iiinova — where your digital self keeps evolving

Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 04/09/2026

Hypokalemic Cardiac Arrest -Critical to get stat lytes -No guideline recs on potassium dosing in these cases -My dose: 40 mEq IVP (have heard anywhere from 20-60 mEq) -Consider holding epinephrine as it pushes potassium into cells + can exacerbate hypoK youtube.com/shorts/lXvtA... #EMIMCC

youtube.com

Hypokalemic Cardiac Arrest #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 09/09/2026

Aortic Dissection Management Rally Consultants: CT surg, Cards, Vascular, IR POCUS for tamponade Anti-impulse therapy -Analgesia 1st -Anti-tachy tx: esmolol bolus + infusion w/ target HR 50-60 -AntiHTN tx: clevidipine/nicardipine w/ target SBP ~ 90-100 mm Hg youtube.com/shorts/3HF4u... #EMIMCC

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Aortic Dissection Management #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 17/08/2026

Rocuronium gives longer safe apneic time than succinylcholine -Sux causes fasciculations which eats your O2 reservoir -Data shows roc gives 45 seconds more safe apneic time (PMID: 2122686, 20402874) youtube.com/shorts/5JAjE... #EMIMCC

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Roc + Safe Apneic Time #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 12/08/2026

Ditch Cephalexin (Keflex) 4 times/day dosing -Fantastic oral abx for SSTI -Q6 dosing hard to remember leading to non-compliance Two alternate strategies: -Cephalexin 1000 mg Q12 (equally effective to Q6 dosing) -Cefodroxil 1000 mg Q24 youtube.com/shorts/-eLQA... #EMIMCC

youtube.com

Keflex Dosing #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 21/05/2026

I'll start- the neutrophil/lymphocyte ratio (NLR) substantially outperforms the WBC for detection of infection Using WBC as an indicator of infection made sense 50 years ago It's 2026, we have better lab instruments, & its time to move on from the WBC more on NLR here: emcrit.org/pulmcrit/nlr/

emcrit.org

PulmCrit: Neutrophil-Lymphocyte Ratio (NLR): Free upgrade to your WBC

introduction The neutrophil/lymphocyte ratio (NLR) has been gaining increasing attention across many fields of medicine within the past five years.

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 10/06/2026

Nicardipine: great for htn emergency but, can see transient hypotension even w/ slow titration -Key is to load + drip -Start 5 mg/hr + titrate up 2.5 mg/hr q5 min -When reach target BP, drop dose back to 5 mg/hr + retitrate infusion until get to steady state youtube.com/shorts/2F0-1... #EMIMCC

youtube.com

Nicardipine Titration #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 10/08/2026

Dangers of Intubation + Mech Vent in Severe Met Acidosis -Pt incr RR to blow down CO2 + maintain pH -Pt actively exhaling cutting down exhalation time -This doesn’t happen after you intubate + knock out respiratory drive -Expiration becomes passive + takes time youtube.com/shorts/ogYvW... #EMIMCC

youtube.com

Mech Vent in Met Acidosis #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 24/07/2026

Lethal Quadrad of Trauma: Hypothermia, Coagulopathy, Acidosis + HypoCa - HypoCa common in major trauma -Aggressive, prophylactic supplementation is key -Standard: 1 gm CaCl w/ 1st 2 units (don’t wait for level). Give another 1 gm CaCl w/ every additional 4 units youtube.com/shorts/43m17... #EMIMCC

youtube.com

Lethal Quadrad - HypoCa in Trauma #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 29/07/2026

Procainamide vs Amio in Stable VT -PROCAMIO (27354046) RCT comparing 2 agents -Amio: 32% more likely cause major adverse event(NNH = 3) -Procainamide 30% more likely convert patient(NNT = 3) but, only 67% conversion rate -Electricity 1st still best approach youtube.com/shorts/W9Kwe... #EMIMCC

youtube.com

Procainamide vs Amiodarone in Stable VT #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 17/06/2026

Phenobarbital a game changer in EtOH w/d -Option 1: No benzos given. Load 10 mg/kg over 30 min + wait 30 min for effect -Option 2: post-escalating BZD. Give phenobarbital 130 mg IV q15 until adequate sedation achieved -Early phenobarbital use can avoid intubation youtube.com/shorts/IMcT7... #EMIMCC

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Phenobarbital in EtOH Withdrawal #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 19/06/2026

Haloperidol is a Fantastic Multi-Tasker -Sedation of the agitated patient -Potent antiemetic particularly in gastroparesis (PMID 28320545) + CHS (PMID: 33160719) -Excellent in migraines (PMID 27510942) -Refractory sickle cell disease pain + chronic abdominal pain youtube.com/shorts/A5Ju5... #EMIMCC

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Haloperidol is Great #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 12/06/2026

Beta blockade in sepsis? -Early, tachycardia compensatory mechanism to increase CO + perfusion -Persistent tachycardia after resus may indicate exaggerated sympathetic response that can cause cardiac dysfunction youtube.com/shorts/nLmSy... #EMIMCC

youtube.com

Esmolol in Sepsis #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 21/05/2026

what is your best pearl, or most useful reference, about interpreting a complete blood count with differential? The blood count is one of the most commonly ordered tests in clinical medicine, but its subtleties are woefully overlooked. #EMIMCC

static.klipy.com

Inception: We Need To Go Deeper Meme with Leonardo DiCaprio

ALT: Inception: We Need To Go Deeper Meme with Leonardo DiCaprio

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 22/05/2026

ED Cardioversion of recent onset AF safe + effective in selected groups: -On AC > 3 weeks regardless of onset -Low risk by structured tool (CHADS-VASC) < 48 hours from onset -High-risk + presents < 12 hours from onset Low risk CHADS-VASC < 2 (men) < 3 (women) youtube.com/shorts/Xdpbk... #EMIMCC

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Which Recen-Onset AF Patients Can Get ED Cardioversion? #emergencymedicine

YouTube video by EMSwami

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Anthony Lau, PharmD BCPS @alaurx.bsky.social · 16/05/2026

We worry a lot about “too much Keppra” but in status epilepticus the greater risk may be underdosing the initial load. Neuropsychiatric adverse effects are largely linked to ongoing maintenance therapy, not a single appropriately dosed loading dose #emimcc #FOAMed #EMsky #RxSky

static.klipy.com

Jim Lake Jr: Why Isn't It Working?

ALT: Jim Lake Jr: Why Isn't It Working?

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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 06/05/2026

This dogma must stop being taught to clinicians and be put out to pasture as a relic of a bygone era in scientific literature. I love this 😍 What other dogmas should we retire? #idsky #microsky #EMIMCC

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 06/05/2026

everyone learns about TCA overdose in med school, but not bupropion XR overdose time to level up bupropion XR overdose is increasingly common & VERY dangerous ongoing drug absorption creates a "toxin bomb" wherein patients look OK initially, but deteriorate later on... (#1/2) #EMIMCC

static.klipy.com

CS:GO Bomb Defuse Timer Countdown Animation

ALT: CS:GO Bomb Defuse Timer Countdown Animation

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 04/05/2026

Propofol in RSI -Unlike ketamine + etomidate, propofol has intrinsic HD effects (vasodilation + cardiac depression) -If using in patients w/ even slight HD compromise, be careful w/ dosing -Can use reduced bolus dose or titrate in small aliquots youtube.com/shorts/p3aji... #EMIMCC

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Propofol in RSI #emergencymedicine #criticalcare #intubation #resuscitation

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 18/04/2026

medicine of the PITT: status epilepticus in pregnancy if you're using levetiracetam as your go-to antiseizure med (as most folks are), then the treatment is essentially the same as usual add Mg, but Mg prevents sz recurrence (rather than lysing active sz) #1/2 #EMIMCC

media.tenor.com

a man with a stethoscope around his neck is sitting in front of a sign that says " only time will tell "

ALT: a man with a stethoscope around his neck is sitting in front of a sign that says " only time will tell "

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 13/04/2026

Myth: Ketamine increases ICP in TBI ➡️worse outcomes -Myth originates from low quality data -Recent data shows ICP unchanged + CPP unchanged or slight incr -Ketamine advantages: more HD stable + physiologically may be beneficial -Bottom line: safe to use in TBI youtube.com/shorts/deykT... #EMIMCC

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Ketamine in TBI #emergencymedicine #criticalcare #trauma #intubation

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 14/04/2026

is there a reason that we don't use more IV glycopyrrolate for status asthmaticus? admittedly minimal direct evidentiary support, but makes sense & indirect evidence seems more benign than various alternative treatments (eg intubation, ECMO, extracorporeal CO2 removal). #EMIMCC

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 27/03/2026

Orthostatics worthless in assessing volume status -50% > 65 + 44% teens orthostatic at baseline(PMID 9109468, 12006955) -Perform poorly in known volume loss(PMID 8198307) -Useless in assessing those w/ fluid depletion from vomiting, diarrhea (PMID 10086438) youtube.com/shorts/Dvq5R... #EMIMCC

youtube.com

Orthostatics Are Useless in Assessing Volume Status #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 23/03/2026

Surviving Sepsis 2026 is here & it's even more loony tunes than I was expecting. They're promoting pre-hospital ABX & preemptive broad-spectrum IV antibiotics for intubated patients. This insane fever dream is an antimicrobial stewardship nightmare. Embarrassment for SCCM. #EMIMCC

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 24/03/2026

kudos to ACEP for calling out the Surviving Sepsis Campaign 2026 guidelines and not joining in this madness. ACEP is great at making evidence-based policies that actually *help* provide better patient care. When ACEP is politely burning your guideline, you’re in trouble. #EMIMCC

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Reposted by Anthony Lau, PharmD BCPS

Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 16/03/2026

One point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working: Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number! #emimcc #cccsky

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 16/03/2026

Sux Contraindications -Bumps K by ~ 0.5 mEq: Problem if ESRD/CKD + unknown K -Exaggerated incr K in malignant hyperthermia, motor neuron disease, muscular dystrophy, GBS -While these situations are uncommon, adds to cognitive load in high stress scenario youtube.com/shorts/kD2IK... #EMIMCC

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Succinycholine Contraindications #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 13/03/2026

Safe to give 3% hypertonic saline through a peripheral IV bit.ly/49t5GcI Retrospective study w/ 216 administrations of 3% by PIV + only 8 minor complications Bottom line: don’t delay 3% hypertonic administration for placement of a central line youtube.com/shorts/M5AyB... #EMIMCC

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Hypertonic Saline Via Peripheral IV #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 12/03/2026

The end of the road for rivaroxaban? Shows how important direct comparative trials among drugs within the same pharmacologic class are. #emimcc #cardiosky www.nejm.org/doi/full/10....

Kaplan-Meier plot showing the relative bleeding risk between rivaroxaban and apixaban over 90 days, clear separation and clearly higher risk from rivaroxaban

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Anthony Lau, PharmD BCPS @alaurx.bsky.social · 12/03/2026

Here's a DOAC–CYP interaction workaround. If DOAC is needed w/ CYP3A4 concerns, consider edoxaban. It’s <4% metabolized by CYP3A4 unlike apixaban, rivaroxaban & dabigatran (20-50%). Caveat..avoid if CrCl>95 mL/min...renal clearance is too efficient, reducing efficacy👇 #emimcc #medsky #hemesky #Rxsky

media.tenor.com

a woman is holding a cup of coffee and saying crisis averted .

ALT: a woman is holding a cup of coffee and saying crisis averted .

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 11/03/2026

Steroids in Asthma Exacerbations -Short course of steroids reduce ED revisits/admissions -Anti-inflammatory reduce bronchial inflammation + bronchospasm -Also upregulate beta receptors in lung incr sensitivity to inhaled beta agonists (effect kicks in in minutes) youtube.com/shorts/PopLV... #EMIMCC

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Steroids in Asthma #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 08/03/2026

New JAMA review attempts to equate pulmonary congestion with systemic congestion ("volume overload") This is sloppy & often wrong Pts w/ LV failure often have pulmonary congestion w/o systemic congestion Pts w/ RV failure usually have systemic congestion w/ dry lungs CVP isn't PCWP #EMIMCC

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Anthony Lau, PharmD BCPS @alaurx.bsky.social · 04/03/2026

For #PharmacyAwarenessMonth, I’m highlighting the role of EM pharmacists in cardiac arrest, traumas & intubations…one of many ways #pharmacists make a difference each day! Optimize #meds, ↓errors, improve lifesaving care timing. Proud to stand with dedicated pharmacists☺️💪🔥 #pharmacy #Rxsky #EMsky

This infographic highlights the critical role of Emergency Medicine Pharmacists in cardiac arrest, trauma resuscitation, and rapid sequence intubation. It demonstrates how pharmacists improve medication safety, optimize dosing and timing, and enhance adherence to evidence-based protocols during high-acuity emergencies. Overall, it showcases the impact of pharmacists in strengthening resuscitation teams and improving patient care when seconds matter most.

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Anthony Lau, PharmD BCPS @alaurx.bsky.social · 03/03/2026

Happy Pharm Awareness Month #PAM2026 to my incredible pharmacy colleagues in Canada & around the🌏! Proud to be a pharmacist alongside such dedicated colleagues. The work we do isn’t always easy but it matters...every💉💊, every💬, every🤒we help. Grateful to be in this with all of you 🙏 #pharmsky #RxSky

media.tenor.com

a man wearing glasses is praying with the words thank you behind him

ALT: a man wearing glasses is praying with the words thank you behind him

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Reposted by Anthony Lau, PharmD BCPS

Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 27/02/2026

🔥Just published 🔥 TAPER-V RCT In this RCT of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to a standard 2-week pulse regimen in patients a first episode or first recurrence of CDI Vanco for 10d is obsolete! #IDSky #EMIMCC jamanetwork.com/journals/jam...

jamanetwork.com

Initial Vancomycin Taper for the Prevention of Recurrent C difficile Infection

This randomized clinical trial tested whether a 4-week pulse and taper vancomycin regimen was superior to a 2-week pulse regimen for preventing recurrence among patients with a first episode or first ...

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 13/02/2026

Insulin bolus typically not necessary in DKA but, consider if: Delay in getting insulin drip from pharamacy. Severe acidosis: reach therapeutic levels faster + fix the acidosis faster Bolus dose: 0.1 U/kg youtube.com/shorts/pYybS... #EMIMCC

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Insulin Bolus in DKA #criticalcare #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 09/02/2026

Fresh Blog: Mythbusting the use of beta-blockers for sinus tachycardia in thyroid storm This is one of the most dangerous & pervasive myths currently in circulation about acute care B-bl commonly precipitate shock or even arrest in these patients...(#1/2) blog: emcrit.org/pulmcrit/tst... #EMIMCC

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Reposted by Anthony Lau, PharmD BCPS

Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 09/02/2026

There are few absolute rules in medicine but «never treat sinus tachycardia, treat the cause» has extremely few exceptions. #emimcc #cardiosky #medsky

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Reposted by Anthony Lau, PharmD BCPS

Anthony Lau, PharmD BCPS @alaurx.bsky.social · 27/01/2026

1/🧵what happens after stopping #glp1 agonists like #semaglutide (#Wegovy #Ozempic) or tirzepatide (#Mounjaro #Zepbound)? Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle

media.tenor.com

a man with a beard is smiling and looking through a hole in a door .

ALT: a man with a beard is smiling and looking through a hole in a door .

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Anand Swaminathan @emswami.bsky.social · 30/01/2026

Avoid crystalloid in hemorrhagic shock -May incr BP but not O2 carrying -Dilute Hgb + clotting factors -Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting Patients don’t bleed crystalloid so don’t give crystalloid youtube.com/shorts/QltA6... #EMIMCC

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Crystalloids in Hemorrhagic Shock #criticalcare #emergencymedicine #trauma

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 30/01/2026

The new 2026 AHA/ASA stroke guidelines include this table 👇 for the management of thrombolytic-induced angioedema. There is NO discussion or any additional text about this topic. I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC

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Reposted by Anthony Lau, PharmD BCPS

Anand Swaminathan @emswami.bsky.social · 28/01/2026

Bicarb Pushes -Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient) -Salicylism: alkalinizes urine incr toxin excretion -HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available youtube.com/shorts/gQrwA... #EMIMCC

youtube.com

Bicarb Pushes Utility #criticalcare #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 24/01/2026

Had a great time running workshop on cardiogenic shock/critical care cardiology for early career cardiology trainees yesterday. A repeat question was wether I have a blood pressure limit for when I give diuretics. I don’t. If the patient is truly volume overloaded, the bp won’t ⬇️ from the diuretic

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Anand Swaminathan @emswami.bsky.social · 23/01/2026

No role for bicarb pushes in metabolic acidosis -Bicarb only incr pH if incr ventilation -Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2 -Intubating unlikely to help -Bicarb pushes will worsen acidosis if not increasing ventilation youtube.com/shorts/uS2VN... #EMIMCC

youtube.com

Bicarb Pushes + Acidosis #criticalcare #emergencymedicine

YouTube video by EMSwami

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Reposted by Anthony Lau, PharmD BCPS

josh farkas 💊 @pulmcrit.bsky.social · 06/01/2026

antiseizure medications has a PK/PD profile similar to beta-lactam antibiotics: -efficacy relates to the trough level -toxicity relates to the peak level so benefit/risk ratio is maximized with smaller, frequent dosing hard to do outside the hospital re: adherence but easy to do for inpatients

media.tenor.com

a close up of a woman 's face with her eyes closed and her mouth open .

ALT: a close up of a woman 's face with her eyes closed and her mouth open .

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Anthony Lau, PharmD BCPS @alaurx.bsky.social · 02/01/2026

In ICH, should we be cautious w/ hydralazine for BP control? Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect Thoughts? #EMsky #EMIMCC #neurosky #pharmsky

media.tenor.com

a man in a suit is taking his blood pressure with a device that says tcm

ALT: a man in a suit is taking his blood pressure with a device that says tcm

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Anthony Lau, PharmD BCPS @alaurx.bsky.social · 02/01/2026

media.tenor.com

a man in a suit is taking his blood pressure with a device that says tcm

ALT: a man in a suit is taking his blood pressure with a device that says tcm

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