ED DOC. A doctor with jungle of thoughts . In search of like minded people, might make acclimatising easier to the uncertainties in the surrounding .

New Delhi, India
Joined October 2021
1/9 “B-lines = Lasix.” It’s an easy reflex in the ED. But a patient can have severe pulmonary congestion without being massively volume overloaded. Before reaching for furosemide, ask: What phenotype am I actually treating? A thread.
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8/9 My bedside mental model: Phenotype → Perfusion → Congestion → Diuretic response → Reassessment Not: B-lines → Lasix → Creatinine rises → Stop. The numbers matter. But they need physiological context.
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I wrote a deeper bedside breakdown: Not Every “Wet” patient needs lasix Read the full article: lifeonthefrontline.com/p/not… If you work in emergency or critical care, follow Life on the Frontline for evidence-based concepts translated into bedside decisions.
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Today's Paper of the Day is: Refractory septic shock: our updated pragmatic approach. criticalcarereviews.com/late… Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
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This case report describes the electrocardiogram findings of a patient in their 40s with dizziness and presyncope after hematemesis and multiple black stools. ja.ma/4cHszNM
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When shock becomes refractory, the next vasopressor isn't always the answer. Sometimes the diagnosis lies in the history you haven't revisited, the medication list you overlooked, or the second pathology hiding beneath the first.
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In our latest publication in Clinical Toxicology, we describe a patient with septic shock whose persistent vasoplegia was compounded by chronic low-dose methotrexate toxicity.
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The case is a reminder that refractory shock is often multifactorial and recognizing the additional contributor can be the turning point in management. Grateful to my co-authors for this collaborative work. Read here - lnkd.in/g23QZKTN
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Arihant Jain, MD retweeted
1⃣ What #echofirst view? 2⃣ What abnormality? #POCUS #FOAMed 📽️courtesy - CASE (Phila). 2025;9(5):164-172. doi: 10.1016/j.case.2025.01.004.
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Grateful to be part of it.
Welcome to our JULY 29 issue of #JACCCaseReports @JACCJournals featuring Part 2 of the EKG Challenge jacc.org/journal/case-report…. Full PDF here: jacc.org/doi/10.1016/S2666-0… Thank you @aroniskn our Associate Editor for this Editor’s Page: Clues, Not Patterns: The Electrocardiogram as a Detective Story jacc.org/doi/10.1016/j.jacca… @minnowwalsh @hmkyale @Justine_Turco Wide-Complex Tachycardia: VT and VT Mimics Wide-Complex Tachycardia in a Neonate jacc.org/doi/10.1016/j.jacca… Atypical Andersen–Tawil Syndrome in an Asymptomatic Child With Bidirectional Ventricular Tachycardia and Incipient Tachycardiomyopathy jacc.org/doi/10.1016/j.jacca… An Extreme Wide-Complex Tachycardia and Tremors jacc.org/doi/10.1016/j.jacca… Seamless Transition Between Narrow- and Wide-QRS Tachycardia Revealing Double Tachycardia jacc.org/doi/10.1016/j.jacca… AVNRT With Intermittent Aberrancy-Mimicking Ventricular Tachycardia: One Tachycardia, Two QRS Morphologies jacc.org/doi/10.1016/j.jacca… Atrial Tachycardia and Bundle Branch Re-Entry Ventricular Tachycardia with Similar QRS Complex Morphology jacc.org/doi/10.1016/j.jacca… Irregularly Irregular Wide Complex Tachycardia: Look Beyond the Atrium jacc.org/doi/10.1016/j.jacca… Ventricular Tachycardia or Not?: Decoding Post-Cardioversion Wide Complex Tachycardia in a CRT-D Patient jacc.org/doi/10.1016/j.jacca… Device Interrogation Unmasking Flecainide-Induced Wide Complex Tachycardia jacc.org/doi/10.1016/j.jacca… Wide QRS Tachycardias With Syncope: Two for One? jacc.org/doi/10.1016/j.jacca… ST-Segment Deviation Patterns and STEMI Mimics Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI jacc.org/doi/10.1016/j.jacca… Atrial Repolarization as a Rare Mimicker of ST-Segment Elevation Myocardial Infarction: Revisiting Ta jacc.org/doi/10.1016/j.jacca… Reading the ECG in Time: Ta-Wave Pseudo-STEMI and Crochetage Sign in Adult Congenital Heart Disease jacc.org/doi/10.1016/j.jacca… Shark-Fin Pattern in aVR Lead as First Manifestation of Acute Left Main Coronary Artery Occlusion jacc.org/doi/10.1016/j.jacca… “Left Main” Pattern Electrocardiogram: A Diagnostic Trap for Cardiologists jacc.org/doi/10.1016/j.jacca… Isolated Cardiac Rhabdomyoma With Marked ST-Segment Elevation: Benign Tumor, Malignant ECG jacc.org/doi/10.1016/j.jacca… Midventricular Hypertrophic Cardiomyopathy With Apical Aneurysm Presenting as Persistent ST-Segment Elevation Mimicking Acute Myocardial Infarction jacc.org/doi/10.1016/j.jacca… ST-Segment Elevation Caused by Lung Cancer Mimicking STEMI jacc.org/doi/10.1016/j.jacca… ST-Segment Elevation in a Patient With Vocal Cord Cancer: A Great Mimicker jacc.org/doi/10.1016/j.jacca… A Dangerous Wave: Recognizing the Shark-Fin ECG Sign in STEMI jacc.org/doi/10.1016/j.jacca… Atrioventricular Block and Conduction A Premature Ventricular Complex as Both Culprit and Cure: Paroxysmal Intrinsic Atrioventricular Block jacc.org/doi/10.1016/j.jacca… Progressive Conduction Disease in a Mitochondrial Disorder jacc.org/doi/10.1016/j.jacca… From Ophthalmoplegia to Multilevel Atrioventricular Block: Timing Cardiac Device Therapy in Kearns–Sayre Syndrome jacc.org/doi/10.1016/j.jacca… Syncope and 2:1 Atrioventricular Block in a Middle-Aged Man jacc.org/doi/10.1016/j.jacca… Idiopathic 2:1 AV Block With Ventriculophasic Sinus Arrhythmia in a Young Male jacc.org/doi/10.1016/j.jacca… Mobitz Type I Progressing to High-Grade AV Block: Beyond Wenckebach jacc.org/doi/10.1016/j.jacca… Intermittent Simultaneous Antegrade Dual Nodal Conduction With Progressive Rate-Dependent Aberrancy jacc.org/doi/10.1016/j.jacca… Dual Atrioventricular Nodal Physiology in Sinus Rhythm: An Extraordinary Manifestation of a Common Substrate jacc.org/doi/10.1016/j.jacca… The Double Fire Phenomenon With Alternating Right Bundle Aberrancy jacc.org/doi/10.1016/j.jacca… Atrial Activation and the PR Interval: Pre-excitation and Impulse-Origin Puzzles The Many ECG Faces of Wolff-Parkinson-White Syndrome jacc.org/doi/10.1016/j.jacca… Left Ventricular Hypertrophy With Pre-Excitation: Thinking Beyond the Usual Hypertrophic Cardiomyopathy Diagnosis jacc.org/doi/10.1016/j.jacca… Evaluation of the Elusive Delta Wave in Intermittent Pre-excitation jacc.org/doi/10.1016/j.jacca… An Abrupt Doubling of Heart Rate jacc.org/doi/10.1016/j.jacca… Junctional Ectopic Tachycardia After Adult Cardiac Surgery jacc.org/doi/10.1016/j.jacca… Three Voices of the Atrium: A Unique Case Finding on a Neonate ECG jacc.org/doi/10.1016/j.jacca… Repolarization Abnormalities — T-Wave, QT and J-Wave Wellens’ Sign and Syndrome Detected With the Home Use of a Novel 12-Lead Electrocardiogram jacc.org/doi/10.1016/j.jacca… Macroscopic T-Wave Alternans in QTc Prolongation: A Warning Sign Before Torsades de Pointes jacc.org/doi/10.1016/j.jacca… Short QT Syndrome Masquerading as Lone Atrial Fibrillation: Hidden in Plain Sight jacc.org/doi/10.1016/j.jacca… A Reversible ECG Signature of Hypothermia jacc.org/doi/10.1016/j.jacca… QRS Axis, Localization and Artifact Posteroseptal RVOT PVCs in a Clockwise-Rotated Congenital Heart: A Left-Sided Illusion jacc.org/doi/10.1016/j.jacca… Northwest Axis on Electrocardiogram: Decoding an Unusual Cardiac Axis in a Young Patient jacc.org/doi/10.1016/j.jacca… Crochetage Sign on Electrocardiography as a Diagnostic Marker of Patent Foramen Ovale jacc.org/doi/10.1016/j.jacca… An Electrocardiographic Artifact Mimicking Pacemaker Malfunction jacc.org/doi/10.1016/j.jacca… This ECG Does Not Fit: Rethinking Left Ventricular Hypertrophy jacc.org/doi/10.1016/j.jacca… Pseudo-Infarction Reversal in Right Precordial Leads: ECG Evolution in Severe Pulmonary Hypertension jacc.org/doi/10.1016/j.jacca… @aroniskn @CraigBasman @JACabreraCardio @MiChen__ @aabha_divya @sarano_maurice @MarcEngels7 @Miho_Fukui_ @CardioOncCO @Nishaki1 @MMarinCuartas @ChrissyMD2000f @ACHDocTMoe @PanjrathG @jsaef1 @Kentso987 @m_taramasso @SyedZaidMD Author’s Handles: @mariaelisasales @BPushparaji @MattSegar @sudarshanballa @sthangjui @aronismd @luisreneps @DrAvinash_ @dlypourlis @dr__hunt @JustinMarkMD @jennyjlcao @abhishek_mbbs @MayoClinicC @MayoCVFellows @mazenkawji @stavrosstavrak1 @drdave0 @AishKamble67 @RobertHelmMD @YooTaeKyung1 @albcipri6 @LauraDemichiel
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Arihant Jain, MD retweeted
Welcome to our JULY 29 issue of #JACCCaseReports @JACCJournals featuring Part 2 of the EKG Challenge jacc.org/journal/case-report…. Full PDF here: jacc.org/doi/10.1016/S2666-0… Thank you @aroniskn our Associate Editor for this Editor’s Page: Clues, Not Patterns: The Electrocardiogram as a Detective Story jacc.org/doi/10.1016/j.jacca… @minnowwalsh @hmkyale @Justine_Turco Wide-Complex Tachycardia: VT and VT Mimics Wide-Complex Tachycardia in a Neonate jacc.org/doi/10.1016/j.jacca… Atypical Andersen–Tawil Syndrome in an Asymptomatic Child With Bidirectional Ventricular Tachycardia and Incipient Tachycardiomyopathy jacc.org/doi/10.1016/j.jacca… An Extreme Wide-Complex Tachycardia and Tremors jacc.org/doi/10.1016/j.jacca… Seamless Transition Between Narrow- and Wide-QRS Tachycardia Revealing Double Tachycardia jacc.org/doi/10.1016/j.jacca… AVNRT With Intermittent Aberrancy-Mimicking Ventricular Tachycardia: One Tachycardia, Two QRS Morphologies jacc.org/doi/10.1016/j.jacca… Atrial Tachycardia and Bundle Branch Re-Entry Ventricular Tachycardia with Similar QRS Complex Morphology jacc.org/doi/10.1016/j.jacca… Irregularly Irregular Wide Complex Tachycardia: Look Beyond the Atrium jacc.org/doi/10.1016/j.jacca… Ventricular Tachycardia or Not?: Decoding Post-Cardioversion Wide Complex Tachycardia in a CRT-D Patient jacc.org/doi/10.1016/j.jacca… Device Interrogation Unmasking Flecainide-Induced Wide Complex Tachycardia jacc.org/doi/10.1016/j.jacca… Wide QRS Tachycardias With Syncope: Two for One? jacc.org/doi/10.1016/j.jacca… ST-Segment Deviation Patterns and STEMI Mimics Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI jacc.org/doi/10.1016/j.jacca… Atrial Repolarization as a Rare Mimicker of ST-Segment Elevation Myocardial Infarction: Revisiting Ta jacc.org/doi/10.1016/j.jacca… Reading the ECG in Time: Ta-Wave Pseudo-STEMI and Crochetage Sign in Adult Congenital Heart Disease jacc.org/doi/10.1016/j.jacca… Shark-Fin Pattern in aVR Lead as First Manifestation of Acute Left Main Coronary Artery Occlusion jacc.org/doi/10.1016/j.jacca… “Left Main” Pattern Electrocardiogram: A Diagnostic Trap for Cardiologists jacc.org/doi/10.1016/j.jacca… Isolated Cardiac Rhabdomyoma With Marked ST-Segment Elevation: Benign Tumor, Malignant ECG jacc.org/doi/10.1016/j.jacca… Midventricular Hypertrophic Cardiomyopathy With Apical Aneurysm Presenting as Persistent ST-Segment Elevation Mimicking Acute Myocardial Infarction jacc.org/doi/10.1016/j.jacca… ST-Segment Elevation Caused by Lung Cancer Mimicking STEMI jacc.org/doi/10.1016/j.jacca… ST-Segment Elevation in a Patient With Vocal Cord Cancer: A Great Mimicker jacc.org/doi/10.1016/j.jacca… A Dangerous Wave: Recognizing the Shark-Fin ECG Sign in STEMI jacc.org/doi/10.1016/j.jacca… Atrioventricular Block and Conduction A Premature Ventricular Complex as Both Culprit and Cure: Paroxysmal Intrinsic Atrioventricular Block jacc.org/doi/10.1016/j.jacca… Progressive Conduction Disease in a Mitochondrial Disorder jacc.org/doi/10.1016/j.jacca… From Ophthalmoplegia to Multilevel Atrioventricular Block: Timing Cardiac Device Therapy in Kearns–Sayre Syndrome jacc.org/doi/10.1016/j.jacca… Syncope and 2:1 Atrioventricular Block in a Middle-Aged Man jacc.org/doi/10.1016/j.jacca… Idiopathic 2:1 AV Block With Ventriculophasic Sinus Arrhythmia in a Young Male jacc.org/doi/10.1016/j.jacca… Mobitz Type I Progressing to High-Grade AV Block: Beyond Wenckebach jacc.org/doi/10.1016/j.jacca… Intermittent Simultaneous Antegrade Dual Nodal Conduction With Progressive Rate-Dependent Aberrancy jacc.org/doi/10.1016/j.jacca… Dual Atrioventricular Nodal Physiology in Sinus Rhythm: An Extraordinary Manifestation of a Common Substrate jacc.org/doi/10.1016/j.jacca… The Double Fire Phenomenon With Alternating Right Bundle Aberrancy jacc.org/doi/10.1016/j.jacca… Atrial Activation and the PR Interval: Pre-excitation and Impulse-Origin Puzzles The Many ECG Faces of Wolff-Parkinson-White Syndrome jacc.org/doi/10.1016/j.jacca… Left Ventricular Hypertrophy With Pre-Excitation: Thinking Beyond the Usual Hypertrophic Cardiomyopathy Diagnosis jacc.org/doi/10.1016/j.jacca… Evaluation of the Elusive Delta Wave in Intermittent Pre-excitation jacc.org/doi/10.1016/j.jacca… An Abrupt Doubling of Heart Rate jacc.org/doi/10.1016/j.jacca… Junctional Ectopic Tachycardia After Adult Cardiac Surgery jacc.org/doi/10.1016/j.jacca… Three Voices of the Atrium: A Unique Case Finding on a Neonate ECG jacc.org/doi/10.1016/j.jacca… Repolarization Abnormalities — T-Wave, QT and J-Wave Wellens’ Sign and Syndrome Detected With the Home Use of a Novel 12-Lead Electrocardiogram jacc.org/doi/10.1016/j.jacca… Macroscopic T-Wave Alternans in QTc Prolongation: A Warning Sign Before Torsades de Pointes jacc.org/doi/10.1016/j.jacca… Short QT Syndrome Masquerading as Lone Atrial Fibrillation: Hidden in Plain Sight jacc.org/doi/10.1016/j.jacca… A Reversible ECG Signature of Hypothermia jacc.org/doi/10.1016/j.jacca… QRS Axis, Localization and Artifact Posteroseptal RVOT PVCs in a Clockwise-Rotated Congenital Heart: A Left-Sided Illusion jacc.org/doi/10.1016/j.jacca… Northwest Axis on Electrocardiogram: Decoding an Unusual Cardiac Axis in a Young Patient jacc.org/doi/10.1016/j.jacca… Crochetage Sign on Electrocardiography as a Diagnostic Marker of Patent Foramen Ovale jacc.org/doi/10.1016/j.jacca… An Electrocardiographic Artifact Mimicking Pacemaker Malfunction jacc.org/doi/10.1016/j.jacca… This ECG Does Not Fit: Rethinking Left Ventricular Hypertrophy jacc.org/doi/10.1016/j.jacca… Pseudo-Infarction Reversal in Right Precordial Leads: ECG Evolution in Severe Pulmonary Hypertension jacc.org/doi/10.1016/j.jacca… @aroniskn @CraigBasman @JACabreraCardio @MiChen__ @aabha_divya @sarano_maurice @MarcEngels7 @Miho_Fukui_ @CardioOncCO @Nishaki1 @MMarinCuartas @ChrissyMD2000f @ACHDocTMoe @PanjrathG @jsaef1 @Kentso987 @m_taramasso @SyedZaidMD Author’s Handles: @mariaelisasales @BPushparaji @MattSegar @sudarshanballa @sthangjui @aronismd @luisreneps @DrAvinash_ @dlypourlis @dr__hunt @JustinMarkMD @jennyjlcao @abhishek_mbbs @MayoClinicC @MayoCVFellows @mazenkawji @stavrosstavrak1 @drdave0 @AishKamble67 @RobertHelmMD @YooTaeKyung1 @albcipri6 @LauraDemichiel
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A technically perfect intubation can still end badly. Not because of what happened before the tube. Because of what happened after.The overlooked 30 minutes following intubation may be more important than we think.
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📖 Read: The Forgotten 30 Minutes lifeonthefrontline.com/p/the… 🔄 Repost if you've ever seen a patient deteriorate after a "successful" airway.
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