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Ben Millette

@benmillette.bsky.social
295 followers 182 following 252 posts

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

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Ben Millette @benmillette.bsky.social · 07/10/2026
Rebel ridge, stranger things, one episode of ted lasso
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The Author, Séamas O'Reilly @seamas.bsky.social · 01/10/2026
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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Ben Millette @benmillette.bsky.social · 11/09/2026
Only 3 Vasopressors? They've missed a trick by not chucking in Methylene Blue and Hydroxocobalamin as well.
static.klipy.com
Hester Sunshine: Go As Hard As Possible
Alt: Hester Sunshine: Go As Hard As Possible
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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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Ben Millette @benmillette.bsky.social · 01/08/2026
Hard agree! In the UK/France they make driving significantly more pleasant. Just don't go to Swindon to take on this beast
Picture of the magic roundabout in Swindon
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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 · 19/07/2026
Interesting, I think this is analogous to the medical profession in that most people would like to meet and see the lives they are saving but if you really want to save the most lives you should get into public health where you will never meet or be credited with the lives you save
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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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Ben Millette @benmillette.bsky.social · 30/06/2026
Totally agree with all you've said, but there are some interesting edge cases in this sphere e.g. pubmed.ncbi.nlm.nih.gov/28661970/ Is this not done outside of China because a) it is not really available b) doesn't pass the sniff test or c) there is bias against TCM
pubmed.ncbi.nlm.nih.gov
Efficacy and Safety of Combination Therapy of Shenfu Injection and Postresuscitation Bundle in Patients With Return of Spontaneous Circulation After In-Hospital Cardiac Arrest: A Randomized, Assessor-...
This study demonstrates that Shenfu injection in combination with conventional postresuscitation care bundle treatment is effective at improving clinical outcomes in patients with return of spontaneou...
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Ben Millette @benmillette.bsky.social · 23/06/2026
static.klipy.com
Terry Crews from B99 asks WHY?!
Alt: Terry Crews from B99 asks WHY?!
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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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Ben Millette @benmillette.bsky.social · 13/06/2026
But then how will we know when to start metoclopramide?
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Ben Millette @benmillette.bsky.social · 12/06/2026
Interesting, but balance this against the weight of observational ICU data showing increasing positive fluid balance correlates with mortality
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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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Ben Millette @benmillette.bsky.social · 12/06/2026
Not if they're unintubated, which is the usual scenario I deploy this strategy in
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Ben Millette @benmillette.bsky.social · 12/06/2026
Very individualised depending on degree of acidosis, fluid status and whether they have a CVC or not. Our shop has a variety of concs from 1.26% to 8.4% and a few in between so we are spoilt for choice!
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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
Won't be surprised if the meta-memefication spirals into an absurd valuation, which then crashes a little further down the line
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Ben Millette @benmillette.bsky.social · 12/06/2026
Yeah agree. I am pretty much president of the bicarb fan club but trying not to let my priors colour my interpretations too much! Also find it quite useful for those with v high WOB due to acidaemia to mitigate subjective discomfort and reduce resp muscle O2 consumption
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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
But no trials have evaluated this "pH guided resuscitation" strategy as far as I am aware. @pulmcrit.bsky.social may know more
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Ben Millette @benmillette.bsky.social · 12/06/2026
Initial thoughts- Lots of potential patients in SODa-BIC who may have benefited from bicarb were excluded Formulation of bicarb varies quite a bit between trials. I use 1.26% for fluid resuscitation in those who need fluid and occasionally use higher concentrations in select other patients
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Ben Millette @benmillette.bsky.social · 12/06/2026
This adds to the complexity of interpreting the totality of bicarbonate evidence. Clearly not indicated for all comers for metabolism acidosis. But for NAGMA with mod-severe AKI there may be benefit. MOSAICC will help elucidate this
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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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Ben Millette @benmillette.bsky.social · 11/06/2026
Well, whether we need it or not, more data is coming 🤷. I think it will still be interesting to see if there are any differences across different health systems and slightly different inclusion criteria
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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
fundingawards.nihr.ac.uk/award/NIHR13... This trial
fundingawards.nihr.ac.uk
Search - NIHR Funding and Awards
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Ben Millette @benmillette.bsky.social · 11/06/2026
But that one doesn't fit my priors so it must be wrong 😜
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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
Will still be a couple of years before we get results of EVIS (and I believe there are one or two similar trials ongoing) Huge organisational implications if we get good evidence of pt centred benefit from early pressors!
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Ben Millette @benmillette.bsky.social · 11/06/2026
Link to paper: bsky.app/profile/jama... #CCR26
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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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Ben Millette @benmillette.bsky.social · 10/06/2026
V interesting. IMO Openevidence is one of the better ones that does a pretty good job of doing a targeted literature search in a fraction of the time it would take me to do (and providing supporting references, unlike some others). But it is no substitute for engaging your brain!
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Ben Millette @benmillette.bsky.social · 09/06/2026
static.klipy.com
Preach! Hallelujah Amen
Alt: Preach! Hallelujah Amen
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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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Ben Millette @benmillette.bsky.social · 09/06/2026
Fair points, all. Where would you lay your money on most likely trial to be positive?
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Ben Millette @benmillette.bsky.social · 08/06/2026
So many good trials reporting, gutted to not be there in person. V interested in MARCH results but I think likely to be null result. IMO SODA-BIC is the trial most likely to be positive
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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
Sometimes used to get more sleep on a night shift than when I was home with the baby... It's tricky to juggle sleep requirements esp with two on call rotas!
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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 · 12/05/2026
FRCA and FICM are already binning viva exams from next year. The writing has been on the wall for them for some time.
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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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Ben Millette @benmillette.bsky.social · 14/04/2026
Your analysis here ignores several ancillary factors affecting pay including the loss of free accommodation in 2008 and the increasing burden of student loan repayments
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Ben Millette @benmillette.bsky.social · 14/04/2026
RPI is used to calculate student loan repayment (Interest is RPI+3%) so there is a reasonable argument to be made to use it in this case, especially as many doctors won't even start paying down the balance of their student loans until they reach consultant ifs.org.uk/articles/how...
ifs.org.uk
How do Plan 2 student loans work, and how have they changed over time? | Institute for Fiscal Studies
Plan 2 student loans were issued to English students who started university between 2012 and 2022.
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