iiinova — where your digital self keeps evolving

Nick Mark, MD @nickmark.bsky.social · 28/02/2026

If you like sci-fi read Hyperion. Trust me. It’s great!

Nick Mark, MD @nickmark.bsky.social · 27/02/2026

🔥 Hot take: The Pentagon has essentially announced that Claude is so much better than other models that they must have it. Anthropic has signaled that they so much more principled than their competitors, that they can’t. When the Pentagon backs down or loses this is a huge PR win for Anthropic.

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Nick Mark, MD @nickmark.bsky.social · 25/02/2026

Important ECG pattern for trainees to know and recognize, particularly at this time of year.

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Nick Mark, MD @nickmark.bsky.social · 22/08/2025

Ok added another mock brand ICU shirt: Just Tube It. Which is is your favorite?

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Nick Mark, MD @nickmark.bsky.social · 20/08/2025

Added some new “mock brand ICU merch” to the @criticalcaretime.bsky.social store & I think it’s pretty awesome! www.criticalcaretime.com/shop

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Nick Mark, MD @nickmark.bsky.social · 30/06/2025

It's that wonderful time of year when new residents are joining the ICU team! Here are a few of my favorite @criticalcaretime.bsky.social infographics to help you understand key concepts: ⚡️Undifferentiated shock 💉 Vasopressors 😮‍💨 The physiologically difficult airway & 🧪 Metabolic acidosis

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Nick Mark, MD @nickmark.bsky.social · 25/05/2025

Do you know about ARDS mimics? These are diseases that *LOOK* like ARDS but have very different treatment: AEP, DAH, OP, HP, EVALI, PJP, AIP, etc. If you care for people with ARDS but this alphabet 🍜 of disease doesn’t immediately ring a 🛎️ you NEED to give this episode a listen! 1/

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Nick Mark, MD @nickmark.bsky.social · 07/05/2025

Vinay Prasad’s appointment to lead the FDA’s CBER division is a disaster for biotech stocks but it’s worse for patients who depend on new therapies. Therapies that Vinay has signaled he won’t approve.

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Nick Mark, MD @nickmark.bsky.social · 02/05/2025

I work with the best team! Love this battle of the inotrope education: milrinone vs dobutamine. Blue 🔵 or 🔴?

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Nick Mark, MD @nickmark.bsky.social · 02/05/2025

Me: ohh is this chylothorax? Student: who’s Kyle Thorax? Me: obv my new pseudonym..

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Nick Mark, MD @nickmark.bsky.social · 02/05/2025

Is this a ratatouille situation? It would kinda explain a lot.

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Nick Mark, MD @nickmark.bsky.social · 25/04/2025

We talk a lot more about how to put an ETT *IN* than how to take em *OUT*. On this week's @criticalcaretime.bsky.social @askinforair.bsky.social & I talk all things EXtubation. - readiness to exubate - breathing trials - overcoming challenges - addressing cuff leak - plus cases Give it a listen! 1/

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Nick Mark, MD @nickmark.bsky.social · 05/04/2025

I really liked Season 1 of Fallout. One thing that struck me as unrealistic was Vault-Tec’s evil plan: to literally nuke the entire world so they could fundamentally reshape society according to their twisted views. Anyway, it feels pretty realistic after this week…

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Nick Mark, MD @nickmark.bsky.social · 30/03/2025

Pretty strong personal statement tbh

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Nick Mark, MD @nickmark.bsky.social · 28/03/2025

🥇 Achievement unlocked! Not only is @criticalcaretime.bsky.social the #1 critical care podcast, we’ve surpassed RFK Jr’s misinformationcast in the rankings.

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Nick Mark, MD @nickmark.bsky.social · 22/03/2025

This is the pinnacle of good design.

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Nick Mark, MD @nickmark.bsky.social · 07/03/2025

So the emotional crux of this week’s Severance involves Ms Corbel suckling at a deflated endotracheal tube?

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Nick Mark, MD @nickmark.bsky.social · 07/03/2025

Also the FAA issuing a ground hold at numerous airports Hopefully this won’t impact POTUS golf game…

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Nick Mark, MD @nickmark.bsky.social · 07/03/2025

Once again a lot of flights are getting diverted to avoid falling debris from a Starship explosion

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Nick Mark, MD @nickmark.bsky.social · 03/03/2025

This may be one of the best forwards to a textbook ever. Very on brand for OB to include the weight & volume of the text…

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Nick Mark, MD @nickmark.bsky.social · 02/03/2025

Is funding for point of care ultrasound (POCUS) endangered because of the anti-woke crusade against “POC”? www.propublica.org/article/ted-... Truly we are living in the dumbest timeline…

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Nick Mark, MD @nickmark.bsky.social · 28/02/2025

The US is experiencing the largest measles outbreak including the first deaths from the disease in decades. RFk Jr - the newly confirmed HHS secretary - believes that this is a big pharma hoax & measles isn’t a deadly disease. We are so screwed.

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Nick Mark, MD @nickmark.bsky.social · 26/02/2025

Musk & his underlings suspended PEPFAR payments despite orders from SecState & the White House to resume them. Suspension of PEPFAR will cause over 14,000 otherwise preventable deaths. pepfar.impactcounter.com After his inevitable split with Trump, Musk & co should be held accountable for this.

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Nick Mark, MD @nickmark.bsky.social · 23/02/2025

Periodic reminder that for most people with vasodilatory shock we should be targeting a MAP > 60 mmHg (not 65). A lower MAP goal was associated with a shortened duration of vasopressors & possibly reduced mortality. With vasopressors, less is truly more. jamanetwork.com/journals/jam...

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Nick Mark, MD @nickmark.bsky.social · 13/02/2025

Guy who understands neither The Matrix nor Star Trek II

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Nick Mark, MD @nickmark.bsky.social · 12/02/2025

lol yes obviously the US government uses SQL. Elon doubling down just shows he has absolutely no idea what he’s talking about…

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Nick Mark, MD @nickmark.bsky.social · 10/02/2025

lol nice try scammers but I don’t think I have any unpaid tolls from +63 aka the Philippines

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Nick Mark, MD @nickmark.bsky.social · 08/02/2025

What’s the *opposite* of primary prevention for pediatric foreign body airway obstruction? This:

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Nick Mark, MD @nickmark.bsky.social · 06/02/2025

Is normal body temperature falling? An analysis of 3 cohorts including 677,423 human temperature measurements spanning 157 years, found that average body temperatures are decreasing by 0.03°C per birth decade. That's 0.45°C overall! Do modern humans have fewer infections or less inflammation?

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Nick Mark, MD @nickmark.bsky.social · 05/02/2025

🥶 It’s cold out! And that means my truck’s tires are learning about Gay-Lussac's Law. P₁/T₁ = P₂/T₂

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Nick Mark, MD @nickmark.bsky.social · 04/02/2025

As for safety, we know from the cardiology literature that ulnar access is comparable to radial in terms of complications. For example, here’s a meta-analysis of 6 studies with n=5276 participants. onlinelibrary.wiley.com/doi/10.1002/...

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Nick Mark, MD @nickmark.bsky.social · 04/02/2025

They’ve even done an RCT comparing ULNAR and RADIAL RCTs. This study - done without the benefit of ultrasound - found similar rates of success with both sites! 2/

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Nick Mark, MD @nickmark.bsky.social · 04/02/2025

Do you place ULNAR arterial lines? Why in 2025 are people still obsessed with RADIAL art lines? The ULNAR artery is usual bigger & farther from the nerve. Yes, the RADIAL is more superficial & easier to landmark but with POCUS it doesn’t matter! Is RADIAL a holdover from the pre-POCUS times? 1/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

This guy has lost his fucking mind. And he’s seizing control of the federal government. Terrifying.

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

No snowfall this season until today, but we’re making up for lost time!

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

The full report by CISA goes into specifics: www.cisa.gov/sites/defaul... One VERY worrisome detail: Despite the manufacturer’s claim that this backdoor was patched, researchers found this it on decompiled binaries with a HIGHER version number. They kept it in the code & lied about fixing it!

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

I’m glad none of the hospitals where I work use Contec monitors! But this highlights the inherent risks of software vulnerabilities in medical devices! We need trusted suppliers & better code review/testing. Hospital admin’s: Don’t buy bargain basement priced Chinese monitors! 9/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

The malicious agent could send code to the device to falsely generate normal looking telemetry data. (The CSM800 actually ships with a demo mode). The SpO2 reads 99% with a good pleth? Someone turns off necessary supplemental O2. Or the BP is “normal” so vasopressors are titrated down. 6/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

Hypothetical: Imagine a VIP has a routine surgery. A malicious actor spots them on the list of patients connected to a CSM8000 monitors. The malicious agent can use this vulnerable moment to attack email accounts, or even physically break into their home or office. But it gets even worse… 5/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

The firmware vulnerability can make the monitor download & run files from the remote server. This could disable alarms or even send *FAKE* telemetry data to fool clinicians! In a critically ill patient, this vulnerability could turn the CSM800 monitor into a cyber murder weapon. 4/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

If the CSM800 monitor is connected to the internet by Ethernet or Wifi it automatically executes this firmware vulnerability. Whoever operates the remote server can see every patient attached to a CSM800 monitor & watch their vitals in realtime. But it’s worse than just compromised privacy! 3/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

What does this mean? Hospitals network monitors like the CSM800 to remotely view patients vitals & telemetry. This way staff outside the patients room can keep multiple patients safe. This means these devices are connected to local networks (& often also to the internet). 2/

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Nick Mark, MD @nickmark.bsky.social · 02/02/2025

🚨Medical device vulnerability: researchers found the Contec CMS800 Monitor contains a firmware backdoor. If connected to the internet, the backdoor automatically connects to a specific IP & uploads patient info & sensor data. It also allows remote code execution, which is potentially lethal! 1/

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Nick Mark, MD @nickmark.bsky.social · 26/01/2025

We’re only one month into 2025 but it’s all over. Just give this photographer the Pulitzer!

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Nick Mark, MD @nickmark.bsky.social · 26/01/2025

Maybe it’s one if these situations

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Nick Mark, MD @nickmark.bsky.social · 25/01/2025

I’m so much more efficient at wasting time since this technology was invented!

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Nick Mark, MD @nickmark.bsky.social · 25/01/2025

Summary stats can be deceptive! Always visualize your data! These datasets have nearly identical mean, SD, & correlation yet they look completely different! You can explore the data yourself in an app I built: nickmmark.shinyapps.io/data_science/

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Nick Mark, MD @nickmark.bsky.social · 25/01/2025

How did dinosaurs 🦕 &how do blue whales 🐋 transport proteins to the ends of those very long neurons? Perhaps if we solve the mystery of the dinosaurs RLN, we can use that understanding to accelerate nerve repair in humans! An example of potential life changing discoveries in unlikely places! 5/

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