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CriticalCareNow

@criticalcarenow.bsky.social
844 followers 21 following 1.3K posts

Educator.Physician

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CriticalCareNow @criticalcarenow.bsky.social · 2h
Your submassive PE patient just dropped their sat to 88% and HR crossed 100. Cheyenne Falat, MD from ResusX:2026: Do you call the PERT team now or wait? These are cutoffs that can trigger escalation. What's your institution's protocol? Drop it below.
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CriticalCareNow @criticalcarenow.bsky.social · 4h
Febrile. Weak for days. Passes out driving. Joshua Rempell, MD from ResusX:2026: You're expecting a cardiac etiology on echo, but CT confirms aortic injury. How do you untangle the timeline at the bedside? Comment with your approach.👇
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CriticalCareNow @criticalcarenow.bsky.social · 7h
Portal vein US shows pulsatility; what's your read? Sharad Patel, MD (@msmsharad) from ResusX:2026: Normally that flow is flat. Pulsatility = liver engorgement + venous congestion. What's your next move? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 22h
Hypoxic cancer pt, soft pressures, and a note saying "scan for PE." Anand Swaminathan, MD (@emswami) from ResusX:2026: You grab the US and find tamponade. No heparin. No tube. Straight to pericardiocentesis. Has anchoring bias ever nearly changed your management? Discuss below.
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CriticalCareNow @criticalcarenow.bsky.social · 05/10/2026
Submassive PE + recent head bleed. Do you anticoagulate? Cheyenne Falat, MD from ResusX:2026: The case for early PERT involvement is stronger than most realize. What does your unit do in this situation? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 05/10/2026
MAP is 55. You grab the ultrasound probe. Joshua Rempell, MD from ResusX:2026: Do you run a protocol start to finish, or let your differential drive where you look first? Comment how your unit handles this.👇
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CriticalCareNow @criticalcarenow.bsky.social · 05/10/2026
Diffuse B lines on lung ultrasound at the bedside. How far is this patient from euvolemia? Sharad Patel, MD (@msmsharad) from ResusX:2026: One marker isn't enough. What's your full congestion assessment before you decide how aggressively to diurese? Drop your approach.👇
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CriticalCareNow @criticalcarenow.bsky.social · 04/10/2026
Submassive PE + recent head bleed. You're not sure if you can anticoagulate. Cheyenne Falat, MD from ResusX:2026: Who do you call? The AHA now says this is exactly when PERT gets involved. How does your unit handle it? Comment below.👇
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CriticalCareNow @criticalcarenow.bsky.social · 04/10/2026
Unstable patient, wide-open differential, clock ticking. Joshua Rempell, MD from ResusX:2026: Are you reaching for POCUS early enough to matter? What does your bedside approach actually look like? Comment and let's compare notes.👇
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CriticalCareNow @criticalcarenow.bsky.social · 04/10/2026
Still diuresing and not sure how far you have to go? Sharad Patel, MD (@msmsharad) from ResusX:2026: E/e', IVC, lung US; get 2 of 3 pointing the same way and you have your answer. What's your bedside approach to gauging congestion? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 03/10/2026
Your patient with a PE is decompensating, and the guidelines are gray. Cheyenne Falat, MD from ResusX:2026: Who are you calling to get a consensus plan STAT? What's your institution's approach? Let's discuss.
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CriticalCareNow @criticalcarenow.bsky.social · 03/10/2026
Patient's hypotensive, etiology unknown, you grab the probe. But a multicenter trial says POCUS didn't change mortality at all. Joshua Rempell, MD from ResusX:2026: Does that shift your bedside approach? Comment and let's talk it through.
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CriticalCareNow @criticalcarenow.bsky.social · 03/10/2026
Your patient is volume-overloaded. How fast do you pull fluid? Sharad Patel, MD (@msmsharad) from ResusX:2026: The speed limit is set by the vascular refilling rate. How do you gauge that ceiling at the bedside? Drop your approach below.
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CriticalCareNow @criticalcarenow.bsky.social · 03/10/2026
Your high-acuity PE patient is in the ICU. PERT data shows mortality and bleeding kept improving year over year, not just at program launch. Cheyenne Falat, MD from ResusX:2026: Are you activating your PERT team on every sick one? How does your unit handle this?
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CriticalCareNow @criticalcarenow.bsky.social · 02/10/2026
MAP dropping, patient barely responsive. Joshua Rempell, MD from ResusX:2026: You grab the probe and the IVC is nearly invisible with a hyperdynamic LV. What's your next move? How do you manage this at your institution? Comment below.👇
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CriticalCareNow @criticalcarenow.bsky.social · 02/10/2026
Your ICU patient is congested but also on pressors. Sharad Patel, MD (@msmsharad) from ResusX:2026: How do you determine the "just right" rate to remove fluid without worsening their shock? What's your first move and what do you monitor? Share your bedside strategy below.
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CriticalCareNow @criticalcarenow.bsky.social · 02/10/2026
Your team is bagging a code pt way too fast. Do you intervene? Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: Hyperventilation raises intrathoracic pressure and kills preload in an already empty ventricle. 10 breaths/min, that's the target. What do you do at your shop?
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CriticalCareNow @criticalcarenow.bsky.social · 02/10/2026
PERT activation in PE: does it increase or decrease IVC filter use? And which advanced therapy decision stays with the bedside physician regardless? Cheyenne Falat, MD from ResusX:2026: Test yourself, then comment with your answer.👇
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CriticalCareNow @criticalcarenow.bsky.social · 01/10/2026
Trauma bay. Hypotensive, hypoxic, tachypneic. Joshua Rempell, MD from ResusX:2026: Team's ready to act, then POCUS shows a pericardial effusion. Do you pivot your whole management? What's your next move? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 01/10/2026
Patient not responding to Lasix. You switch to Bumex and they flood. Sharad Patel, MD (@msmsharad) from ResusX:2026: Was it the drug, or did you just multiply the dose without realizing it? How do you approach loop diuretic escalation? Comment below.
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CriticalCareNow @criticalcarenow.bsky.social · 01/10/2026
Young penetrating trauma. Cardiac arrest. Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: Your team starts compressions, but the ventricles are empty and output is zero. What does your unit actually do? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 01/10/2026
MAP tanking. Massive PE confirmed. PERT isn't reachable yet. Cheyenne Falat, MD from ResusX:2026: Do you lyse now or wait for the team? There's no clean algorithm for this. What's your move? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 30/09/2026
Hypotensive patient, probe in hand. Joshua Rempell, MD from ResusX:2026: Are you running a structured US exam or just winging views? Does your team actually follow a specific protocol? Tell us what bedside ultrasound looks like in your unit.👇
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CriticalCareNow @criticalcarenow.bsky.social · 30/09/2026
Hypotensive vented patient, no echo available. Sharad Patel, MD (@msmsharad) from ResusX:2026: Did you know your vent screen is already tracking a volume responsiveness signal? A greater than 5% EtCO2 rise = fluid responder. How do you use this at your bedside? Comment below.👇
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CriticalCareNow @criticalcarenow.bsky.social · 30/09/2026
Unstable pelvis. Open fractures. Traumatic arrest. Your EMS crew wants to work the airway on scene. Do you let them? Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: This is the call that changes outcomes. What would you do? Comment below.
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CriticalCareNow @criticalcarenow.bsky.social · 30/09/2026
Tachy. Hypotensive. Hypoxic. Tachypneic. Cheyenne Falat, MD from ResusX:2026: All four at once; what's your lead diagnosis? Septic shock, PE, cardiogenic, tension pneumo? Drop your answer and let's discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 29/09/2026
You're at the bedside of a crashing, hypotensive patient. Joshua Rempell, MD from ResusX:2026: Do you trust your POCUS findings to guide immediate therapy, even if the data shows no mortality benefit? What's your protocol? Comment to discuss.
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CriticalCareNow @criticalcarenow.bsky.social · 29/09/2026
Admitting a CHF exacerbation and the pt's on 80mg PO Lasix at home. Sharad Patel, MD (@msmsharad) from ResusX:2026: Do you match it via IV or increase? The 2.5x rule says 200 mg IV. Uncomfortable number, but under-diuresing has consequences too. How does your team approach this?
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CriticalCareNow @criticalcarenow.bsky.social · 29/09/2026
Family is recording on their phones as you call it. Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: The team knows CPR is futile, but does that change your decision? What would you do at that bedside. Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 29/09/2026
It's 2 AM and you need rapid consensus from 3 different services on a complex patient with ambiguous guidelines. Cheyenne Falat, MD from ResusX:2026: What’s your first move to get everyone on the same page? Share your strategy in the comments.
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CriticalCareNow @criticalcarenow.bsky.social · 28/09/2026
RV looks massive on echo. D-sign present, IVC dilated without variation. What's the diagnosis? Joshua Rempell, MD from ResusX:2026: Normal RV is ~60% of LV. When that ratio flips, you should know exactly why. Drop your answer below.
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CriticalCareNow @criticalcarenow.bsky.social · 28/09/2026
What happens when your decongestion rate exceeds the max refilling rate? Sharad Patel, MD (@msmsharad) from ResusX:2026: It's more than just hypotension. Think ischemia, diastolic dysfunction, and end-organ damage. What's your answer here? Comment to discuss.
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CriticalCareNow @criticalcarenow.bsky.social · 28/09/2026
Trauma patient loses pulses in your bay. Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: Do you run a standard ACLS code, or does the physiology change everything? The pump is empty. What's your next move? Comment to discuss.
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CriticalCareNow @criticalcarenow.bsky.social · 27/09/2026
Non-compressible femoral vein + intraluminal echogenicity. What's your diagnosis? Joshua Rempell, MD from ResusX:2026: This is a bread-and-butter DVT finding at the bedside. What's the highest-yield location to compress first? Comment with your answer.
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CriticalCareNow @criticalcarenow.bsky.social · 27/09/2026
Vasopressor-dependent, ARDS, AKI, and a huge fluid balance. Sharad Patel, MD (@msmsharad) from ResusX:2026: How aggressively do you pull fluid off, and how do you know when to back off? Comment with what you do at your institution.
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CriticalCareNow @criticalcarenow.bsky.social · 27/09/2026
Pulseless GSW pt in front of you. Your instinct says start CPR, but what if decompressing the chest brings them back first? Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: This case is a gut-check on your trauma arrest sequence. What's your first move? Comment below.
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CriticalCareNow @criticalcarenow.bsky.social · 27/09/2026
Undifferentiated patient, clock ticking. Do you grab the ultrasound probe right away or wait for labs? Joshua Rempell, MD from ResusX:2026: A 2004 RCT showed POCUS first cuts your differential significantly within 15 min. What's your bedside approach? Comment below.👇
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CriticalCareNow @criticalcarenow.bsky.social · 26/09/2026
Your nurse says: "They're on levophed. You want to pull MORE fluid?" Sharad Patel, MD (@msmsharad) from ResusX:2026: How do you explain the physiology and make the call? Drop your bedside approach in the comments.👇
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CriticalCareNow @criticalcarenow.bsky.social · 26/09/2026
Trauma arrest just rolled in. You have seconds to decide: start compressions or fix the trauma first? Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: What’s the single most important factor that dictates your next move? Share your approach in the comments.
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CriticalCareNow @criticalcarenow.bsky.social · 26/09/2026
Your hemorrhagic shock pt got pre-hospital blood, but does your system have the QA and blood bank infrastructure to back that up? Mike Carunchio, FP-C (@okmedicpodcast) from ResusX:2026: The product is only as good as the program behind it. How does your shop handle this?👇
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CriticalCareNow @criticalcarenow.bsky.social · 26/09/2026
You're scanning a hypotensive patient and see a massive RV with a flattened septum. Joshua Rempell, MD from ResusX:2026: D sign. MAP is 55. What's your first move? How does your unit handle this? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 25/09/2026
Aggressive diuresis on your volume-overloaded patient; but are you pulling fluid faster than the vasculature can refill? Sharad Patel, MD (@msmsharad) from ResusX:2026: At 70 kg, that ceiling is ~500 cc/hr. What's your approach at the bedside? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 25/09/2026
You're managing the case correctly, but the family thinks you're the problem. Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: How do you handle mistrust at the bedside before it escalates? Has this happened in your unit? Comment to discuss.👇
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CriticalCareNow @criticalcarenow.bsky.social · 25/09/2026
RePhill randomized pts to crystalloid vs. PRBCs + lyophilized plasma pre-hospital and found no mortality benefit with blood. Mike Carunchio, FP-C (@okmedicpodcast) from ResusX:2026: But the trial was stopped early. Underpowered or a real signal? What's your read? Comment below.
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CriticalCareNow @criticalcarenow.bsky.social · 25/09/2026
The nose bleed is controlled but your patient still looks sick. Joshua Rempell, MD from ResusX:2026: Do you stop there, or keep digging? How early would you pivot to a PE workup? Comment with your approach.👇
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CriticalCareNow @criticalcarenow.bsky.social · 24/09/2026
Aggressively decongesting your pt; but how fast is too fast? Sharad Patel, MD (@msmsharad) from ResusX:2026: The vascular refilling rate maxes out around 5–7 cc/kg/hr. Pull beyond that and the tank runs dry, even in a fluid-positive pt. Comment with how you set your target rate.
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CriticalCareNow @criticalcarenow.bsky.social · 24/09/2026
Penetrating chest trauma, no pulse, pt was talking 4 minutes ago. Do you open the chest? Mohamed Hagahmed, MD (@hagahmedmd) from ResusX:Rounds: ED thoracotomy is a narrow indication, and the clock is the deciding factor. What's the threshold at your institution? Comment below.
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CriticalCareNow @criticalcarenow.bsky.social · 24/09/2026
Your pt is in hemorrhagic shock in the field. The reason the medics don't have blood might be because of a turf war with another agency. Mike Carunchio, FP-C (@okmedicpodcast) from ResusX:2026: Have you seen local politics compromise patient care? Let's discuss this reality.
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CriticalCareNow @criticalcarenow.bsky.social · 24/09/2026
You find a large pericardial effusion in your hypotensive patient. Joshua Rempell, MD from ResusX:2026: What's your immediate next move with the ultrasound probe? Let's see your workflow in the comments.
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CriticalCareNow @criticalcarenow.bsky.social · 23/09/2026
Your pt is +7L and the IVC is > 2 cm, barely moving. What do you do next? Sharad Patel, MD (@msmsharad) from ResusX:2026: Now check the portal vein. Pulsatile flow means the liver is engorged and congestion is real. Comment with how your team uses POCUS to guide decongestion.
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