Zhen Cahilog @ZhenCahilog

training to become a #Zentensivist, forever 🏀 rookie, lifelong #space 🛸 & #POCUS 🔦enthusiast. @Imperial_SoM alum. it's pronounced like Jen Joined December 2016

Tweets

1K
Followers

274
Following

1K
Likes

5K

Katie Wiskar @katiewiskar

2 weeks ago

I say this as kindly as possible: “volume status” should not be the cornerstone of your hyponatremia evaluation ❌ I am admittedly someone who LOVES fluid physiology and hemodynamic assessment, but - it is TOO COMPLICATED 😵‍💫 We have much simpler, more intuitive methods for…

Aravind Palraj @Rheumat_Aravind

2 weeks ago

2 1 29 43K 19

Download Image

15 32 232 41K 244

Ashley Miller @icmteaching

3 weeks ago

🧵“Thresholds, consensus & physiology” Decades of critical care research have produced few reproducible breakthroughs. Maybe the problem isn’t our interventions — it’s that we reduce patients to syndromes, instead of treating them as individuals with distinct physiology.

2 43 113 21K 75

Ross Prager @ross_prager

3 weeks ago

(1/3) The hemodynamic interfaces paradigm proposed by @ThinkingCC et al. is probably the most comprehensive paradigm for assessing shock. Not going to lie, its a bit complicated. I comprehensive calculator with theory and practice tips to help you understand the interfaces as…

6 73 233 28K 236

Download Video

IMCrit @IM_Crit_

a month ago

14. Shock is not about hypotension, shock is about hypoperfusion

1 9 64 4K 5

Ross Prager @ross_prager

2 months ago

(2/4) First failure to perform point-of-care ultrasound when indicated it's still more likely to result in medical legal action than inappropriately performing POCUS cmpa-acpm.ca/en/research-po… With that said, over-reliance on POCUS findings and discrediting physical examination…

1 1 8 745 5

Ross Prager @ross_prager

2 months ago

(7/x) The biggest challenge to phenotyping patients is that it does require skills in ultrasound, which is not universally accessible to clinicians in real life. This is why groups like @AndromedaShock are performing studies like Andromeda Pegasus, trying to better estimate…

3 4 38 4K 11

Ross Prager @ross_prager

2 months ago

(3/x) Patients with septic shock can have any of the following patterns hemodynamics (which we will explore in more detail): 1. Distributive shock with high cardiac output and low filling pressures (‘warm’) 2. Distributive shock with low cardiac output and low filling pressures…

1 8 39 5K 18

Download Image

Ross Prager @ross_prager

2 months ago

(2/x) In medical school, septic shock is described as a distributive shock where patients have hyperdynamic circulation with bounding pulses and warm extremities. This is true in some patients, but not the majority. The problem here is that the cause of the shock is being…

1 5 44 6K 20

Download Image

Ashley Miller @icmteaching

2 months ago

1/ Shock is complex. But our tools are often simplistic. This paper proposes a new model: 🩸 Four circulatory interfaces that must stay coupled to maintain perfusion. Uncouple any one — and shock worsens. #Shock #MedX #FOAMcc Here’s the framework. 🔗 doi.org/10.3390/jpm150…

2 98 232 30K 282

Download Image

POCUS Med Ed @pocusmeded

2 months ago

This is a great example of how a zoomed in view of the pleura can lead you to the diagnosis. Irregular pleura is consistent with pneumonia, pulmonary fibrosis or ARDS, not cardiogenic pulmonary edema. The absence of pleural effusions is also a clue. @NephroP @POCUSpeek…

3 4 23 2K 5

IMCrit @IM_Crit_

2 months ago

Do you use a cardiac output (CO) monitor in patients with septic shock? This - just published - study is for you:

10 63 303 42K 228

Download Image

Dr Julia Grace Patterson💙 @JujuliaGrace

2 months ago

Ask a resident doctor what their commute is. Ask if they chose the town they live in. Ask how many friends’ weddings they have missed. Ask if they have a hobby. Ask if they have had to delay starting a family because of exams or training. They sacrifice *relentlessly*.

1K 602 3K 275K 72

Zhen Cahilog @ZhenCahilog

4 months ago

First time at #CCR25 and I’m feeling so inspired! As someone just starting my journey of becoming an intensivist, I am learning so much from this unique format of discussing a trial. Can’t believe tomorrow is the last day already - I’ll definitely be back in the years to come! 🙌🏻

0 1 4 4K 0

Ross Prager @ross_prager

4 months ago

(5/5) Low PF ratios associated with benefit from proning in ARDS, yet, it is likely not the PF ratio improvement with proning that causes benefit to patients. This one is a bit more complex. Studies like PROSEVA have shown that in ARDS low PF ratios (severe ARDS with worst…

3 3 48 4K 9

Download Image

Ross Prager @ross_prager

4 months ago

(3/5) Hyperglycemia is associated with increased infections in the ICU, but likely does not cause them. This is a common one. Numerous studies have demonstrated and association between hyperglycemia and infection rate and superficially it makes sense. Glucose = food for…

1 5 48 4K 5

Download Image

Ross Prager @ross_prager

4 months ago

(1/5) Elevated Lactate is correlated with mortality YET itself, does not cause harm. People give fluids to "clear the lactate" as if the lactate is toxic. It isn't. Lactate is a cardiac fuel source and actually an inotrope when infused in animal studies. Lactate generation is…

6 12 64 7K 22

Download Image

Critical Care Reviews @CritCareReviews

4 months ago

Measurement and interpretation of central venous pressure: a narrative review CCR Journal Watch - tracking the critical care literature daily criticalcarereviews.com/latest-evidenc…

0 37 127 8K 86

Download Image

Ross Prager @ross_prager

4 months ago

Lesson 5: Most patients or families who say “do everything” actually do not want everything done. Instead, with clarification, they want you to CARE with everything you have, fix / treat what you can, but ultimately, if they are dying, support them in a peaceful and dignified…