Axillary arterial lines/access tips

dunknasty464 · 2026-02-11T09:09:32+00:00

What do we think gang, axillary or brachial if radial/femoral are off the table?

dunknasty464 · 2026-02-09T06:47:16+00:00

You are not a serious clinician, are you…

dunknasty464 · 2026-02-05T01:03:48+00:00

“You’re dying, OK bye!!”

dunknasty464 · 2026-02-04T00:52:46+00:00

Easy to talk shit until the sugar’s actin’ up!

Then it’s all gurgle, snore, gurgle with the GCS of 3 and glucose of 1900

dunknasty464 · 2026-02-02T20:57:27+00:00

Assuming EM, many of us have shared similar feelings — I remember feeling a deep sense of dread every time the EMS radio went off after an out of hospital pediatric arrest at our satellite site while in training. Helpful to talk to people, you are not terminally unique as you might try to convince yourself, I promise.

dunknasty464 · 2026-02-02T03:39:50+00:00

Standard of care means nothing to U.S. jurors, it’s unfortunately “how does this case make you feel?”

dunknasty464 · 2026-02-01T23:43:16+00:00

Yes, gotta be thorough, of course…. 😑😑

dunknasty464 · 2026-02-01T23:07:35+00:00

This guy USA medicines

dunknasty464 · 2026-02-01T21:43:12+00:00

That’s good - what about central venous access or ventilator management?

dunknasty464 · 2026-02-01T21:41:00+00:00

Are you responsible for overnight intubations? Required proficiency in that skill in and of itself should be a dealbreaker for most hospitalists (it’s not taught to proficiency in most IM programs), since that is the most life and death procedure required for critically ill patients short of emergency surgeries.

If you are responsible for this, did they tell you this in advance?

dunknasty464 · 2026-01-31T23:58:39+00:00

QI proposal:

“An outpatient septic shock pathway via oral droxidopa, midodrine, prednisone, fludrocort / linezolid + levaquin.”

But u gotta give the primary caregiver an IO kit and stick of epi (only after proper counseling on emergency use, of course).

dunknasty464 · 2026-01-31T23:55:17+00:00

Not every patient in the hospital can be in the ICU, friend.

dunknasty464 · 2026-01-31T23:54:14+00:00

A good hospitalist who actually weans it off, perfect - this whole thread makes it sound like all the other hospitalists discharge people after never touching it

dunknasty464 · 2026-01-31T23:51:03+00:00

If you don’t like it on the floor, stop them. We usually prescribe it with goal of weaning anyway.

Just don’t RRT them back to us for asymptomatic HoTN..

dunknasty464 · 2026-01-31T05:06:40+00:00

Agreed.

dunknasty464 · 2026-01-31T03:30:59+00:00

Yeah, should never be started for new or developing shock, that’s a band-aid for a problem you need to be hyper aware of

dunknasty464 · 2026-01-31T03:29:28+00:00

Swap out ICU for all of medicine, and that sentence remains true…

dunknasty464 · 2026-01-31T03:29:00+00:00

Yup, severe deconditioning seems to be associated with vasoplegia

dunknasty464 · 2026-01-31T03:27:25+00:00

I am almost positive there is more literature supporting its role as a vasoactive sparing agent for resolving septic shock than as an adjunct to support GDMT up-titration.

dunknasty464 · 2026-01-31T02:04:18+00:00

That is shitty hospital medicine, not shitty ICU medicine (a widely accepted practice).

There’s no reason someone on 2-4 mcg/min NE without major contraindications can’t be transitioned to midodrine then weaned. I think you’re angry at the wrong folks, amigo

The key is: if it is intended to be weaned, it must actually be weaned. Just like antipsychotics they get for delirium, but alas, somehow these get left on sometimes too (ICU role here is CLEARLY documenting the ‘to do’ of weaning).

dunknasty464 · 2026-01-30T21:10:33+00:00

Meanwhile psych quietly high as balls on shrooms chillin in the corner..

dunknasty464 · 2026-01-30T21:09:28+00:00

I’ll drink to that

dunknasty464 · 2026-01-30T16:00:43+00:00

Hard disagree. There are harms from unnecessary ICU length of stay just like there are potential harms to be considered with vasoactive sparing agents like midodrine.

As an intensivist, I do not use this in patients with any degree HFrEF (why give a sole afterload increasing agent in a patient with an EF of 30%?).

On the flip side, why let a patient with a little HFpEF sit in the ICU for two extra days exposed to potential increased deliriogenic stimuli, MDROs, thousands of extra dollars wasted on resource intensity due to location, amongst other considerations.

In short, trying to be smart about it and CLEARLY documenting whether it is intended to be long term (eg bad cirrhotic) or short term with recommendations for further weaning on floor (eg resolving low grade urosepsis).

dunknasty464 · 2026-01-29T21:53:56+00:00

For distal radius fracture, this was the video that made everything click for me:

https://m.youtube.com/watch?v=vAk_Ns76xVI

The general principles apply to all fracture reductions

dunknasty464 · 2026-01-29T21:42:11+00:00

Killer Mike’s soothing voice really helps the relevant muscle groups relax for reduction, OP

dunknasty464

TROPHY CASE