Reposted by Steven Ilko 🏥 🚁💨Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 03/09/2026Agree The only place balanced solutions convincingly showed benefit was where we do give loads of fluids and risk of AKI is high www.nephjc.com/news/bestflu... (SALTED/SMART with 1-2 litres total was implausible)nephjc.comArt of Balance In Preventing Delayed Graft Function - BEST FLUIDS for better outcomes — NephJCThis week, we put our best fluid forward to discuss whether balanced crystalloids reduce the incidence of DGF after deceased donor kidney transplant compared to normal saline. 151
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 25/08/2026When ppl testing frontier AI models are impressed with how fast and ruthless models perform attacks while breaking rules to not do certain things... And we build autonomous war drones and have military incorporated AI... But: "Don't worry. We set restrictions" That's exactly how you get SkyNet 👍static.klipy.comSkynet Is The Virus: A Chilling RevelationALT: Skynet Is The Virus: A Chilling Revelation 010
Reposted by Steven Ilko 🏥 🚁💨@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
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 12/08/2026What is something in your consult/progress note that someone else would almost immediately recognize as being only from you? I'll start: -"Avoid avoidable nephrotoxins" -"low threshold for methylene blue" An RN pointed out some of my note quirks and it made me curious. #emimcc #medsky #icusky 550
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 31/07/2026Circa 2020. Just intern me learning real quick what kind of EM-ICU doc I would someday become. 021
Reposted by Steven Ilko 🏥 🚁💨Jack Iwashyna @iwashyna.bsky.social · 17/07/2026My daughter just texted me about my new (and 1st) @nejm.org #Voices column: ‘From my pre med friend: “it’s things like that, that make me rly excited to go into this profession”’ And I am going to be smiling all day I would love your thoughts voices.nejm.org/doi/full/10....voices.nejm.orgWhy I Choose the Hospital in JulyHouse staff have a lot to learn, and July is a great time to teach them. 43013
Reposted by Steven Ilko 🏥 🚁💨The Paramedic Academic @paramedicacademic.bsky.social · 14/07/2026The Paramedic Academic is now live. A new space for evidence-informed commentary on #paramedicine, emergency systems, regional #health and equity. The Paramedic Academic promises to provide less jargon, no paywalls and the occasional strong opinion. www.paramedic-academic.com 022
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 09/07/2026An absolute gem of a video for first year residents, early trainees and even seasoned docs with some potentially bad habits. 100
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 09/07/2026Having had a few cases like this recently. Dutiful vent management and interventions like APRV can be immensely satisfying. 010
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 27/06/2026Proud to share the published results of an international collaboration assessing the outcomes of various ED-ICU care models. (I read 2000 abstracts so you didn't have to) 📉Lower ICU admission rate 📉Shorter hospital LOS (0.5d) 📈Longer ICU LOS (0.5d) 🙅No difference 28d mortality rdcu.be/fqNAI #EMIMCCrdcu.beCritical care delivery models in emergency departments: a systematic review of the literature and meta-analysis of related outcome effects 151
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 12/06/2026It's a bit fun when your workplace abilities to switch day/night shifts become a Spanish vacation super power -- easily taking on the Ibiza nightclubs till the early hours. Jet lag? Never heard of it. Sleeping during the day? Ez-pz. "Unhealthy" amounts of caffeine? Seems homeostatic to me. 020
Reposted by Steven Ilko 🏥 🚁💨Ben Millette @benmillette.bsky.social · 10/06/2026Wow! MARCH trial results show no significant benefit for hypertonic saline and carbocisteine in ventilated ICU patients, and significant harm associated with both. Very well done to all of the investigators! www.nejm.org/doi/full/10.... #CCR26nejm.orgCarbocisteine or Hypertonic Saline for Acute Respiratory Failure | NEJMMucoactive agents are widely used in patients with acute respiratory failure despite limited evidence of their effectiveness or safety. We conducted a multicenter, open-label, randomized trial with... 074
Reposted by Steven Ilko 🏥 🚁💨Emily Moin @emilymoin.com · 08/06/2026Sorry, I am extremely skeptical that the language model underlying OpenEvidence is trained on an exclusively biomedical corpus – all the available evidence suggests it is RAG on a third-party foundation model. 2193
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 08/06/2026If we can't get studies to answer even "basic questions" (like ICU fluids). No way can an LLM use subsets of the lit to answer more complex questions. TL;DR- OpenEvidence is pitching itself to healthcare organizations and physicians as the answer to thinking. #emimcc www.nytimes.com/2026/06/08/b...nytimes.comHave a Thorny Medical Question? Your Doctor May Be Using A.I. for That. 293
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 28/05/2026OG Coca-Cola is effectively human draino and you won't be able to convince me otherwise at this point. #emimcc #medsky Anyone else have a favorite case report so far this year? www.cureus.com/articles/424...cureus.comMassive Fecaloma Dissolved by Coca-Cola: A Case ReportFecalomas are hardened masses of fecal material that are a rare complication of chronic constipation and require surgical resection when conservative measures fail. Recent reports suggest that Coca-Co... 071
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 26/05/2026Anyone have any experience with medetomidine withdrawal, and spotting it from fentanyl withdrawal? I am thinking about it in a guy with maybe the worst opioid withdrawal I've ever seen. Otherworldly severe. #emimcc 113
Reposted by Steven Ilko 🏥 🚁💨NY Times Pitchbot @nytpitchbot.bsky.social · 24/05/2026Donald Trump promised the war in Iran would end with unconditional surrender. But he never said which country would do the surrendering. 623286720
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 22/05/2026That's the power of PEEP! Excellent proof of concept. 000
Reposted by Steven Ilko 🏥 🚁💨Jack Iwashyna @iwashyna.bsky.social · 19/05/2026Over on LinkedIn, Dr Jorge Salluh shared a very thoughtful post on how his journal, Crit Care Science, thinks about single center studies I’m sharing it here: 132
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 15/05/2026If I have a spill in my kitchen. And you provide me with 5 different ways to categorize and stratify my spill. But then tell me I'm to use my own judgement on how I clean it. You've done nothing. You've created a distinction without a difference. Waste of time, energy and money. 010
Reposted by Steven Ilko 🏥 🚁💨Florian Zores @fzores.eurosky.social · 15/05/2026A trial is negative because the wrong patients were included (even after half a dozen of negative trials). Results of positive trials can always be extended to the whole population 192
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 13/05/2026For anyone paying attention... Of course this is the solution. The tech is sold to admin as a way to allow me to see more patients in less time. Not for my wellness, nor the benefit of the patient. But for higher productivity. Their $$ benefit. My liability. Checks out. 032
Reposted by Steven Ilko 🏥 🚁💨ScreamingMD @screamingmd.bsky.social · 04/05/2026EM workrooms are just neurodivergent people trading medical stories to relate to each other. 4152
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 03/05/2026More poorly designed "AI Trials" with even worse reporting. The frequency with which ppl are using AI to alter care/decision making is rising. AI queries can be a helpful part of the conversation to generate questions... But I'm seeing cases of people using AI as the sole mode of decision making. 000
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 08/04/2026Anyone else using music as an anxiolytic for patients either on the vent or for "routine procedure" (excluding low frequency high risk, and procedures while in extremis) #emimcc #icusky #emsky Did dissociated laryngoscopy and intubation and it seemed to keep the room and the patient cool 😎 141
Reposted by Steven Ilko 🏥 🚁💨Critical Care Reviews @criticalcarereviews.com · 08/04/2026Interested in the major trials in critical care? We have summarised and critiqued 250 of the most important randomised controlled trials stretching back over the past 25 years. criticalcarereviews.com/collections… 1137
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 05/04/2026ACS (but not the kind I usually worry about now I'm in the micu more) is a serious and sometimes delayed/missed diagnosis. Know about it. Have a plan. 000
Reposted by Steven Ilko 🏥 🚁💨Doctor The Frog @skipbidder.bsky.social · 04/04/2026Also, AI can't pass medical exams. 26515
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 04/04/2026Man in his 60s presented w/ syncope and bilateral knee soreness. No swelling, nor SOB. Progressive hypoxia, diaphoresis and hypotension. Eventually intubated but DNR. Get the admission call for "ACS- new RBBB, elevated trop in shock". Performed POCUS and CT-Angio. Worst RV failure I've ever seen. 172
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 03/04/2026Another study showing how we treat women differently. More research is needed to find causes and direct our efforts towards more equitable care. We still have work to do. 010
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 02/04/2026Was on call for a small hospital. Finished work for the morning, went home and then to the gym to swim/rehab. Did not keep an extra set of scrubs in the car, so had to go in as is. RN got me a pair of scrub bottoms. Anyone else have fun "just got called into work from doing something else" story? 010
Reposted by Steven Ilko 🏥 🚁💨CriticalCareNow @criticalcarenow.bsky.social · 31/03/2026Stop waiting, start liberating By identifying candidates with reversed insults and successful SBTs, we can bypass the ICU bottleneck safely. It’s the next logical step for Emergency Medicine. Comment to discuss. 111
Reposted by Steven Ilko 🏥 🚁💨Critical Care Reviews @criticalcarereviews.com · 25/03/2026Assessment of Congestion in Heart Failure Using VExUS: Current Evidence, Limitations and Clinical Perspectives CCR Journal Watch criticalcarereviews.com/latest-evid… 221
Reposted by Steven Ilko 🏥 🚁💨josh farkas 💊 @pulmcrit.bsky.social · 24/03/2026kudos to ACEP for calling out the Surviving Sepsis Campaign 2026 guidelines and not joining in this madness. ACEP is great at making evidence-based policies that actually *help* provide better patient care. When ACEP is politely burning your guideline, you’re in trouble. #EMIMCC 43311
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 24/03/20262 very long months off work, getting back to the grind was a lot. But it was incredible to return to a tribe that embraced me, helped me navigate some temporary limits and made me laugh along the way. #icusky #medsky 010
Reposted by Steven Ilko 🏥 🚁💨Matt Thau @thaumatturgist.bsky.social · 23/03/2026Only in Texas it is a cowboy extubation. Everywhere else it’s a sparkling grip-it-and-rip-it 121
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 20/03/2026I'm frequently asked what I keep on my person as an EM-CC trained doctor. In my pocket I always keep a long 16g angiocath, and a #10 scalpel. Then there is the contents of my fanny pack... What do you keep on you for your shift #emimcc , #emsky #medsky ? 212
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 30/01/2026Any recommendations for leadership courses that people have liked? There may be some upcoming opportunities for guiding/leading an intensive care unit and while I'm quite adept at the learn by doing... I feel there may be a better way to do things right the first time. #EMIMCC #ICUsky #medsky 100
Reposted by Steven Ilko 🏥 🚁💨Sherrilyn Ifill @sifill.bsky.social · 25/01/2026I cannot imagine the devastation this family is experiencing today. This statement is powerful and must be read. 5337061414
Reposted by Steven Ilko 🏥 🚁💨Dimitri Drekonja, MD, MS @dimitridrekonja.bsky.social · 24/01/2026Alex Pretti was a colleague at the VA. We hired him to recruit for our trial. He became an ICU nurse- I lover working with him. He was a good kind person who lived to help and these fuckers executed him. White. Hot. Rage. 13856007018636
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 25/01/2026This is the moment to identify media accomplices, false-opposition democrats and those who are readily willing to ignore the truth of their own eyes and ears. I sincerely hope this will be a turning point. The schism between the federal fascists and law enforcement is increasing ever more. 000
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 11/01/2026Phenomenal write up for anyone working in EMS/Code Team/RRT quality and safety. I will be referencing this. TCP is always thrown out as "what they should have done"-- but lit is showing this is a low success maneuver. I'll still do it-- but good to escalate chronotropes and prep for TVP. 221
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 10/01/20263 weeks into recovery! Had a child sitting with their family and I could hear them talking about my walker and scars. Mom made it a teaching moment, and had her kid ask me some questions-- to talk to me and not about me. She was so kind and got us a gift card. The world needs more parents like this. 010
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 02/01/2026Day 10/10 of self-administered enoxaparin inj. I don't particularly enjoy the sensation of subq needles and meds. However the burn was only minimal and short lasting. I do however appreciate not developing a DVT and the pharmacologic profile is phenomenal Final rating: 8/10 - would stab self again 000
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 01/01/2026Walking into 2026. (well... walkering for me) Wishing everyone a happy and healthy New Year 010
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 23/12/2025As a doc, 13 days as an inpatient gives you some perspective of what our patients go through in severe injury/illness. What an experience. Thankful to have my health, my mental acuity. Here is a photo of the thank you card my partner and I left our Ortho unit. More reflections to come as I recover. 140
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 18/12/2025Turns out my superb pre-hospital trauma care was in reality 4 deployments of WMDs. Do I contact FEMA as a victim of terrorism? www.whitehouse.gov/presidential...whitehouse.govDESIGNATING FENTANYL AS A WEAPON OF MASS DESTRUCTIONBy the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered: Section 1. Purpose and 000
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 15/12/2025There is no greater betrayal of your own body than waking up in 10/10 pain from hypnic jerks while in an ex-fix. Not even naps are safe 000
Steven Ilko 🏥 🚁💨 @zentensivistilko.bsky.social · 15/12/2025Navigating a critical injury far from home. 1/5 stars. Don't recommend. Thankful for all the support shown by my colleagues and family. It means so much. 000