The concept that thyroid storm is an indication for beta-blockers is a widespread myth. Indiscriminate use of beta-blockers in thyroid storm can actually kill people. I half-heartedly tried submitting an article about this to two journals (@JHospMedicine, @CritCareExplore). JHM thought that thyroid storm isn't common enough to warrant publication in @TWDFNR. CCE never replied to my email. So I posted it as a blog (below). A lot of smart people read it and nobody found any errors in it, which makes me pretty confident that it's a valid article. The myth of beta-blocking everyone with thyroid storm will probably persist for a long time in the conventional medical literature. Most people who write articles about thyroid storm don't practice critical care cardiology, so my guess is that this dogma will persist for decades.

pretty picture but mental status is over-hyped as an index of perfusion in PE (& cardiogenic shock in general) in my experience, PE patients will mentate well until about five minutes before they arrest I'm not reassured by normal mentation at all

The central theorem of RV failure 😁 In LV failure, excessive afterload reduction can cause systemic hypotension (MAP << 60mm), vasodilatory shock, systemic malperfusion, and death. In RV failure, excessive afterload reduction doesn't really exist. Low pulmonary artery pressures are well tolerated (the lung remains well perfused by *dual* pulmonary & bronchial artery circulations). This essential difference opens a unique avenue for treating RV failure with much more aggressive afterload reduction (as compared to LV failure). The RV is different from the LV and requires unique management strategies (not just copy/pasting a generic LV failure strategy). #ThePeoplesVentricle

in response to this blog, lots of folks commented that hyperangulated videolaryngoscopy is great at visualizing the cords but makes tube passage difficult my team hasn't encountered this problem. why?? I think it's because we use sniffing position +/- laryngeal manipulation