Joined April 2009
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- Following 1,641
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Photos and videos
Jun 11
Arbitrary numbers
Jun 11
30 mL/kg has never been supported by evidence and physiologically it is nonsensical to think a weight-based prescription would be beneficial. Assess the hemodynamics in front of you and treat accordingly
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Great thread on Albumin
24 Nov 2025
🧵 Albumin in Critical Care: 70 Years, 700 Papers… Zero Benefit
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Albumin is the most studied fluid in critical care.
Decades of trials. Endless meta-analyses.
And yet – not a single clinically meaningful benefit.
Here’s why the entire theory collapses once you understand Extended Starling. 👇
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Abdullah AlSomali retweeted
May 6
25 years ago today, the Sopranos gave us Pine Barrens, the greatest episode in TV history
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Abdullah AlSomali retweeted
May 6
25 years ago today Pine Barrens first aired.
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911
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Abdullah AlSomali retweeted
Intubation used to be a lot scarier 😱
Relying on a straight line of sight meant difficult anatomy often left you flying blind. Modern VL turns scary surprises into manageable procedures. Don't risk it—relying on your eyes alone is an unnecessary risk in 2026. #AirwayManagement
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Abdullah AlSomali retweeted
Mar 16
Fresh blog: Six reasons to stop relying on the NPi (neurological pupil index)
👁️ NPi is based on a secret, proprietary formula used by one company
👁️ The neuroICU field was somehow convinced that we're too stupid to understand pupillometry tracings, so we need the NPi...(#1/2)
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Abdullah AlSomali retweeted
Mar 13
Antibiotics probably aren’t beneficial for patients with cirrhosis & GI bleeding
It will take time to change practice on this, but this is probably ripe for some antimicrobial stewardship
The idea that a few doses of ceftriaxone improve *mortality* in GI bleed was always sus…
Mar 13
classic teaching: cirrhosis upper GI bleed = antibiotics for everyone.
But how strong is the evidence behind that practice?
This Annals of Emergency Medicine Systematic Review Snapshot highlights a Bayesian meta-analysis of 14 randomized trials examining antibiotic prophylaxis in cirrhotic patients with upper GI bleeding. The analysis raises important questions about duration of therapy, while also reminding us about the limitations of older, heterogeneous trials and potential bias in the data.
📚 The takeaway: worth reading, worth discussing, and worth scrutinizing the methods before changing practice.
Check out the full Systematic Review Snapshot in Annals of Emergency Medicine and decide for yourself.
Reference:
Prosty C, Noutsios D, Dubé LR, et al. Prophylactic antibiotics for upper gastrointestinal bleeding in patients with cirrhosis: a systematic review and Bayesian meta-analysis. JAMA Intern Med. 2025;185:1194-1203.
Discussed in: Annals of Emergency Medicine Systematic Review Snapshot.
#EmergencyMedicine #MedEd #FOAMed #EvidenceBasedMedicine #AnnalsOfEM
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Abdullah AlSomali retweeted
Feb 23
What’s optimal PEEP for your patients with an increased BMI?
Our study showed a simple equation you can use:
PEEP = BMI/3
There’s variability, but BMI/3 approximates the mean optimal PEEP (by esophageal manometry) from BMI 25 to > 40
#foamcc
sciencedirect.com/science/ar…
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Albumin (A) replacement therapy in septic shock
In a multicenter RCT, 440 pts w septic shock were treated w A aiming to keep serum A >3.0 g/dL or w standard fluid therapy. 90-day mortality did not differ between the A group (43.3%) & controls (45.9%)
jamanetwork.com/journals/jam…
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Abdullah AlSomali retweeted
Feb 12
Poor guy died because the doctor had been fooled into the myth of contrast nephropathy. When death is on the
Iine, fuck the kidneys.
A medical malpractice case about communication failures around imaging: 🧵
A young, very tall man with chest pain, nausea, and abdominal pain presented to the ED and was worked up by the emergency physician.
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Abdullah AlSomali retweeted
Do you feed ICU patients on vasopressors? Evidence says it can be safe—and lifesaving when patients are adequately resuscitated.
🆕 New paper online today in @SurgicalClinics
Key points 👇
• Vasopressors ≠ automatic contraindication to enteral nutrition
• Dose, stability, and trends matter more than presence alone
• Early trophic EN is reasonable once resuscitated
• Close monitoring for intolerance is essential
• PN remains critical when EN isn’t safe or feasible
Not “feed everyone early” ❌
Feed the right patient, at the right time, the right way ✅
How do you approach feeding patients on pressors in your ICU?
Protocol-driven or individualized?
Read the full paper: authors.elsevier.com/a/1mate…
#ICUNutrition #FOAMcc #ICURehab
@ICUnutrition @YukiKotani5
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Abdullah AlSomali retweeted
Feb 7
Check out trial bites
Each week, trialnites will post digestible, bite-sized information on a pivotal trial on an ICU topic, such as ARDS, sepsis, pressors, and more! Each topic will contain five weeks of trial summaries before transitioning into the next one. @NephroP @PulmPEEPs
pulmonarypocus.com/trial-bit…
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Abdullah AlSomali retweeted
What's happening here?
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Abdullah AlSomali retweeted
Feb 5
مقال أ. أحمد الجبرين عن العلاقة بين الهجرة الوظيفية والتزايد السكاني في العاصمة السعودية،
اقرأ أحدث أعداد نشرة #الجبرين_الاقتصادية عن «معضلة تكدس الوظائف في الرياض».
thmanyah.com/post/1mqy0e0mmm…
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Abdullah AlSomali retweeted
Jan 11
EMCrit 416 - JanuAIRWAY - State of the Airway 2026
-Difficult Airway Assessment
-PreOx
-Med Choices
-eFONA
Let's reestablish our intubation foundations by using the new DAS guidelines as a guide to discussion...
emcrit.org/416
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Abdullah AlSomali retweeted
Jan 20
A really important study on CAPNOGRAPHY TRACES DURING OESOPHAGEAL INTUBATION
Important for three reasons
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It provides important support for needing to satisfy the criteria for sustained exhaled CO2* to exclude oesophageal intubation
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The morphological differences in CO2 trace from oesophageal and tracheal intubation offer technological opportunity for monitoring solutions to rapidly detect unrecognised oesophageal intubation
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Sadly, they report a >10% unrecognised oesophageal intubation rate and all out of hospital services should be monitoring theirs and making changes (capnography, capnography interpretation, VL and if this doesn’t work stopping intubating and using SGAs or changing personnel) to make sure the rate is well below this
*Sustained exhaled CO2
- rises and falls with ventilation
- sustained (>7 breaths)
- amplitude > 1kPa
- clinically appropriate
resuscitationjournal.com/art…
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Abdullah AlSomali retweeted
24 Jan 2025
Thread : Frédéric Malle, The man who gives perfumers total freedom
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