iiinova — where your digital self keeps evolving

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Segun Olusanya (He/Him) @drfreeze.bsky.social · 27/07/2026

One of the biggest areas in critical care echo is its role in haemodynamic phenotyping. This excellent talk from Prof Sam Orde highlights this. Join us in September in London at our course to learn more. The talk: lnkd.in/eUDCm5xe The course booking link: lnkd.in/e93iqdXd #echofirst #pocus

lnkd.in

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 27/07/2026

But Amgen keeps fighting for Avacopan Another ‘3rd party’ reanalysis suggests Avacopan might indeed be non-inferior but not superior www.medpagetoday.com/rheumatology...

medpagetoday.com

New Avacopan Analysis Sent to FDA After Data Manipulation Allegations

Agency has been calling for the vasculitis drug to be pulled from the market since January

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Intensive Care Medicine Journal @intenscaremed.bsky.social · 27/07/2026

Prone positioning improves oxygenation, reduces lung stress and strain, and lowers mortality when applied early for prolonged sessions in selected intubated patients with moderate-to-severe acute respiratory distress syndrome. zurl.co/ZjW6e

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Saganism @sagan.bsky.social · 26/07/2026

"In our tenure on this planet, we have accumulated dangerous evolutionary baggage. Propensities for aggression and ritual, submission to leaders, hostility to outsiders. All of which puts our survival in some doubt. But we’ve also acquired compassion for others, love for our children, a desire to learn from history, and a soaring passionate intelligence, the clear tools for our continued survival and prosperity."

— Carl Sagan

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Intensive Care Medicine Journal @intenscaremed.bsky.social · 26/07/2026

Drug-induced acute kidney injury has distinct recovery patterns, and normalization of serum creatinine may conceal persistent structural damage. zurl.co/g6xGO

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Critical Care Reviews @criticalcarereviews.com · 25/07/2026

Our latest blog is out: The Nothing-to-Lose Fallacy criticalcarereviews.com/2026/the-no…

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Intensive Care Medicine Journal @intenscaremed.bsky.social · 24/07/2026

Critical illness changes antiseizure medication exposure, requiring tailored selection, dosing, and monitoring in intensive care. zurl.co/69LiK

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Intensive Care Medicine Journal @intenscaremed.bsky.social · 22/07/2026

Persistent tissue hypoperfusion combined with vasopressor dose improved risk stratification in early septic shock and identified a small subgroup with markedly increased 28-day mortality. zurl.co/Rkm1g

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JAMA @jama.com · 22/07/2026

📝 JAMA Patient Page: #Cyclosporiasis is an infection of the small bowel caused by the #parasite Cyclospora cayetanensis, primarily acquired by ingesting #contaminated food or water—most often fresh produce with crevices, such as leafy #greens, #herbs, and #berries. 🔗 ja.ma/4b69SCM

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Anaesthesia @anaesjournal.bsky.social · 22/07/2026

A good death in intensive care "Increasingly, ICU is recognised not only as a place of rescue, but also as a place where compassion, dignity and comfort can be provided at the end of life." #AnSky #ICUSky #MedSky doi.org/10.1111/anae...

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REBEL EM @rebel-em.bsky.social · 21/07/2026

🆕 New REBEL EM Post Can #POCUS improve outcomes in shock resuscitation? ✅ ↓ Mortality ✅ ↓ Vasoactive days ✅ ↑ Lactate clearance 💥 Bedside ultrasound isn’t just diagnostic—it’s therapeutic. 🔗 loom.ly/083PigU 🧠 By Christopher Karnicki #FOAMed

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Astronomy 🔭 @astronomy.bsky.social · 19/07/2026

13 years ago today, NASA's Cassini spacecraft captured this iconic view of Earth from Saturn's orbit 🪐 That tiny blue dot is us from nearly 900 million miles away!!

A view from Saturn's orbit showing the planet's dark silhouette in the upper left, its tan and brown rings stretching across the top right, and a thin blue atmospheric glow. A tiny blue dot, representing Earth, is visible against the dark background.

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Critical Care Reviews @criticalcarereviews.com · 19/07/2026

Vasoactive Management of Cardiogenic Shock in Severe Aortic Stenosis: A Phenotype-Based Approach CCR Journal Watch criticalcarereviews.com/latest-evid…

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@IM_Crit_ @imcrit.bsky.social · 18/07/2026

Unpopular ICU opinion: When a patient becomes apneic during a spontaneous breathing trial, we often declare that the patient failed the trial Maybe not. Maybe we failed the patient by stopping the trial too soon, before sedatives had worn off and the respiratory drive had a chance to return

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/07/2026

Excellent read from @iwashyna.bsky.social voices.nejm.org/doi/full/10.... I still struggle with this, as a PGY29 #MedSky

At a less acute level, Alice was struggling with the question of how much of the scut work she should do and how much to delegate to the intern. When was doing the scut work giving her intern time to think and learn? And when was it interfering with the intern’s learning by depriving them of their experience? In other words, when is sitting back and letting someone else do the tedious work of hospital care “growth,” and when is it “exploitation”?
Even more poignantly, Alice was asking how much she should let her trainees do things differently than she would. The interns are, after all, doctors. Surely they can organize their notes in their own way.

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REBEL EM @rebel-em.bsky.social · 16/07/2026

🫀Norepi or Epi after Cardiac Arrest? 🤔Was there a lower rate of recurrent cardiac arrest when using one over the other? 📚This meta-analysis & systematic review sought to answer that! 👀Check out the full post by Drs. Elizabeth Smith & Dorian Alexander from UTHealth Houston (@uthoustonemres)

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Intensive Care Medicine Journal @intenscaremed.bsky.social · 16/07/2026

Septic shock extends beyond vasoplegia to involve microcirculatory, metabolic, endocrine, myocardial and neural disturbances that shape its presentation and response to treatment. zurl.co/X1mMh

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REBEL EM @rebel-em.bsky.social · 15/07/2026

🥇What does performance under pressure in medicine look like? 🏃🏽‍♂️‍➡️What if we had the same tools as professional sports teams and elite athletes? 🧠 We've partnered with Arena Labs for data driven insights! 👀https://loom.ly/YvLC3F8 @Arena_Labs @MRamzyDO @Marco_propersi @EMSwami

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Critical Care Reviews @criticalcarereviews.com · 06/07/2026

Today's Paper of the Day is: Modulation of the Vasopressin System in Distributive and Cardiogenic Shock: Principles and Practical Applications criticalcarereviews.com/latest-evide... Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026

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Saganism @sagan.bsky.social · 03/07/2026

“The question is, are we happy to suppose that our grandchildren may never be able to see an elephant except in a picture book?” — David Attenborough

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Segun Olusanya (He/Him) @drfreeze.bsky.social · 03/07/2026

Spaces are filling up fast for this! Don’t miss out-outstanding faculty including: Prof Michel Slama Prof Sam Orde Prof Andre Denault Felipe Teran Hazem Lashin Alexa Bond All true experts in critical care ultrasound. VEXUS and reporting masterclasses included!

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Saganism @sagan.bsky.social · 29/06/2026

“If mankind were to disappear, the world would regenerate back to the rich state of equilibrium that existed ten thousand years ago. If insects were to vanish, the environment would collapse into chaos.” — E.O. Wilson

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 28/06/2026

Boom The European Medical Agency @ema.europa.eu pulls the approval for Tavneos aka Avacopan over trial shenanigans #Vasculitis cc @kidneyboy.bsky.social @brycebarr.bsky.social

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WHO @who.int · 27/06/2026

Drowning prevention starts with you. Here are some water safety rules. ⬇️

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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 26/06/2026

Systemic vascular resistance is not a realiable measure of left ventriclar afterload. In this study, noradrenaline actually decreased left ventricular wall stress even though SVR increased. Higher heart rate and contractility leads to a smaller LV, lower wall stress. #emimcc #cccsky #cardiosky

ahajournals.org

Systemic vascular resistance: an unreliable index of left ventricular afterload. | Circulation

Systemic vascular resistance (SVR) is a frequently used clinical index of left ventricular afterload. However, SVR may not adequately assess left ventricular afterload (i.e., ventricular internal fibe...

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@IM_Crit_ @imcrit.bsky.social · 25/06/2026

Schrodinger's arrhythmia: atrial fibrillation/flutter (A. Fib/flutter)

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Anand Swaminathan @emswami.bsky.social · 17/06/2026

Phenobarbital a game changer in EtOH w/d -Option 1: No benzos given. Load 10 mg/kg over 30 min + wait 30 min for effect -Option 2: post-escalating BZD. Give phenobarbital 130 mg IV q15 until adequate sedation achieved -Early phenobarbital use can avoid intubation youtube.com/shorts/IMcT7... #EMIMCC

youtube.com

Phenobarbital in EtOH Withdrawal #emergencymedicine #criticalcare

YouTube video by EMSwami

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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 18/06/2026

🔥Just approved 🔥 The FDA has approved Utebzi (tebipenem pivoxil) tablets as the first oral carbapenem therapy for adults with complicated urinary tract infections, including pyelonephritis #idsky #EMIMCC www.fda.gov/drugs/news-e...

fda.gov

FDA approves first oral carbapenem therapy for complicated urinary tra

FDA approves first oral carbapenem therapy for complicated urinary tract infections

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Saganism @sagan.bsky.social · 19/06/2026

“Education is not the learning of facts but the training of the mind to think.” — Albert Einstein

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Astronomy 🔭 @astronomy.bsky.social · 19/06/2026

Looking out into the vastness of space from the windows of the ISS ✨ 📷 @Thom_astro

A view from space shows the curved horizon of Earth with a blue and orange atmospheric glow at the top. Below, a dense field of stars fills the dark sky. In the bottom right, parts of the International Space Station, including modules and solar panels, are visible.

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Richard Hurley @rich-hurley.bsky.social · 18/06/2026

Water bankruptcy: new #BMJEditorial has urgent actions for health systems in richer and poorer countries facing rising risks to clinical and public health. @kavehmadani.bsky.social @unuinweh.bsky.social @ununiversity.bsky.social @bmj.com #WaterSecurity www.bmj.com/content/393/...

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Neil deGrasse Tyson @neildegrassetyson.com · 18/06/2026

This conversation on @briantylercohen.bsky.social's podcast contains everything important that I’ve said in the past five years on aliens, conspiracies, science vs politics in America, colonizing Mars, sentient AI, NASA’s budget, etc. And it all fit within 1-hr. www.youtube.com/watch?v=odh_...

youtube.com

MUST-SEE: Neil DeGrasse Tyson on Trump, Obama, and aliens

YouTube video by Brian Tyler Cohen

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Jack Iwashyna @iwashyna.bsky.social · 11/06/2026

Friends, so exciting to see this piece led by Hanna Vollbrecht out

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Ken Milne MD @thesgem.bsky.social · 12/06/2026

“It is not knowledge, but the act of learning, not possession but the act of getting there, which grants the greatest enjoyment.” @casinoshiftmd.bsky.social

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redneeraj.bsky.social @redneeraj.bsky.social · 11/06/2026

Audience reaction to the panel considering another fluid trial. #CCR26

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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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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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Critical Care Reviews @criticalcarereviews.com · 11/06/2026

CCR26 FISSH - we've get you 🎣 P: Critically ill adults with suspected infection, hypotension/organ hypoperfusion, require fluids, and within 6h of ED/ICU consult I: Ringer's lactate C: Normal NaCl O: 30d 💀 S: 30 centres 🇨🇦🇸🇦 Protocol: shorturl.at/i625v

shorturl.at

https://shorturl.at/i625v

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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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Canadian Critical Care Trials Group (CCCTG) @ccctg.bsky.social · 11/06/2026

🐟 Coming up at 8:30 AM ET / 5:30 AM PT: results from the FISSH (Fluids in Septic Shock) trial Join the #CCR26 Belfast livestream for the presentation and discussion: criticalcarereviews.com

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Critical Care Reviews @criticalcarereviews.com · 11/06/2026

#CCR26 Bram Rochwerg is now presenting the FISSH trial! Join the meeting and conversations online (and for free!) at criticalcarereviews.com

criticalcarereviews.com

Home

The most up-to-date critical care website in the world

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Critical Care Reviews @criticalcarereviews.com · 11/06/2026

#CCR26 Ary Serpa Neto provides the editorial for the BIHCA trial. He reiterates the absence of evidence of bicarb and that we all use it (!) What should clinicians do tomorrow? Dr Serpa Neto: avoid routine use, but role as a rescue therapy / specific conditions not tested

criticalcarereviews.com

Home

The most up-to-date critical care website in the world

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Segun Olusanya (He/Him) @drfreeze.bsky.social · 11/06/2026

I think it’s a real lesson in how much septic shock management has changed The “liberal” fluid arms in trials is not that liberal anymore

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JAMA @jama.com · 11/06/2026

📊 Research Summary: Sodium bicarbonate did not improve sustained return of spontaneous circulation or survival in adults with in-hospital cardiac arrest, supporting guidelines against its routine use. #CCR26 @criticalcarereviews.com ja.ma/43stWv0

JAMA Research Summary on Sodium Bicarbonate for In-Hospital Cardiac Arrest. A visual shows icons of a patient with a heart, a syringe, and vials. A clinical trial on 913 adults (median 73) found no significant improvement in sustained spontaneous circulation (39% with bicarb vs 37% with placebo) or survival outcomes.

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JAMA @jama.com · 11/06/2026

Sodium bicarbonate did not improve sustained return of spontaneous circulation, survival, or neurologic outcomes in adults with in-hospital cardiac arrest compared to placebo. #CCR26 @criticalcarereviews.com ja.ma/43XgEXs

JAMA study: 779 adult in-hospital cardiac arrest patients (median age 73) were randomized to sodium bicarbonate (372) or placebo (407). Sustained spontaneous circulation returned in 39% (bicarb) vs 37% (placebo). Results were not statistically significant. Conclusion: Bicarbonate is not supported.

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redneeraj.bsky.social @redneeraj.bsky.social · 10/06/2026

The maths may allow for multinational trials which allow sites to enroll at different time points, have adaptive enrollment and not have controls but I think that allows for a lot of real world confounders. #CCR26

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