iiinova — where your digital self keeps evolving

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

13/3. Baby BIG (botulism Immune Globulin intravenous – human)[package insert]. Richmond, CA: Baxalta Inc.; 2021. 4. Botulism antitoxin Heptavalent (A, B, C, D, E, F, G) – (Equine)[package insert]. Winnipeg, Manitoba: Cangene Corporation; 2017.

000

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

12/References: 1. Richardson J, Viviano S. From beauty to botulism: a case report highlighting the rare risk of botox administration. Cureus. 2024;16(2):e54090. 2. Rao AK et al. Clinical guidelines for diagnosis and treatment of botulism, 2021. MMWR Recomm Rep. 2021;70(2):1-30.

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

11/Treatment options do not reverse paralysis, only neutralize circulating endotoxin. Affected nerve terminals will require time to regrow and reverse paralysis. Recovery may take weeks to months. Retreatment/additional doses of BIG/BAT are rarely needed.

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

10/ADEs include infusion, hypersensitivity, and delayed allergic reactions. Have epinephrine and diphenhydramine readily available. Additional ADEs including edema, falsely elevated glucose (d/t maltose in infusion), hypo/hypertension, agitation, anxiety, and urinary retention.

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

9/Administer at 0.5 mL/min and double the infusion rate every 30 minutes up to a maximum of 2 mL/min. A 15-micron, sterile, nonpyrogenic, low protein-binding, in-line filter should be used. BAT requires a dedicated IV site; do not infuse other medications with the therapy.⁴

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

8/For our case, we would use BAT. The usual adult dose (>55 kg) is 1 vial. For pediatrics and weight <55 kgs, a percentage of the vial is administered. The dose is determined once the vial is in hand. BAT is further diluted in a ratio of 1:10 with normal saline.⁴

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

7/Consultation with DPH/CDC will help with ordering and dosing. Payment must be arranged prior to BIG being sent. Check your EMAR for order entry options and if no option in EMAR, work with your pharmacist and IT team to build BIG or BAT orders.³

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

6/BIG is ordered through the California Department of Public Health (DPH) whereas BAT is ordered through your state’s department of public health or the US Centers for Disease Control and Prevention. The process for ordering botulism treatments can be found below.

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

5/There are two treatment options for botulism, immunoglobulin (BIG) or antitoxin (BAT). BIG is for children 15 months or younger and is specific for botulism types A and B. BAT is available for those >16 months and treatment of 7 types of botulinum toxin (A-G).

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

4/Supportive care is the mainstay of treatment. Early treatment (within 48 hours) with botulism antitoxin may limit disease progression, hospital time, and may have the greatest impact on morbidity. Treatment after 7 or more days may not be useful but may limit circulating toxin.²

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

3/Botulism results in a descending paralysis with effects at proximal musculature followed by distal musculature. Voice changes may occur from vocal cord paralysis. The diagnosis may be mistaken as alcohol intoxication, myasthenia gravis, Guillain-Barré or other causes.¹,²

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

2/Botulism paralysis is caused by neurotoxin release from Clostridium species. The neurotoxin results in irreversible prevention of acetylcholine release from nerve cells (see image). There are 5 types: Food borne, wound, intestinal colonization, iatrogenic, and inhalation.²

100

SCCM Midwest Chapter @sccmmw.bsky.social · 11/10/2026

A 47-year-old received Botox® 3 weeks ago. She presents with blurred vision, difficulty swallowing, shortness of breath, and weakness. Who should you contact to get botulism antitoxin?¹ 1️⃣ Poison Control 2️⃣ California Health Department (HD) 3️⃣ State HD 4️⃣ The CDC 5️⃣ The ID physician 📊 Show results

111

SCCM Midwest Chapter @sccmmw.bsky.social · 02/10/2026

Want to get more involved with the SCCM Midwest Chapter? 🙌 We have committee opportunities for critical care professionals who want to connect, share ideas, and make an impact in our critical care community! Come get involved with us! Join below! 👇 sccmmwc.starchapter.com/form.php?for...

sccmmwc.starchapter.com

SCCM MIDWEST CHAPTER - Get Involved Form

010

SCCM Midwest Chapter @sccmmw.bsky.social · 11/09/2026

🚨 Just 7 days until Midwest Strong! 🚨 Join the SCCM Midwest Chapter’s 7th Annual Conference on Sept. 18! This year’s focus: Critical Care & Crisis, featuring tabletop crisis scenarios, an expert panel, research, discussion, and networking. 💻 Virtual participation available 📧 SCCMMWC@gmail.com

001

SCCM Midwest Chapter @sccmmw.bsky.social · 07/09/2026

Check out Dr. Rozenbaum's free comprehensive mechanical ventilation course: themvedproject.com/comprehensiv.... The short videos cover foundations to advanced concepts, such as advanced mechanics, esophageal pressure monitors, and dyssynchronies. Claim free CME credits as you complete each module!

112

SCCM Midwest Chapter @sccmmw.bsky.social · 04/09/2026

🚨Less than two weeks away!🚨 Register today for the 7th Annual SCCM Midwest Conference on Sept 18th! We hope to see you there! sccmmwc.starchapter.com/meetinginfo....

011

SCCM Midwest Chapter @sccmmw.bsky.social · 27/08/2026

What happens when a tornado or cyber attack hits your hospital? Find out at the 7th Annual SCCM Midwest Chapter Critical Care Conference on Sept. 18 in Mount Prospect, IL! Join us for interactive simulations, expert speakers, CE, and more. Register: sccmmwc.starchapter.com/meetinginfo....

000

SCCM Midwest Chapter @sccmmw.bsky.social · 15/08/2026

🚨 SAVE THE DATE! 🚨 Don’t miss the SCCM Midwest Chapter’s 7th Annual Critical Care Conference on September 18th! Strong teams. Strong communities. Stronger together. 💪 👇 Details on the flyer! Register today!

000

SCCM Midwest Chapter @sccmmw.bsky.social · 09/08/2026

Registration is open! Join the Midwest Chapter on Friday, Sept 18 at @sccmcriticalcare.bsky.social headquarters in Mt. Prospect for our annual conference: Midwest Strong - Crisis & Critical Care.

000

SCCM Midwest Chapter @sccmmw.bsky.social · 29/07/2026

Call for ABSTRACT SUBMISSIONS! Submission deadline for SCCM-MWC's 7th Annual Critical Care Conference is August 17. The conference - Midwest Strong: Crisis and Critical Care - will be held on September 18, 2026 at SCCM Headquarters in Mount Prospect, IL. sccmmidwestchapter.org/survey.php?i...

sccmmidwestchapter.org

SCCM MIDWEST CHAPTER - Surveys

000

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

10/ Bottom line: ketamine may no longer be just a rescue therapy for SE in the ICU — but more evidence is needed. What is your institution's current practice? 📷 Never 📷 ICU only 📷 Along with/after 2nd-line therapy 📷 RSI only 📷 Other (reply below)

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

9/ Trials to watch: KESETT (NCT06907173) — Phase III RCT, adults + children, benzo-refractory SE: - LEV 60mg/kg alone - LEV + ketamine 1mg/kg - LEV + ketamine 3mg/kg KLaSSEC (NCT07046611) — pediatric RCT (Sohag, Egypt): - LEV 60mg/kg + placebo - LEV + ketamine 2mg/kg

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

8/ Where are we today? Ketamine: ✅ Mechanistic plausibility ✅ Reasonable safety ✅ May be effective earlier than traditionally used ✅ Hemodynamic stability; preserves airway — often avoids intubation Questions: timing, dosing, patient selection More prospective RCTs needed.

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

7/ Ket-Mid (2025) — RCT, 144 children, Egypt: Ket 2mg/kg + midaz: 76% cessation at 5 min; Placebo + midaz: 21% (RR 3.7, 95% CI 2.3–5.9); Intubation: 4.2% vs 20.8%. ⚠️Median arrival 34 min post-onset; 58% seizing >30 min — low control arm reflects treatment delay.

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

6/ Zitek et al (2025) — before-and-after cohort, 688 patients, single Florida EMS system: Midazolam ×2: 82.0% cessation; Midazolam + ketamine: 94.4% (Δ12.4%, 95% CI 3.1–21.7%); Intubation: 1.1% both groups (propensity-matched) ⚠️ Single system; nonrandomized.

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

5/ Historically, ketamine SE data came from: ✅ Retrospective studies ✅ Intubated ICU patients ✅ Refractory/super-refractory SE Seizure control rates ~40–70%, but ketamine was started late. Key observation: later ketamine = higher failure rates. Should we use it earlier?

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

4/ As seizures continue: 👎GABA receptor responsiveness — internalization away from synapse 👍 NMDA-mediated excitation When GABAergic therapies lose effectiveness, blocking excitatory NMDA pathways may terminate seizure activity. Image created in biorender.com

121

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

3/ At baseline, there is a balance of inhibitory (GABA) and excitatory (NMDA) receptors post-synaptically. Benzodiazepines target GABA-A receptors. Ketamine is an NMDA receptor antagonist. Different target. Different mechanism. Image created in biorender.com

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

2/ SE is a race against time 📷 Benzos are first-line, but fail in 30–40% of patients. Guidelines recommend 2nd-line agents (LEV, VPA, fosphenytoin) if BDZs fail. After that, many require anesthetic infusions — often with intubation. aesnet.org/.../clini......

111

SCCM Midwest Chapter @sccmmw.bsky.social · 09/07/2026

1/ 🧶Too Little, Too Late? Rethinking Ketamine in Refractory Status Epilepticus (SE). Ketamine has long been reserved for refractory/super-refractory SE in the ICU. Newer data suggest earlier use may be warranted. Here is a quick review of the evidence.

122

SCCM Midwest Chapter @sccmmw.bsky.social · 30/06/2026

There is still time to register for tomorrow's FREE virtual webinar. Critical Care Pharmacy Resident Hannah Hinrichs will be reviewing the pharmacology of Rapid Sequence Intubation. RSVP required via the link below to obtain Teams access. When: July 1 at 6pm CST RSVP: shorturl.at/DYONx

000

SCCM Midwest Chapter @sccmmw.bsky.social · 16/06/2026

Midwest Chapter's 7th Annual Critical Care Conference is 3 months away! Time to register! Join the Midwest Chapter on September 18, 2026 at SCCM Headquarters in Mount Prospect, IL for Midwest Strong: Crisis and Critical Care. Register here: sccmmwc.starchapter.com/meetinginfo....

011

SCCM Midwest Chapter @sccmmw.bsky.social · 10/06/2026

We invite you to join the Midwest Chapter for our next FREE virtual webinar on July 1 at 6pm CST. Critical Care Pharmacy Resident Hannah Hinrichs will be reviewing the pharmacology of Rapid Sequence Intubation. RSVP: shorturl.at/DYONx

001

SCCM Midwest Chapter @sccmmw.bsky.social · 26/05/2026

New Member Spotlight! We invite our followers to help welcome Annie Echelbarger, an ICU nurse practitioner, to the Midwest Chapter! Welcome, Annie. We cannot wait to get to know you and work with you in the MWC.

000

SCCM Midwest Chapter @sccmmw.bsky.social · 14/05/2026

Abstract Submissions are officially being accepted for the Midwest Chapter's 7th Annual Critical Care Conference! Submission deadline: July 31 at midnight CST Submission form: sccmmwc.starchapter.com/form.php?for...

001

SCCM Midwest Chapter @sccmmw.bsky.social · 02/05/2026

Are you wondering what all the excitement is about the ICU Liberation bundle? Take a listen! #icu #criticalcaremedicine #ICUliberation

000

SCCM Midwest Chapter @sccmmw.bsky.social · 13/04/2026

Only 2 weeks left to nominate SCCM - Midwest Chapter Officers! Nominations end on 4/27. sccmmidwestchapter.org/survey.php?i...

sccmmidwestchapter.org

SCCM MIDWEST CHAPTER - Surveys

000

SCCM Midwest Chapter @sccmmw.bsky.social · 08/04/2026

We are two weeks away from Critical Care Pharmacist Rebecca Hilton's virtual webinar reviewing Stress Ulcer Prophylaxis. Claim your FREE spot by RSVPing to SCCMMWC@gmail.com!

000

SCCM Midwest Chapter @sccmmw.bsky.social · 27/03/2026

Are you or a colleague interested in getting more involved with the Midwest Chapter in a leadership capacity? Please consider nominating yourself or someone you know for a leadership role in SCCM-MWC by completing a very brief survey. sccmmidwestchapter.org/survey.php?i...

sccmmidwestchapter.org

SCCM MIDWEST CHAPTER - Surveys

000

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

15/ DCD + NRP Fundamentals: ~ 5-minute observation rule ~ Death declared before perfusion ~ Cerebral circulation excluded ~ Real-time organ assessment ~ Expands heart transplant access + improves transplant outcomes across multiple organs. When the heart stops… it may still save a life. 🫀

001

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

14/ The bigger picture: Technology is expanding the donor pool. NRP + ex-vivo perfusion are transforming what was once “non-viable.” Critical care doesn’t stop at death. It enables legacy. 🕊️

101

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

13/ Ethical safeguards are non-negotiable: ✔ Decision for WLST made independently ✔ Death declared by treating team ✔ No brain reperfusion ✔ Transparent communication 🛡️ Trust is everything.

111

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

12/ ICU relevance: Your role is critical. ~Timely OPO referral ~Hemodynamic optimization before WLST ~Clear separation of care decisions ~Family-centered communication DCD starts in the ICU.

101

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

11/ Why this matters: DCD hearts have increased transplant volume significantly in centers using NRP. In some programs, DCD now accounts for 20–30% of heart transplants. That’s lives saved.

101

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

10/ What happens next? Cardiac activity may resume within the isolated regional circulation. This allows organs to be: 🔍 Assessed in real time 🫀 Hemodynamically optimized ⭐ Procured under controlled perfusion Outcomes with NRP now approach those of brain-death donors.

101

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

9/ Let’s be clear. Regional blood flow is re-established to: 🫀 Heart 🫁 Lungs 🫄 Abdominal organs But NOT the brain. This preserves the ethical boundary.

101

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

8/ Adapted from Alamouti-Fard et al., 2022 (Cureus), CC BY 4.0

101

SCCM Midwest Chapter @sccmmw.bsky.social · 25/03/2026

7/ Abdominal NRP (A-NRP) ~Perfuses abdominal organs only ~No thoracic perfusion Thoraco-abdominal NRP (TA-NRP) ~Perfuses heart + lungs+ abdominal organs Result: Organs perfused. Brain remains without flow.

101