unique situations encountered among critically ill patients. Over time, they develop a basic approach and knee-jerk response to mos…

www.critcon.org

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@critconcepts

Critical Concepts

2 years

Conclusions: a state of purely laminar flow as sometimes seen with mechanical circ support (more classically ECMO or a VAD) is weird, and often undesirable. But it highlights some important physiological concepts. If you can understand these ideas, you understand hearts. [Fin.]

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@critconcepts

Critical Concepts

5 years

The topic needs more attention, but per recent discussion, a VERY quick tutorial on vent synchrony. #medtwitter #FOAMcc #FOAMed #pulmcc #som4 The MOST common dyssynchrony you'll see in an AC mode? Two types: - Breath stacking - Flow mismatching

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@critconcepts

Critical Concepts

3 years

@PulmCrit nothing matters josh

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@critconcepts

Critical Concepts

1 year

@DrPayItBack Joint Commission

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@critconcepts

Critical Concepts

2 years

@pathologiste08 I want to see the contents of that lady’s purse

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@critconcepts

Critical Concepts

4 years

What’s an end organ? Are there middle organs? #medtwitter

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@critconcepts

Critical Concepts

1 year

Spot diagnosis. A cardiac arrest patient with prolonged downtime. You perform a quick TCD and find… #medtwitter #FOAMcc #FOAMus #FOAMed #pocus

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@critconcepts

Critical Concepts

2 years

In a cohort of ICU patients with sepsis of unknown source, PET/CT imaging was able to identify the source in 66%, and 38% ultimately had a musculoskeletal cause (particularly spine). Hmm... #medtwitter #FOAMcc

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@critconcepts

Critical Concepts

1 year

@olsonplanner We spendin 180k on sausages and having a cookout this weekend

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@critconcepts

Critical Concepts

2 years

Forget ketofol… How come nobody is combining ketamine and dexmedetomidine? Directly balance a sympathomimetic with a sympatholytic to maintain a normal heart rate… both respiratory sparing… Enter dexetaminodine! Patent pending. #medtwitter #FOAMcc #FOAMed

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@critconcepts

Critical Concepts

1 year

hmm

@SamGoodhand

Sam Goodhand

1 year

Surprised how few people know this little “hack” for giving salbutamol down your asthmatic or COPD patient’s ET tube… 🫁 All you need is a 50ml syringe & their inhaler (disclosure - not my idea!) #medtwitter

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@critconcepts

Critical Concepts

10 months

An idea... tell me your take, #medtwitter friends: Accurate diagnosis is important, but focusing on it during admission to the ICU may be unreasonable due to the fog of resuscitation. To account for this, yet still encourage the transition from stabilization to diagnosis...

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@critconcepts

Critical Concepts

1 year

Micropunctures! 60 seconds on the little device that turns you into an access Jedi. #medtwitter #FOAMcc #FOAMed #meded #pulmcc

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@critconcepts

Critical Concepts

3 years

How often have you shocked A-fib with RVR in the setting of critical illness and seen it convert, without using other tools like antiarrhythmics? Over the years, I think I’m at 0%? ACLS is sweet sweet lies. #medtwitter #FOAMcc #FOAMed #CardioTwitter

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@critconcepts

Critical Concepts

4 years

So vital. Things should get calmer when you walk in the room. Take it down a notch. Much to learn from EMS here, where it's even more important. The paramedic Kelly Grayson likes to say: when you arrive, your demeanor should convey the message that the emergency is now over.

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@critconcepts

Critical Concepts

3 years

A new text with chapters on just about every procedure you might care to perform in an ICU. Chris Atkins and I wrote about placing dialysis catheters. Check it out! #medtwitter #FOAMcc #FOAMed #NephTwitter

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@critconcepts

Critical Concepts

3 years

@jtrebach Poison Control is the romantic ideal of the Good Consult. One call, you get a nice person, they tell you useful things without hedging, and they stick around as long as you need them. Oh, and it’s free, and they don’t clutter your chart with notes. So great.

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@critconcepts

Critical Concepts

2 years

Rib fixation… finally some data! @rbarbosa91 #FOAMcc #medtwitter

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Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries

This randomized clinical trial investigates if the surgical treatment of unstable chest wall injuries improves ventilator-free days and outcomes compared with nonoperative treatment.

jamanetwork.com

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@critconcepts

Critical Concepts

7 months

Predictions for 2024: EM will be nebulizing ketamine Paul Young will prove that progress notes don’t improve outcomes We all start ultrasounding tongues #medtwitter

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@critconcepts

Critical Concepts

5 years

The frustrating management of the obese ICU patient with mixed respiratory failure: Behold SARFO! Thanks to @gsmartinmd , @PulmCrit , and @MedEd_PA for putting their heads together. Let's hear your thoughts too! #FOAMed #FOAMcc #pulmcrit #medtwitter #ohs

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SARFO: The syndrome of acute respiratory failure in obesity

Have you seen these patients? I have, and I find them very challenging. In fact, it’s a sufficiently unique phenotype that I’ve started to think of them as a syndrome—let’s call i…

www.critcon.org

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@critconcepts

Critical Concepts

2 years

Findings: RV is dilated and clearly strained, reduced TAPSE + apical sparing (McConnell's sign). Wide open TR (not mentioned by many!). LV is hypertrophied and poorly filled, yet LVEF still reduced. Pericardial effusion, not significant. Points (🧵): #medtwitter #FOAMcc #FOAMed

@critconcepts

Critical Concepts

2 years

An echo case. 75m dialysis patient with bowel perforation. Ex-lap, resection, and extubated. 2L fluid given. Arrives in ICU on escalating norepinephrine doses. #POCUS shows the below. 1. What are the most key abnormalities? 2. How will you manage hemodynamics? #FOAMcc #FOAMus

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@critconcepts

Critical Concepts

4 years

I have a Lasix joke, but it tends to piss people off.

@rosieICM

Rosie Baruah

4 years

I have an ICU joke but I refuse to admit it.

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Critical Concepts

3 years

@DShadowgazer a sea arm

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@critconcepts

Critical Concepts

3 years

hmmm… in-plane ultrasound-guided supraclavicular subclavian lines better than infra? #FOAMcc #medtwitter

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@critconcepts

Critical Concepts

3 years

I increasingly think that most uses of push-dose pressors in my setting (ICU) are really cases you should have anticipated by hanging a pressor drip proactively. #medtwitter

@ThePeoplesRuben

Ruben Santiago, PharmD

@ThePeoplesRuben

3 years

Push-dose pressors are becoming more and more common in the ED in the management of the hypotensive patient. Check out my post on @CriticalCareNow discussing the pearls and pitfalls of push-dose pressors.

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@critconcepts

Critical Concepts

4 years

Okay folks, it's here... the Laws of Critical Care. I don't always get it right, but when I do, it's usually because I followed these. Share your own rules! #medtwitter #FOAMcc #FOAMed #pulmcc #physicianassistICU

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@critconcepts

Critical Concepts

3 years

Placing both central and art lines? Most of the time is in preparing equipment and establishing the field. Maximize efficiency with a shared, simultaneous prep. Here are some of the tricks! #medtwitter #FOAMcc #FOAMed #pulmcc @PulmCrit

The simultaneous line setup

Two of the most common bedside procedures in the ICU are placement of central venous catheters (for reliable venous access) and arterial catheters (for hemodynamic monitoring). Since both devices a…

www.critcon.org

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@critconcepts

Critical Concepts

6 years

@reepRN You should at least pick it up off the floor first.

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@critconcepts

Critical Concepts

2 years

@pathologiste08 Now I am intrigued by this traveling peddler of goods and potions

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@critconcepts

Critical Concepts

8 months

ileus is the delirium of the gut delirium is the A-fib of the brain ARDS is the sepsis of the lungs don't @ me #medtwitter

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@critconcepts

Critical Concepts

4 years

Increasingly, I find that the only medical belief I really respect is humility. No matter how well-founded your positions, there’s always a chance they are wrong. If you believe anything too strongly, you’re almost certainly wrong, a lot — and won’t ever believe it. #medtwitter

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@critconcepts

Critical Concepts

2 years

Very grateful to be accepted by the ACCM/ @SCCM as an FCCM as of Congress next year. This has been a crazy few months with a new baby, job, and house, and this is an incredibly welcome piece of good news to top it all off. Hope to see some of you in San Francisco! #medtwitter

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@critconcepts

Critical Concepts

3 years

@issypips @cliffreid Man vs beast (infection) Man vs time (degenerative diseases) Man vs randomness (cancer) Man vs himself (autoimmune)

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@critconcepts

Critical Concepts

4 years

@DGlaucomflecken The ability to pipette is what distinguishes a doctor from the haters, the cheaters, the jokers, the smokers, the fornicators, the butchers, the bakers, the renal dopaminers, the white-after-labor-dayers, the piss-in-the-winders, and my uncle Jeff, may all the gods damn him.

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@critconcepts

Critical Concepts

4 years

Please do not place orders on ICU patients without discussing with the ICU team. If it’s something wacky and they concur, they may beg you to place the order yourself. But for all you know they’re currently cracking their chest. These folks are too complicated for a free-for-all.

@JacobFlemingMD

Jacob Fleming, MD

@JacobFlemingMD

4 years

I've never understood the practice of a consultant telling the primary team what imaging/tests to order instead of just ordering them. Almost always the primary team has less knowledge of the specialized orders. Often the wrong thing gets ordered.

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@critconcepts

Critical Concepts

6 years

@MDaware @concernecus An optimist is someone who says things like "Fine V-fib" A pessimist is someone who says things like "Coarse asystole"

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@critconcepts

Critical Concepts

7 months

Reason for consult: need more codefendants

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@critconcepts

Critical Concepts

2 years

Overall: B agonists have no impact on positive ARDS outcomes, only negative ones. Stop it!

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@critconcepts

Critical Concepts

3 years

I've realized is that when I get along with my colleagues (attendings, nurses, surgeons, etc) -- mutual respect, friendliness, no toe-stepping -- the patient care seems to be better. Somehow I make better decisions, my guesses tend to be right, patients do better. #medtwitter

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@critconcepts

Critical Concepts

3 years

At this point in my career I have seen at least three Cordis (introducer sheath) lines extravasate during big resuscitations. They are just too short for deeper vessels/bigger patients. Can we all start using dialysis lines? What's the benefit here? #medtwitter #FOAMcc #FOAMed

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@critconcepts

Critical Concepts

10 months

I like driving pressure too, but it's been 8 years. Why don't we have an RCT yet comparing driving pressure-titrated tidal volume to the ARMA strategy? #medtwitter #FOAMcc #FOAMed #some4mv

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Driving Pressure and Survival in the Acute Respiratory Distress Syndrome | NEJM

Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (VT), and higher positive end-expiratory pressures (PEEPs) can improve survival in p...

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@critconcepts

Critical Concepts

4 years

@AvrahamCooperMD I'm all for patient autonomy, but this seems like creating a problem where none exists. There's nothing PC about it; you're ordering them to do something. I think few brain-injured patients are consciously choosing not to squeeze their hands as a demonstration of their rights.

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@critconcepts

Critical Concepts

2 years

why aren’t all tests like INR I don’t want to remember what a normal phenytoin level is, I just want a phenytoin ratio of normalness what’s the temp? oh it’s 1.3x normal

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@critconcepts

Critical Concepts

6 years

@DGlaucomflecken No, we usually intubate them while we come up with a plan. What's an exam?

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@critconcepts

Critical Concepts

4 years

@medevidenceblog @christifulli88 Endorse. Not all lung units are recruitable. The PEEP Prayer: “May Safar grant me the pressure to recruit the recruitable lung, the patience to tolerate that which is not recruitable, and the wisdom to know the difference.”

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@critconcepts

Critical Concepts

3 years

Steve Hollenberg: As PAP increases, CO is preserved until RV begins to fail, then PAP starts to decrease along with CO. So high PAP = hard to know whether you're on ascending or descending limbs. #medtwitter #FOAMcc #POCUS #CCC50 #pulmcc #physicianassistICU

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@critconcepts

Critical Concepts

2 years

@rbarbosa91 man, respect for taking a patient to the OR who'd been sick enough to get methylene blue though

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@critconcepts

Critical Concepts

2 years

Killing it with these infographics #medtwitter

@CritCultivation

Critical Cultivation

@CritCultivation

2 years

Candida be popping up everywhere in the ICU! Thank you @iBookCC for doing what you do. Because of you guys I am not as scared of candida. #MedTwitter #ICU #CriticalCare

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