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Ben Millette

@benmillette.bsky.social
293 followers 182 following 251 posts

Consultant in Intensive Care and Anaesthesia. POCUS, Antibiotic stewardship, MedEd, Cinema and Mexican food

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Reposted by Ben Millette
The Author, Séamas O'Reilly @seamas.bsky.social · 17h
If you're in my GP's office any time soon, prepare yourself for what many are calling the greatest mnemonic of all time. Come for E and P, but sit down and clap for I.
A screen in my GP's office advertising a mnemonic of signs to spot SEPSIS.

S slurred speech of confusion 
E extreme shivering or muscle pain 
P passing no urine all day
S severe breathlessness
I ot feels like you are going to die
S skin mottled or discoloured
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Christos Chamos @hamos1977.bsky.social · 09/09/2026
This.is.not.an.artefact. (Context to follow). #ifyouknowyouknow #echofirst #cardiosky #ansky #echosky
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Seth Trueger @mdaware.org · 28/07/2026
according to his prior predictions, Tesla should have had fully autonomous cars since… 2017, 2018, and 2019, plus a Mars Colony since 2024, so I do not think this a reason to be bearish on med school en.wikipedia.org/wiki/List_of... www.aol.com/articles/10-...
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Ben Millette @benmillette.bsky.social · 28/07/2026
journal.chestnet.org/article/S001... POCUS has a lower diagnostic yield than CT post arrest but actually identifies the cause of arrest as often as CT (and much more quickly...)
journal.chestnet.org
Diagnostic Yield of CT Imaging and Point-of-Care Ultrasound After In-Hospital Cardiac Arrest
Our results show that among survivors of IHCA, CT imaging and POCUS frequently identified new pathologic features, including suspected arrest causes, with subsequent management changes in a substantia...
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Ben Millette @benmillette.bsky.social · 16/07/2026
Point of care D dimer in space? I guess interesting from a research perspective but maybe not the most useful medical investigation to have on the ISS! theijf.org/brief/blood-...
theijf.org
Canadian device soon to test for blood clots in space
A made-in-Canada device that can detect blood clots in astronauts is expected to launch into orbit this fall, the Canadian Space Agency confirmed.
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josh farkas 💊 @pulmcrit.bsky.social · 21/06/2026
Fresh Blog: Is oseltamivir assassinating ICU patients? ☠️ The REMAP-CAP trial has concluded with >98% certainty that oseltamivir is killing patients. ☠️ This is an extraordinary claim that requires extraordinary evidence. #1/2... #EMIMCC
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Andy Conway Morris @andymoz78.bsky.social · 12/06/2026
Important study of real-world use of rapid respiratory diagnostics. Encouragingly, pace INHALE, no signal to harm in the intervention group (indeed signal to benefit in those with panel-detectable organisms on culture).
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 11/06/2026
Counterpoint: Treat fluids like the drugs they are, especially considering Give the right one for the right patient. Hyperkalemia? Avoid NS Hypochloremia? Give NS (Traumatic) brain injury? Give NS Hyperkalemia and fluid overload? Give furosemide Etc.
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Ben Millette @benmillette.bsky.social · 12/06/2026
Take home messages so far from #CCR26 1. Stop routine carbocisteine/HT saline nebs- no benefit & may be harmful 2. Stop prescribing oseltamivir in critically unwell flu- it probably kills patients 3. Don't use bicarb in ❤️ arrest or for 'all comers' with metab acidosis but may be useful in some circs
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Ben Millette @benmillette.bsky.social · 12/06/2026
Fascinating results of SODa-BIC trial at #CCR26 - no difference in primary outcome of MAKE-30. Well done to the triallists- first double blind bicarb trial! Marlies Ostermann doing a great job of putting these results in context with previous and ongoing studies www.nejm.org/doi/full/10....
A table showing a comparison of different bicarbonate trials
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 11/06/2026
Yes Just give whatever crystalloid you have in your cupboard. Don’t give colloids.
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Ben Millette @benmillette.bsky.social · 11/06/2026
Interesting results from the FISSH trial at #CCR26 ! No difference in mortality overall but some signal for benefit for balanced crystalloid in patients with AKI, esp those with Stage 2 or 3 AKI Have we now had enough fluid trials comparing NS and balanced crystalloid? 🤔
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Ben Millette @benmillette.bsky.social · 11/06/2026
I will never understand the seeming widespread enthusiasm internationally for giving bicarb in cardiac arrest. I have almost never seen this in UK practice and there's little evidence to support it. Why is this a thing???
static.klipy.com
Paul Rudd Confused Reaction
Alt: Paul Rudd Confused Reaction
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Ben Millette @benmillette.bsky.social · 10/06/2026
Jaw-dropping results from REMAP-CAP- oseltamivir domain today. I believe this is the first randomised evidence for oseltamivir in the critically unwell. No evidence of benefit and 98% probability of harm 🤯🤯🤯 #CCR26
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 10/06/2026
So is it finally dead yet, or do we need precision medicine to identify vitamin C responders? (This is sarcasm)
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Ben Millette @benmillette.bsky.social · 10/06/2026
Wow! MARCH trial results show no significant benefit for hypertonic saline and carbocisteine in ventilated ICU patients, and significant harm associated with both. Very well done to all of the investigators! www.nejm.org/doi/full/10.... #CCR26
nejm.org
Carbocisteine or Hypertonic Saline for Acute Respiratory Failure | NEJM
Mucoactive agents are widely used in patients with acute respiratory failure despite limited evidence of their effectiveness or safety. We conducted a multicenter, open-label, randomized trial with...
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Ben Millette @benmillette.bsky.social · 10/06/2026
Interesting! This is at odds with the ICU ROX subgroup results...
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Mark Borthwick @markborthwick.bsky.social · 08/06/2026
41% of ventilated patients receive a mucoactive agent If you exclude (prescribed) NaCl 0.9%, it’s 27% of all ventilated patients pmc.ncbi.nlm.nih.gov/articles/PMC... MARCH will change practice whichever way it goes
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 08/06/2026
#ccr26 is this week. Sadly can’t attend so will be following the live stream. Anyone got any interesting predictions to make? I’m expecting a surge of interest in bicarbonate… #emimcc #foamcc
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JAMA @jama.com · 03/06/2026
💡 JAMA Insights: #POCUS by trained clinicians is a guideline-endorsed alternative to chest #radiography for #pneumonia diagnosis, offering higher sensitivity and specificity, immediate results, and no ionizing radiation. ja.ma/4xbZ9QI
JAMA Insights: "Point-of-Care Ultrasound for the Diagnosis of Pneumonia" by Kumar & Le. Six grayscale ultrasound images (A-F) show normal lung, B-lines, subpleural consolidation, lobar consolidation, air bronchogram, and effusion. A table lists sonographic criteria with pooled sensitivity and specificity.
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Ben Millette @benmillette.bsky.social · 18/05/2026
Strong opinion of the day: there seems to be a trend for presenting slideshows online in 'normal view' (I.e. in editing mode) Please stop doing this!🙏🙏🙏 It's just awful
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Ben Millette @benmillette.bsky.social · 08/05/2026
Seems open evidence is no longer available in Europe 😭 Anyone have suggestions for a suitable replacement- reliable and transparently-evidenced medical AI
We are sorry, open evidence is not available in your location at this time
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💉Josh Rubin, MD @drsandman11.medsky.social · 10/04/2026
Inglourious Basterds meme, with “medical shows” as Michael Fassbender holding up 3 fingers, with “health care workers” as the German officer looking on skeptically
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Ben Millette @benmillette.bsky.social · 08/04/2026
Only just learned this great fact- the white crust on cheeses like brie and camembert is actually penicillium mold! Only produces trivial amount of penicillin so cross reactive allergies are very rare en.wikipedia.org/wiki/Penicil...
media.tenor.com
two pieces of cheese are sitting on a wooden table and the words food and wine are on the bottom
Alt: two pieces of cheese are sitting on a wooden table and the words food and wine are on the bottom
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josh farkas 💊 @pulmcrit.bsky.social · 30/03/2026
Fresh blog on the HI-PEITHO trial 😁 🔊 ~18 mg alteplase over 7 hrs is safe (no ICH, no difference in bleeding rates) 🔊 Alteplase reduces the risk of cardiopulmonary decompensation and poor functional outcomes #1/2 #EMIMCC
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 30/03/2026
There are lots of ongoing studies The PRECARE study from Sydney suggested malposition 89% of the time pubmed.ncbi.nlm.nih.gov/40090608/m
resuscitationjournal.com
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Damien BARRAUD @damienbarraudmd.bsky.social · 30/03/2026
#TEElovers @drfreeze.bsky.social @thinkingcc.bsky.social @load-dependent.eurosky.social any thoughts ? jamanetwork.com/journals/jam...
jamanetwork.com
Transesophageal Echocardiography During CPR in Patients With Out-of-Hospital Cardiac Arrest
This randomized clinical trial tests whether the use of transesophageal echocardiography during cardiopulmonary resuscitation (CPR) increases the rates of sustained return of spontaneous circulation a...
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 28/03/2026
The plot thickens @pulmcrit.bsky.social
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Ben Millette @benmillette.bsky.social · 25/03/2026
Any consultants who find their sympathy for resident doctors waning in the wake of the newly announced strike action would do well to read the conditions of their current student loan repayments. If you don't find it monstrously unjust, you don't understand it.
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Shai @shaiuk.bsky.social · 25/03/2026
I wonder if it means that when PCT tells us the high NEWS2 is not sepsis, we think a bit harder. The need for more study into the outcome won’t identify this unless we have sufficient granularity (of clinical reason). “When the PCT is ⬇️, we find ⬆️ time is spent with the patient, with more DDxs”
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Ben Millette @benmillette.bsky.social · 25/03/2026
This study is a real headscratcher. None of the other studies of PCT in ED have shown any benefit so my priors lean towards not believing it. But even so... www.thelancet.com/journals/lan...
thelancet.com
Procalcitonin testing combined with NEWS2 evaluation compared with usual care based on NEWS2 for identification of sepsis and antibiotic initiation in the emergency department in England and Wales (PR...
Making a procalcitonin-guided algorithm available to clinicians in emergency departments did not change intravenous antibiotic initiation at 3 h in patients managed as suspected sepsis, but a decrease...
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NEJM.org @nejm.org · 17/03/2026
Presented at #ISICEM: In a multicenter trial involving patients with acute hypoxemic respiratory failure, 28-day mortality with high-flow oxygen was not significantly different from that with standard oxygen. Full SOHO trial results: www.nejm.org/doi/full/10.... @isicem.bsky.social
45th International Symposium on Intensive Care and Emergency Medicine 
Original Article | Mar 17, 2026 | NEJM.org 

High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure (SOHO) 

Figure 2A. Overall Survival.
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Seth Trueger @mdaware.org · 16/03/2026
commentary by @zentensivist.bsky.social in @jamanetworkopen.com on the safety of peripheral pressors: "PIV administration of vasopressors likely can be accomplished safely, with perhaps less discomfort and harm, compared with conventional CVC-based approaches in some critically ill patients."
jamanetwork.com
Peripheral Vasopressors for Shock
Interest in the use of peripheral intravenous (PIV) catheters to administer vasoactive medications to patients in shock has grown in recent years. Potential benefits include faster shock reversal as w...
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 12/03/2026
Paediatric and adult Neuro POCUS: The UK Accreditation Pathway New article demonstrating the latest addition to #FUSIC in the UK journals.sagepub.com/doi/10.1177/... #POCUS #medsky
journals.sagepub.com
Paediatric and adult neurological point-of-care ultrasound: Review of the evidence, and the UK accreditation pathway - Manprit Waraich, Bogdana Zoica, Emma Alexander, Jennie Stephens, Hannah Conway, M...
Neurological emergencies such as stroke and traumatic brain injury are major contributors to morbidity and mortality in critically ill patients. These condition...
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 10/03/2026
Found on the other place Terrifyingly accurate davetriska.substack.com/p/the-long-s...
davetriska.substack.com
The Long Silent Scream into the NHS
I’ve been in hospital with a relative this week.
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josh farkas 💊 @pulmcrit.bsky.social · 06/03/2026
Link to fresh blog below The trial surely has limitations, but it's been increasingly clear that catheter-directed thrombolysis is silly for over a decade now TBH, this is a wild story about device manufacturers using sponsored RCTs to torture EBM emcrit.org/pulmcrit/cdt/
emcrit.org
PulmCrit: Catheter-directed lysis = Peripheral lysis for PE (STRATIFY trial!)
Catheter-directed thrombolysis for PE has always been a silly idea, for numerous reasons: Clots are widely distributed throughout both lungs. 100% of the
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Ben Millette @benmillette.bsky.social · 03/03/2026
The enormous unfairness in the current system is demonstrated by the modeling done by the IFS here. Many medical students have loans of £70-100k and won't actually start paying down their loans for many years ifs.org.uk/articles/how...
A visualisation depicting how student loans amounts change depending on loan amount and salary
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Shai @shaiuk.bsky.social · 26/02/2026
It may well remain the most realistic medical TV show….
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Luc Rocher @rocher.lc · 09/02/2026
⚠️ Despite all the hype, chatbots still make terrible doctors. Out today is the largest user study of language models for medical self-diagnosis. We found that chatbots provide inaccurate and inconsistent answers, and that people are better off using online searches or their own judgment.
Banner image with screenshot of scientific article from nature Medicine, as well as two panels from the study method and results
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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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Segun Olusanya (He/Him) @drfreeze.bsky.social · 07/02/2026
Refractory septic shock: our pragmatic approach AKA the “Tommy’s Tonic” Now updated for 2026 link.springer.com/content/pdf/... Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social
link.springer.com
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Ben Millette @benmillette.bsky.social · 04/02/2026
Great discussion here that reminds me of the old medtwitter
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Ben Millette @benmillette.bsky.social · 03/02/2026
This year's scoring matrix for ICM ST3 applications contains 3 references to POCUS. Looks like we think this is important for the practice of ICM and maybe should be on the curriculum? 🤔
Intensive care medicine ST3 scoring matrix that references POCUS multiple times
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 15/01/2026
Fantastic to see this published at last An objective assessment of the efficacy of home pulse oximeters on different skin tones Ping @iwashyna.bsky.social Open to comments from all #foamed #medsky www.bmj.com/content/392/...
bmj.com
The impact of skin tone on performance of pulse oximeters used by NHS England COVID Oximetry {at}home scheme: measurement and diagnostic accuracy study
Objectives To assess the impact of skin tone on the measurement and diagnostic accuracy of five fingertip pulse oximeters used by patients in the NHS (National Health Service) England COVID Oximetry {...
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Dr. Casey Fiesler @cfiesler.bsky.social · 05/12/2025
I mean we are absolutely in a place now where the only solution to this information disorder is for everyone to constantly evaluate the source of information. Never trust a chatbot, but also don't believe a video unless you know and trust where it comes from. Unfortunately... that's a lot of work.
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 22/12/2025
I used to think lung was quite widespread Then I looked at NEAT-ECHO again and did the math Remember that with FUSIC heart any cardiac physiologist can be a supervisor- this hugely increases the pool…
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Ben Millette @benmillette.bsky.social · 22/12/2025
Am I alone in being surprised by how dominant Heart is over all the other FUSIC modules? I feel like Lung is the low hanging fruit, accessible to a wider range of professionals esp AHPs. Is there better provision of Heart mentors or is it just sexier? #pocus #emimcc
New accreditation registrations: Top three modules: 756 Heart 380 Lung 59 Cactus Lung
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Ben Millette @benmillette.bsky.social · 21/12/2025
It really is remarkable how much better flow through the hospital is on strike days. Maybe having a few more senior decision makers around on normal days will pass a cost benefit analysis?
media.tenor.com
a man is standing in front of a whiteboard with the words nice flow written on it
ALT: a man is standing in front of a whiteboard with the words nice flow written on it
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NEJM.org @nejm.org · 10/12/2025
In a randomized trial involving critically ill patients undergoing intubation in EDs or ICUs, the use of ketamine for the induction of anesthesia did not lead to significantly lower in-hospital mortality than etomidate. Full trial results: nej.md/44EOlxB @criticalcarereviews.com
CCR Down Under 2025 
Original Article | Dec. 9, 2025 | NEJM.org 
Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults 

Figure 1. In-Hospital Death, According to Trial Group. 

The NEJM identity sits at the bottom.
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josh farkas 💊 @pulmcrit.bsky.social · 24/11/2025
Trimethoprim-sulfamethoxazole carries a very low (but real) risk of causing ARDS. Duration of therapy is a risk factor (>7 days). Could likely be minimized by avoiding unnecessarily long courses. TMP-SMX is usually well tolerated, but can wreak havok (SJS, ARDS, drug-induced meningitis). #EMIMCC
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