iiinova — where your digital self keeps evolving

Ed Palmer @doced.bsky.social · 02/07/2026

Congrats to @thecollegeoficm.bsky.social I’m quite excited to see the future of my specialty take shape.

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Ed Palmer @doced.bsky.social · 25/05/2026

Prep since last night. Brining the poussins! Probe will be coming out later today for sure.

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Ed Palmer @doced.bsky.social · 24/05/2026

lol. High risk phenphttye. Oh, but the biochemical criteria begin to solifdd. Of course. Totally makes sense.

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Ed Palmer @doced.bsky.social · 24/05/2026

Serum bichbonbate. Artih. Bismolality… I think we have an AI article on our hands! @retractionwatch.com

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Ed Palmer @doced.bsky.social · 22/05/2026

it does if you clamp a dogs coronary artery? 😂

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Ed Palmer @doced.bsky.social · 22/05/2026

Question, @drfreeze.bsky.social @load-dependent.eurosky.social in the failing LV does the Frank-Starling curve actually fall again as pre-load increases? Or does it just flatten off down and to the right? (Like in the image)

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Ed Palmer @doced.bsky.social · 02/05/2026

End result. Totally worth it.

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Ed Palmer @doced.bsky.social · 17/03/2026

Signposting this. Would love to see more intensivists at this course. Really educational day with a dedicated faculty.

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Ed Palmer @doced.bsky.social · 03/01/2026

That's a coincidence. This is on my christmas reading list.

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Ed Palmer @doced.bsky.social · 25/03/2025

In todays exciting chapter of AI confidently making stuff up:

A chat GPT response to explain “Palmers law of pH”.

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Ed Palmer @doced.bsky.social · 21/01/2025

Cool cool... just confidently lying about my new fictional inflammatory marker.

A chatCPT prompt states "A 95 y/o patient presents with 3 day history of productive cough, shortness of breath and pleuritic chest pain. On arrival to the emergency department they have SpO2 of 75% requiring supplemental oxygen. Their initial CRP is 250 and serum IL-TKP is over 2000. What is the cause of the elevated IL-TKP?". The response is "The elevated IL-TKP (Interleukin-TKP) suggests a severe inflammatory response, likely due to an acute infectious process, such as pneumonia or another lower respiratory tract infection. The combination of productive cough, shortness of breath, pleuritic chest pain, and high CRP supports this diagnosis. The severe hypoxemia on arrival indicates significant respiratory compromise, potentially from extensive lung involvement or sepsis, both of which can drive up IL-TKP levels." Note: IL-TKP is completely fictional.

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Ed Palmer @doced.bsky.social · 03/01/2025

Reminds me of this gem of a comment during the pandemic. This was the moment I knew for certain he was an absolute moron.

Elon Musk writes in a tweet dated 2020/04/15: "Depends on patient lung strength, but, again just my personal opinion, I wouldn't go much above their natural lung pressure" He's referring to ventilator settings in COVID. For reference, natural lung pressures are negative, and artificial ventilation is performed using a positive pressure. It's a remarkably stupid thing for someone to say.

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Ed Palmer @doced.bsky.social · 20/12/2024

New Christmas read just arrived. Appropriate given recent events across the pond. I had the great pleasure of working with Prof Wunsch while she was visiting London a few years back. Excited to finally read this!

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Ed Palmer @doced.bsky.social · 03/12/2024

SSC splits out septic shock from sepsis, as that’s where the strongest evidence sits. These guidelines have changed markedly over the years, which shows the dynamic nature of this field and a willingness to be able to change your practice based on new evidence. 18/n

Surviving sepsis guidelines for antibiotic administration. In the absence of shock, and where the diagnosis of sepsis is in question, it is appropriate to hold back antibiotics while seeking confirmation of the diagnosis. There are many sepsis mimics, which will not benefit from ABx treatment, while early termination of the diagnostic process may lead to a delay in treating other life threatening pathologies.

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Ed Palmer @doced.bsky.social · 03/12/2024

The original Kumar paper from 2006 was observational. What often isn't discussed is that patients who received antibiotics *before* they became hypotensive had *worse* outcomes. I’ve adjusted their headline figure to show this group. 14/n

Original figure from Kumar 2006 paper showing the association between antibiotic administration and survival in sepsis. The figure uses time brackets of varying size to give the impression of a strictly linear reduction in survival. Notably missing from the plot is those who were already receiving antibiotics, who faired much worse (52% survival) than those who received antibiotics within 1 hour (around 80% survival). This is a bad plot and should have been picked up in peer review IMO.

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Ed Palmer @doced.bsky.social · 03/12/2024

I like the waterfall analogy. Imagine two people moving in a flowing river that ends in a waterfall. Person A (blue) is still upstream of the waterfall, we can intervene “early” and save them from falling. Person B (red) however has already gone over the cliff edge. 9/n

A flowing river ending in a waterfall. One person, depicted by blue dots, is shown moving through the river before the waterfall. Another, depicted by red dots, is shown falling down the waterfall. A simple intervention in a timely fashion can rescue the blue person, before they fall off the waterfall. So such intervention could prevent the red person from falling to their demise.

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Ed Palmer @doced.bsky.social · 20/11/2024

I find it really hard to parse mixed units like this. Is this not just 3.9 terawatts? Why say millions of millions using 2 different conventions in the same sentence?

Guardian article using mixed metric prefixes for describing power.

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Ed Palmer @doced.bsky.social · 19/11/2024

Oh Marik… I will never truly know how much of my practice is based in reality.

Text book “evidence based critical care” by Paul Marik.

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Ed Palmer @doced.bsky.social · 04/10/2024

Going into every night shift:

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Ed Palmer @doced.bsky.social · 17/09/2024

Bluesky now has over 10 million users, and I was #6,221,371!

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