iiinova — where your digital self keeps evolving

Anand Swaminathan @emswami.bsky.social · 07/10/2026

Cremasteric Reflex in testicular torsion -Sensitivity ranges from 21-100% (PMID: 40537283) -Clearly, inadequate to rule out the diagnosis of torsion youtube.com/shorts/_lB3m... #EMIMCC

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Cremasteric Reflex #emergencymedicine

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 05/10/2026

Optimal ETT Shape w/ standard geometry blade (DL or VL) is 25-35 degrees (PMID: 17079788) -Straight to cuff w/ 25-35 degree angulation -Anything beyond that increased the risk of difficult or impossible tube delivery youtube.com/shorts/aDtpx... #EMIMCC

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Anand Swaminathan @emswami.bsky.social · 02/10/2026

ABIs in Extremity Trauma -Normal ABI greater than 1.0. ABI less than 1.0 should prompt immediate surgical evaluation + CT Angio -Critical part of evaluation. If abnormal should prompt rapid evaluation by surgery + CTA youtube.com/shorts/pthcD... #EMIMCC

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Ankle Brachial Index in Extremity Trauma #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 30/09/2026

Calcium doesn’t stabilize cardiac myocytes in hyperK -Ca restores Ca dependent propagation -Doesn’t matter clinically as Ca2+ will reverse hyperK induced ECG changes -Ca2+ is still the treatment of choice in hyperK w/ significant ECG changes like QRS widening youtube.com/shorts/9wRbG... #EMIMCC

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Calcium in HyperK #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 28/09/2026

Laryngoscope Grip -Proper technique makes lifting easy -Choke up on handle (fingers as close to where handle meets blade as possible) -2 Fingers on for placement then 3rd + 4th applied when lifting -This technique uses mechanical advantage to make lifting easy youtube.com/shorts/gmNf1... #EMIMCC

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Laryngoscope Grip #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 25/09/2026

Calling a Good Consult -Introduce yourself/be polite -Start with the end: diagnosis/clinical question 1st to frame conversation -Close the loop: make it clear what you want (admission, ED consultation, follow up) youtube.com/shorts/BJJFY... #EMIMCC

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Calling a Consult #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 23/09/2026

Relative Adrenal Insufficiency -Key point: consider this diagnosis in every patient presenting w/ shock -Typically occurs in patients on low dose daily steroid -Chronic steroid use suppresses intrinsic steroid synthesis. -Tx: hydrocortisone 100 mg IV youtube.com/shorts/qoRal... #EMIMCC

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Relative Adrenal Insufficiency #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 21/09/2026

Fluid Load in Severe Asthma -Intubation + mech vent switches pt from negative to positive pressure vent ➡️ ⬆️ intrathoracic pressure + drops preload -In severe asthma, huge insensible losses due to ⬆️ work of breathing -Consider early fluid load to avoid HD decomp youtube.com/shorts/EcWqC... #EMIMCC

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Fluid Load in Severe Asthma #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 18/09/2026

YEARS Algorithm in Active Cancer (PMID: 42437322) -YEARS: If “No” to clinical signs of DVT, hemoptysis + PE, can double d-dimer upper limit -RCT 700 patients w/ cancer showed 1.8% miss rate w/ YEARS (same as standard group) -Potential reduced CTPA rate by 22% youtube.com/shorts/Dl5ko... #EMIMCC

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YEARS in Active Cancer #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 16/09/2026

Let’s Play Right Drug, Wrong Dose: -Rocuronium Wrong dose: 0.6 mg/kg Right dose: 1.2 mg/kg (paralysis onset less than 60 sec) -Epinephrine in Anaphylaxis Wrong dose: 0.3 - 0.5 mg IM Right dose: 0.5 mg IM - simplify decision in critical scenario youtube.com/shorts/f6e-W... #EMIMCC

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Right Drug Wrong Dose #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 14/09/2026

Do bougies incr risk of airway injury? -Poor technique/blind placement of a bougie can cause airway injuries. Same is true of ETT + rigid stylets -RCT data (PMID: 29800096 + 34879143): 2000 patients, no airway injuries youtube.com/shorts/0fdgt... #EMIMCC

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Do Bougies Cause Airway Injury? #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 11/09/2026

Brisk trach bleeding = tracheoinnominate fistula Initial Management -Call vascular/CT surgery -Overinflate trach balloon to tamponade innominate (works 85% of time) -Intubate from above, remove trach + place finger into stoma to compress innominate anteriorly youtube.com/shorts/mvnwR... #EMIMCC

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Tracheostomy Bleeding #emergencymedicine #criticalcare

YouTube video by EMSwami

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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 Anand Swaminathan

Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 07/09/2026

Another location to get hung is the anterior ring especially when using hyperangulated. There, the trick is to load the ett against the natural curve of the rigid stylet. As it comes off the stylet it will want to bend posteriorly and stay off the anterior tracheal rings.

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Anand Swaminathan @emswami.bsky.social · 07/09/2026

Scenario: you’re intubating, great view, place tube but can’t advance it? Often occurs due to the ETT bevel (or bougie coude tip) getting hung up on the arytenoid cartilage. Easy fix: back up ~ 1 cm and rotate ETT 90 degrees counterclockwise. youtube.com/shorts/GaZqp... #EMIMCC

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ETT Rotation #emergencymedicine #criticalcare

YouTube video by EMSwami

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

Peripheral or IO is fine but if I’ve got a central that’s great. Wouldn’t delay administration to get one in

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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

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Hypokalemic Cardiac Arrest #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 02/09/2026

Intraosseous lines vital in critically ill patients -Use “1, 2, IO” approach: 2 shots at peripheral IV then put in IO. Ensures we don’t waste time getting access -Location: prox humorous w/ better flow rates than prox tibia. youtube.com/shorts/c5AJW... #EMIMCC

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IO Tips #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 31/08/2026

Thumbs Down Mask Seal Technique -Place both thumbs on top of mask -Use other 4 fingers under jaw to pull jaw up to mask -Keys: Mask seal is a 2 hand technique + pull face to mask, not pushing mask down into face youtube.com/shorts/tH8PP... #EMIMCC

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Thumb Down Mask Seal #emergencymedicine #criticalcare #airway

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 28/08/2026

K3tamine in peds PSA -Doesn’t suppress respiratory drive or drop BP Registry data (PMID: 40481829) 13k peds PSAs -0.016% critical event rate (1 possible aspiration, 1 anaphylaxis) -0.52% high-risk event (mostly need for BVM) - Laryngospasm - 7/13,000 youtube.com/shorts/gaXI3... #EMIMCC

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Ketamine in Peds PSA #emergencymedicine

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 26/08/2026

Hypertrophic Cardiomyopathy -ECG: LVH + deep, narrow “dagger-like” Q waves in inf/lat leads -Classic presentation: exertional syncope -Predisposes to ventricular dysrhythmias + sudden cardiac death -Slower HR better as improves LV filling + relieves obstruction youtube.com/shorts/9M5Hn... #EMIMCC

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Hypertrophic Cardiomyopathy #emergencymedicine #criticalcare

YouTube video by EMSwami

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Reposted by Anand Swaminathan

REBEL EM @rebel-em.bsky.social · 25/08/2026

🧪The lab differences between TTP and DIC can be confusing! 🩸Heres REBEL REVIEW highlighting the differences! #FOAMed @mramzydo.bsky.social @emswami.bsky.social @marco-propersi.bsky.social

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Anand Swaminathan @emswami.bsky.social · 24/08/2026

Pre-Oxygenation + Washing Out N2 -Don’t start RSI right when O2 sat hits 99% - fails to take advantage of N2 washout -Pre-ox washes out N2 replacing w/ O2 creating resevoir -NIV pre-ox + give solid 5 min AFTER reach sat 99% can help wash out N2 + fill up resevoir youtube.com/shorts/YPh_Y... #EMIMCC

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Pre-ox + O2 Reservoir #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 21/08/2026

Age-Adjusting the D-dimer -Safely reduces the number of patients who need a CT scan -FEU Assay (normal upper limit 500): age X 10 -DDU Assay (normal upper limit 250): age X 5 -Ample data (PMID: 41490105, 24439717) to support + endorsed by AHA, ACEP + more youtube.com/shorts/dIFoH... #EMIMCC

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Age-Adjusting Dimer #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 19/08/2026

How closely do blood gas electrolytes correlate w/ BMP electrolytes? -Na value statistically significantly different but clinical difference is meaningless (PMID: 31070468 + 20157454) -K value w/ no statistically significant difference (PMID: 20157454 + 35371883) youtube.com/shorts/cmBcl... #EMIMCC

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VBG Electrolyte Accuracy #emergencymedicine #criticalcare

YouTube video by EMSwami

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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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Anand Swaminathan @emswami.bsky.social · 14/08/2026

Great way to hammer this home. Agreed and I’ve ditched the needle completely. All you need is a scalpel and a finger

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Anand Swaminathan @emswami.bsky.social · 14/08/2026

Stop doing needle decompression @ 2nd ICS MCL -Critical structures in region: aortic arch, L atrium, great vessels -Poor location based on data(PMID: 16244336 + 26724173) Go 4th/5th ICS anterior axillary line. Even better, ditch needle + do a finger thoracostomy youtube.com/shorts/4MK6t... #EMIMCC

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PTX Decompression #emergencymedicine #criticalcare

YouTube video by EMSwami

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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

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Keflex Dosing #emergencymedicine

YouTube video by EMSwami

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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

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Mech Vent in Met Acidosis #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 31/07/2026

Peritonsillar Abscess Management -Old: I+D all PTA -New: data points towards medical management alone (PMID: 32482146) -For small PTA, non-toxic pt, antibiotics + steroids alone w/ close f/u very reasonable youtube.com/shorts/jARG2... #EMIMCC

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PTA Management - Drain or Not? #emergencymedicine

YouTube video by EMSwami

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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

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Procainamide vs Amiodarone in Stable VT #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 27/07/2026

Have it ready every time. Lead with suction but don’t always park

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Anand Swaminathan @emswami.bsky.social · 27/07/2026

Anatomically Challenging Airways: The key in being ready isn’t assessment tools; it’s assuming every airway is anatomically challenging + preparing appropriately -My setup: SGVL, bougie first, SALAD technique every time -Backup: HAVL, scalpel-bougie-ETT for cric youtube.com/shorts/V7l-V... #EMIMCC

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Anatomic Airway Assessment in the ED #emergencymedicine #criticalcare #airway

YouTube video by EMSwami

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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

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Lethal Quadrad - HypoCa in Trauma #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 22/07/2026

I like holding and starting after lytics completed but I know many who will do simultaneously

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Anand Swaminathan @emswami.bsky.social · 22/07/2026

Systemic Lytics in Sick Massive PE -Delay in care can lead to rapid decompensation -My approach: 1/2 dose alteplase: 10 mg bolus then 40 mg over 30 min (can repeat) -Tenecteplase 25 mg bolus -Systemic lytics do not preclude other therapies like thrombectomy youtube.com/shorts/Tx1zu... #EMIMCC

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Thrombolytics in Sick Massive PE #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 21/07/2026

Pulmonary HTN Intubation -Avoid if possible but if have to, focus resus on relieving pulmonary HTN/RV strain -Hypoxemia: HFNC -Hypotension: Improved tone + DBP will improve coronary perfusion + RV fxn -Ideal is awake approach: avoid apnea + maintain catecholamines youtube.com/shorts/qi2NY... #EMIMCC

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Intubating Pulm HTN #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 17/07/2026

OMI vs STEMI Paradigm -STEMI paradigm flawed: insensitive in detecting acute coronary occlusion (ACO) -Occlusion myocardial infarction (OMI) approach incr early detection ACO requiring immediate cath -Great discussions Steve Smith and Pendell Meyers youtube.com/shorts/DlJHn... #EMIMCC

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Occlusion MI (OMI) vs STEMI Criteria #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 15/07/2026

Management of Agitated Trauma Patient bit.ly/3UTG4QR -Multifactorial: injury, hypoperfusion, hypoxemia, intoxication, pain -Treatment depends on severity of trauma + severity of agitation -Critical Injury: Dissociative dose ketamine: 1-2 mg/kg IV or 5 mg/kg IM youtube.com/shorts/lLvE1... #EMIMCC

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Agitation in Trauma #emergencymedicine #criticalcare #trauma

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 13/07/2026

Pulmonary HTN + Airway Management -Induction agents ➡️ catecholamine tone ➡️ hypotension, RV hypoperfusion + drop in RV fxn -Paralysis ➡️ hypercapnea, pulmonary vasoconstriction + drop in RV output -Positive pressure ventilation ⬆️ PA + RV pressure youtube.com/shorts/gJ8cz... #EMIMCC

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Dangers in Intubating Patients with Pulmonary HTN #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 10/07/2026

Electrical Alternans Case: 58 yo woman w/ breast CA p/w SOB + BP 90/55 ECG: sinus tach, low voltage + variable QRS complex sizes Electrical alternans + low voltage suggestive of pericardial tamponade Take Home: low voltage = pocus TTE youtube.com/shorts/H1IUP... #EMIMCC

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Electrical Alternans #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 08/07/2026

Speeding up the Trial of Void (Tip via David Carr) -Before you pull the foley, instill 250-300 cc of 0.9% saline -Bladder is now full + pt should want to void immediately -If no voiding in 20-30 min, TOV failed: replace foley youtube.com/shorts/bXeQL... #EMIMCC

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Trial of Void Hack #emergencymedicine

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 06/07/2026

Proper BVM Technique as Important as Proper Intubation Technique -BVM requires 2 operators - one to use 2 hands to hold mask, one to bag -Place 1st/2nd digits on top of mask lightly holding in place + 3rd-5th digits posterior to mandible + pull jaw up in to mask youtube.com/shorts/vCsXo... #EMIMCC

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BVM Technique #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 04/07/2026

Peripheral (Bell Palsy) vs Central Facial Droop -Upper + Lower facial muscles affected = peripheral CN VII -CN VII responsible taste anterior 2/3 of tongue -Taste only affected in peripheral CN VII palsy -Testing taste can help differentiate in equivocal cases youtube.com/shorts/xDlDL... #EMIMCC

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Bell Palsy + Taste #emergencymedicine

YouTube video by EMSwami

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Reposted by Anand Swaminathan

md-dm-pccm.bsky.social @md-dm-pccm.bsky.social · 01/07/2026

One of the first questions I ask my trainees when they suggest an ABG is if they have ever had one drawn on themselves to see how painful it is. If we are going to be invasive, should make sure the info is worth it to the patient.

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Anand Swaminathan @emswami.bsky.social · 01/07/2026

ABG can largely be replaced by VBG pH: VBG ~ 0.03 units lower than ABG PCO2: VBG 6-10 mm Hg higher than ABG HCO3: VBG 1-2 mmol lower than ABG Under most circumstances, these differences won’t affect management making ABG unnecessary youtube.com/shorts/OMFEo... #EMIMCC

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VBG vs ABG pH, PCO2, HCO3 #emergencymedicine #criticalcare

YouTube video by EMSwami

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Anand Swaminathan @emswami.bsky.social · 26/06/2026

Approach to Chest Pain Tips -Ask if sudden/severe/max at onset: pushes to consider dissection -ACS likelihood incr: exertional, radiates R shoulder or b/l shoulders or assoc w/ diaphoresis or vomiting -Pleuritic pain virtually rules out diagnosis of ACS youtube.com/shorts/uRWhk... #EMIMCC

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Chest Pain History Tips #emergencymedicine

YouTube video by EMSwami

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Reposted by Anand Swaminathan

CriticalCareNow @criticalcarenow.bsky.social · 24/06/2026

You're at the bedside. Bilateral chest tubes placed, 100% FiO2, PEEP 10 — patient still satting 72% and hypotensive. Sara Crager, MD (@teachicu) from ResusX:2026: What do you do next? Have you managed a case like this? Comment to discuss.👇

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Anand Swaminathan @emswami.bsky.social · 24/06/2026

Cardiac arrest/peri-arrest w/ high suspicion for PE -Systemic thrombolytics clearly indicated -Arrest: alteplase 100 mg IV push or tenecteplase 30-50 mg IV push (weight based) -Peri-arrest: 1/2 dose - alteplase 50 mg IV push w/ option to redose if no improvement youtube.com/shorts/mFRJ8... #EMIMCC

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Lytics in PE - Arrest #emergencymedicine #criticalcare

YouTube video by EMSwami

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