@IM_Crit_ @imcrit.bsky.social · 28/09/2026ICU hot take: A white-out lung is not, by itself, an indication for intubation and bronchoscopy. Intubating someone for a “therapeutic bronch” without first putting an ultrasound probe on the chest should be a federal crime. #POCUS #FOAMcc 130
@IM_Crit_ @imcrit.bsky.social · 26/09/2026The return-to-work rules just changed for healthcare workers with respiratory infections The practical change: Day 4 may now be the EARLIEST return to work but ONLY IF you meet ALL the criteria below CDC now uses the SAME framework for COVID-19, influenza, RSV & several other respiratory viruses 311
@IM_Crit_ @imcrit.bsky.social · 21/09/2026There are now two #RSIs that worry me. One can rapidly take away a patient's ability to breathe. The other could give an #AI system the ability to recursively improve beyond humanity's ability to reliably control it. Rapid Sequence Intubation. Recursive Self-Improvement. 210
@IM_Crit_ @imcrit.bsky.social · 20/09/2026#Thiamine in the ICU: 10 high-yield pearls 1. Unexplained lactate? Think thiamine T is required for pyruvate dehydrogenase. Deficiency blocks conversion of pyruvate to acetyl-CoA, shunting pyruvate toward lactate. Thus, T deficiency belongs in the diff dx for otherwise unexplained lactic acidosis 181
Reposted by @IM_Crit_Cardiac Output @cardiacoutput.bsky.social · 20/09/2026Today it's transthoracic echo on the intensive care unit: the views, and the patterns you are looking for in a shocked patient. @ics-updates.bsky.social @imcrit.bsky.social podcasts.apple.com/gb/podcast/c...podcasts.apple.comTransthoracic Echo on the Unit: Five Views and Six PatternsPodcast Episode · Cardiac Output · 20 September · 14min 023
@IM_Crit_ @imcrit.bsky.social · 20/09/2026Answer: C. Lumbar drain The clear nasal discharge after a basilar skull fracture is traumatic CSF rhinorrhea. A lumbar drain can reduce CSF pressure and promote spontaneous closure of the dural defect, particularly when leakage is substantial or increasing. 101
@IM_Crit_ @imcrit.bsky.social · 19/09/2026ICU Board Review: A 34 yo previously healthy man experienced a severe/sudden headache & is admitted to the ICU because of acute subarachnoid hemorrhage. Non-con CT of the head and CT angiography of the head and neck: subarachnoid hemorrhage and a distal left anterior cerebral artery aneurysm. 140
@IM_Crit_ @imcrit.bsky.social · 15/09/2026ICU Board Review: Trauma 38 yo man admitted to the ICU after a high-speed motor vehicle accident. Head CT: a nondisplaced basilar skull fracture. Abdominal CT: a high-grade splenic laceration requiring emergent splenectomy On ICU day 4, he develops increasing clear, watery drainage from the nose 130
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 09/09/2026Cardiothoracic ICU Case: Four hours after CABG, something is wrong A 70 yo female patient had underwent a 2-vessel CABG (LIMA to LAD, SVG to OM). A 90% proximal RCA lesion could not be bypassed because the vessel was not "good target" Four hours post-op and while getting ready for extubation, 142
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 13/09/2026Unpopular opinion (that shouldn't be unpopular): If the BP drops right after turning off pressors, the answer is restarting the drip, NOT giving a 500 mL normal saline bolus or 250 ml of albumin. Stop treating vasoplegia with a fluid bolus. Agree or disagree? #foamed #foamcc #emimcc 273
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 13/09/2026Your regularly scheduled reminder: If you were on call Saturday night, Sunday is not a “day off.” It’s a recovery day disguised as a day off. Don’t be gaslit. #emimcc 416310
@IM_Crit_ @imcrit.bsky.social · 13/09/2026Your regularly scheduled reminder: If you were on call Saturday night, Sunday is not a “day off.” It’s a recovery day disguised as a day off. Don’t be gaslit. #emimcc 416310
@IM_Crit_ @imcrit.bsky.social · 13/09/2026Unpopular opinion (that shouldn't be unpopular): If the BP drops right after turning off pressors, the answer is restarting the drip, NOT giving a 500 mL normal saline bolus or 250 ml of albumin. Stop treating vasoplegia with a fluid bolus. Agree or disagree? #foamed #foamcc #emimcc 273
@IM_Crit_ @imcrit.bsky.social · 09/09/2026Cardiothoracic ICU Case: Four hours after CABG, something is wrong A 70 yo female patient had underwent a 2-vessel CABG (LIMA to LAD, SVG to OM). A 90% proximal RCA lesion could not be bypassed because the vessel was not "good target" Four hours post-op and while getting ready for extubation, 142
@IM_Crit_ @imcrit.bsky.social · 07/09/2026I decided to refresh my memory on cardiac surgery "stuff" and honestly I don't get what surgeons / anesthesiologists / CRNAs / perfusionists complain about. It’s literally just blue tube out, red tube in... #foamed #emimcc 141
@IM_Crit_ @imcrit.bsky.social · 07/09/2026POCUS refresher: detecting tamponade A small but important machine-setting pearl: slow down the sweep speed Slower sweep = more time displayed on the same screen → more consecutive cardiac/respiratory cycles to compare This can make respiratory variation in mitral/tricuspid inflow velocities much 130
@IM_Crit_ @imcrit.bsky.social · 04/09/2026ICU Physiology Secrets: There is no such thing as a "normal" cardiac output value Sure, a CO of 1 L/min for a 19 yo college athlete is obviously terrible but context is everything What's "adequate" for a resting 80 yo on beta-blockers will look completely different for a septic patient in her 20s 110
@IM_Crit_ @imcrit.bsky.social · 03/09/2026I watched an excellent #ESICM webinar discussing the 2026 SSC Guidelines on hemodynamics Interesting talks, but two points I feel strongly about: 1. Stop repeating fluid boluses in persistently hypotensive pts, even if still hypoperfused and dynamic measures show fluid responsiveness 151
@IM_Crit_ @imcrit.bsky.social · 01/09/2026Ischemic cascade: According to the original description 40 years ago, symptoms are a late feature of #ischemia, and #echo can detect changes prior to this point By the time a patient has developed symptoms, some echo abnormalities are expected to be seen by #POCUS #foamed 110
@IM_Crit_ @imcrit.bsky.social · 29/08/2026ICU Stories: I stood at the bedside of a young patient we had just extubated after 4 days on a ventilator and heavy sedative infusions for severe polysubstance withdrawal As soon as the tube came out, she demanded to leave against medical advice (AMA) We tried everything to convince her to stay 130
@IM_Crit_ @imcrit.bsky.social · 26/08/2026Open letter to my surgical colleagues: Dear friends, We never send one of our ICU patients to the OR without making sure you know who the patient is, why they're going, and what needs to be done Please don't send a postoperative patient from the OR to the ICU without telling us... 👇 120
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 22/08/2026"Clinical intuition" is a fancy term for educated guessing, and frankly, I’m not smart enough to roll those dice... I use #POCUS because I require proof of what’s happening (or not happening...). Call it low intellect; I call it help for keeping critically ill patients alive #FOAMed #foamcc #meded 282
@IM_Crit_ @imcrit.bsky.social · 25/08/2026Medical news: Finally, a robot that wants your blood! 🤖🩸 FDA just cleared "Aletta," an autonomous blood-drawing device that uses near-infrared light and Doppler ultrasound so you never have to be treated like a human pincushion... 110
@IM_Crit_ @imcrit.bsky.social · 24/08/2026Quick reminder: this is a masterclass in how *not* to perform CPR 🫀 130
Reposted by @IM_Crit_Ken Milne MD @thesgem.bsky.social · 22/08/2026"I’m telling you this because lately I keep hearing people say the hospitals were empty. That the ICUs were quiet. That it wasn’t what we told you it was... COVID killed people. A lot of people. I know because I watched them say goodbye". kevinmd.com/2026/08/covi...kevinmd.comCOVID trauma in emergency physicians can surface suddenlyCOVID trauma in emergency physicians can surface without warning. A tablet holding 53 final goodbyes reveals the hidden, enduring weight of pandemic grief. 085
@IM_Crit_ @imcrit.bsky.social · 22/08/2026"Clinical intuition" is a fancy term for educated guessing, and frankly, I’m not smart enough to roll those dice... I use #POCUS because I require proof of what’s happening (or not happening...). Call it low intellect; I call it help for keeping critically ill patients alive #FOAMed #foamcc #meded 282
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 19/07/2026If you have a little bit more time, a cooperative patient, and the necessary expertise: The “clean duo”: 1 axillary/subclavian venous line + 1 arterial line Different patients. Different circumstances. Different priorities 121
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 12/07/2026Life in the ICU: My favorite line during rounds is: "This doesn't make any sense" Case in point today from a surgical colleague: "Leave the chest tube until output is <10 mL/day" Fun fact: normal pleural fluid production is ~15-20 mL/day I guess that this chest tube will have to stay for ever... 0113
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 22/07/2026For every complex (ICU) problem there is an answer that is clear, simple, and wrong. H. L. Mencken 041
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 23/07/2026If you never “treated” pulmonary edema with rotating tourniquets in a desperate situation, you missed the good old days & I can tell that you are not GenX (or a boomer!). We placed (& inflated) BP cuffs on 3 limbs at a time to pool venous blood in the extremities and reduce venous return and preload 272
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 26/07/2026Nothing good happens in the ICU at 3 am 1123
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 28/07/2026One of the most demoralizing parts of being an ICU physician is watching a patient fight tooth and nail for every intervention while in our unit, only to abandon it the second they walk out the hospital door. Sometimes even before leaving the hospital! 111
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 26/07/2026ICU (Night) Stories: 90-year-old admitted to the ICU at 8 pm with complete heart block. Cardiology had semi-emergently placed a temporary transvenous pacemaker just before ICU admission. At 3 am, we found her delirious but triumphantly holding this in her raised right hand: 2112
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 25/07/2026ICU/ED Secrets: It’s common knowledge that the more times you inflate the BP cuff, the higher the blood pressure gets 072
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 02/08/2026Every time I see a continuous renal replacement (CRRT) order for an ultrafiltration rate of 25 mL/hour, a small part of me dies If we're afraid that the patient will crash from removing 0.4 mL/min, perhaps we should also stop sending blood cultures and morning labs... I am just saying... 011
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 07/08/2026Key applications in Critical Care: 1. Differentiating shock phenotypes 2. Assessing hemodynamics & preload responsiveness 3. Evaluating hypoxemia You may find useful the proposed algorithms for the evaluation of patients with hypotension and/or hypoxemia: 002
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 07/08/2026Take-home points: *POCUS expanded from simple bedside "rule-in/rule-out" exam into a comprehensive diagnostic approach **"POCUS Pyramid": Effective hemodynamic evaluation relies on integrating 3 pillars rather than evaluating an organ in isolation: echo+lung US+systemic venous assessment (VEXUS) 122
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 07/08/2026Nice review article examining the evolution, physiological principles, and clinical applications of point-of-care ultrasound (POCUS) and Critical Care Echocardiography (CCE) 111
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 08/08/2026I have never noticed dexmedetomidine associated with tachycardia: 211
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 17/08/2026Exclusive: Unedited footage from the multidisciplinary Heart Team meeting (interventional cardiologists versus cardiac surgeons): 061
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 17/08/2026"Future generations of doctors will find it hard to believe that, in 2013, many clinicians were still relying on the vague findings of a 200-year-old traditional physical examination and were compromising clinical efficacy when direct information was available from point-of-care echocardiography. 133
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 18/08/2026ICU Practice Fact: “When people don't want to do something, they cite a study that shows it doesn't work”... #foamed #foamcc #emimcc 294
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 20/08/2026ICU Snapshots: It's the start of your night shift, and all eyes are on the monitor... What is going on with patient #4? 👀👇 131
Reposted by @IM_Crit_@IM_Crit_ @imcrit.bsky.social · 22/08/2026I get why some of my ICU colleagues prefer working nights; fewer rounds, less bureaucracy, and a tighter-knit team. But no matter how you justify it, the biological reality catches up to you: we’re dying one night shift at a time 261
@IM_Crit_ @imcrit.bsky.social · 22/08/2026I get why some of my ICU colleagues prefer working nights; fewer rounds, less bureaucracy, and a tighter-knit team. But no matter how you justify it, the biological reality catches up to you: we’re dying one night shift at a time 261
@IM_Crit_ @imcrit.bsky.social · 20/08/2026ICU Snapshots: It's the start of your night shift, and all eyes are on the monitor... What is going on with patient #4? 👀👇 131
@IM_Crit_ @imcrit.bsky.social · 18/08/2026ICU Practice Fact: “When people don't want to do something, they cite a study that shows it doesn't work”... #foamed #foamcc #emimcc 294
@IM_Crit_ @imcrit.bsky.social · 17/08/2026"Future generations of doctors will find it hard to believe that, in 2013, many clinicians were still relying on the vague findings of a 200-year-old traditional physical examination and were compromising clinical efficacy when direct information was available from point-of-care echocardiography. 133
@IM_Crit_ @imcrit.bsky.social · 17/08/2026Exclusive: Unedited footage from the multidisciplinary Heart Team meeting (interventional cardiologists versus cardiac surgeons): 061
