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  • S01E22 2026 AHA/ASA Stroke Guideline: Tenecteplase, Thrombectomy Expansion, and Bedside Workflow

    S01E22 2026 AHA/ASA Stroke Guideline: Tenecteplase, Thrombectomy Expansion, and Bedside Workflow
    2026/03/02

    Stroke alert at 2 a.m. hits different—so in S01E22 we run playful “teaching rounds” on the AHA/ASA 2026 Guideline for the Early Management of Acute Ischemic Stroke, published in Stroke. We translate the biggest recommendations into what you actually do at the bedside: EMS prenotification and destination decisions, rapid imaging workflows (and what not to delay), IV thrombolysis decisions including tenecteplase vs alteplase within the 4.5-hour window, and how to approach disabling vs non-disabling symptoms when NIHSS looks “low.”

    Then we shift to endovascular therapy: what “expanded eligibility” means in practice, including selected patients with larger ischemic cores, and the guideline’s support for basilar artery occlusion thrombectomy in the appropriate window. We close with the underrated outcome-shapers—glucose and blood pressure targets (including what to stop doing out of habit), plus early complications like dysphagia/aspiration risk.

    Designed for trainees and FOAMed listeners: high-yield, practical, and just enough stroke-alert banter to keep you awake.


    PubMed:


    https://pubmed.ncbi.nlm.nih.gov/41582814/


    Tags

    #Stroke #AcuteIschemicStroke #Neurology #EmergencyMedicine #CriticalCare #ICU #FOAMed #AHA #ASA #Guidelines #StrokeAlert #Thrombolysis #Tenecteplase #Alteplase #MechanicalThrombectomy #EndovascularTherapy #BasilarArteryOcclusion #LargeVesselOcclusion #NeurocriticalCare #EMS #Telestroke #CTAngiography #BPManagement #GlucoseControl #Dysphagia
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    28 分
  • S01E21 Acute Pulmonary Embolism: 2026 AHA/ACC Multisociety Guideline

    S01E21 Acute Pulmonary Embolism: 2026 AHA/ACC Multisociety Guideline
    2026/02/27

    We walk through the 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN guideline for evaluation and management of acute pulmonary embolism in adults (Circulation, 2026). We focus on the guideline’s top take-home messages trainees need on rounds: the new A–E clinical categories for severity/triage, who can be discharged early, who should be hospitalized, when to activate PERT, and how to think about escalation therapies in the sickest patients—plus practical anticoagulation choices (LMWH vs UFH, DOACs vs warfarin) and follow-up to screen for post-PE limitations/CTEPD. Educational use only—not medical advice.

    Source (guideline):

    https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415


    Pubmed: https://pubmed.ncbi.nlm.nih.gov/41712677/

    Tags

    #CriticalCare #ICU #PulmonaryEmbolism #PE #VTE #Thrombosis #Anticoagulation #DOAC #Heparin #LMWH #PERT #EmergencyMedicine #HospitalMedicine #Cardiology #PulmonaryMedicine #MedEd #FOAMed #Guidelines #Circulation #ResidentEducation #FellowEducation #RVRstrain #CTPA #D_Dimer #CTEPD
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    42 分
  • S01E20 PreVent 2 and Subglottic Secretion Drainage After Emergency Intubation (Lancet Respir Med)

    S01E20 PreVent 2 and Subglottic Secretion Drainage After Emergency Intubation (Lancet Respir Med)
    2026/02/24
    On today’s PRISM Rounds we discuss PreVent 2, the multicenter randomized trial in The Lancet Respiratory Medicine (2025) testing whether a polyurethane cuff + subglottic secretion drainage (PU-EVAC) endotracheal tube improves outcomes after emergency intubation—and what the accompanying editorial argues about the real-world value of subglottic suction devices.We translate the methods and results into what matters on shift: CDC ventilator-associated event metrics (IVAC / possible VAP), workflow realities (cuff pressure checks, suction setup), and why “VAP reduction” only matters if it moves objective outcomes. We also step back to the 2016 AnnalsATS Deem et al. pilot trial as historical context—then return to the core question: should these tubes be routine in emergency intubations, or is it time to move on?Friendly ICU banter included (with love for RTs and nursing). Educational use only.Sources (PubMed):PreVent 2 (Lancet Respir Med, 2025):https://pubmed.ncbi.nlm.nih.gov/41319662/Deem et al. pilot (AnnalsATS, 2016): https://pubmed.ncbi.nlm.nih.gov/26523433/Tags#CriticalCare #ICU #MechanicalVentilation #AirwayManagement #Intubation #VAP #VentilatorAssociatedPneumonia #VentilatorAssociatedEvents #IVAC #SubglotticSuction #EndotrachealTube #RespiratoryTherapy #Nursing #FOAMed #MedEd #JournalClub #EvidenceBasedMedicine #LancetRespiratoryMedicine #AnnalsATS
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    48 分
  • S01E19 PROMIZING: PAV+ vs PSV for Ventilator Liberation

    S01E19 PROMIZING: PAV+ vs PSV for Ventilator Liberation
    2026/02/24
    In this PRISM Rounds episode, we break down the PROMIZING randomized trial in the New England Journal of Medicine (2025) comparing proportional-assist ventilation with load-adjustable gain factors (PAV+) versus pressure-support ventilation (PSV) during weaning. We cover the physiology case for PAV+, the pragmatic reasons the primary outcome was neutral, and the most actionable takeaway for ICU teams: a consistent liberation workflow (readiness checks, SBT quality, timely extubation, and sedation strategy) often matters more than the ventilator mode itself. Education only — not medical advice. PubMed: https://pubmed.ncbi.nlm.nih.gov/40513024/Tags#CriticalCare #ICU #MechanicalVentilation #VentilatorWeaning #RespiratoryTherapy #RT #ARDS #SBT #PAVplus #PSV #NEJM #JournalClub #EvidenceBasedMedicine #FOAMed #Pulmonary #IntensiveCare #Sedation #PatientVentilatorSynchrony
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    30 分
  • S01E18 Selective Digestive Decontamination: What SuDDICU Actually Shows

    S01E18 Selective Digestive Decontamination: What SuDDICU Actually Shows
    2026/02/24

    In this episode of PRISM Rounds, Host and Analyst break down the SuDDICU trial from The New England Journal of Medicine (Oct 29, 2025), testing selective digestive decontamination (SDD) in mechanically ventilated ICU patients using a cluster crossover design across 26 ICUs. We cover the headline result—no statistically significant reduction in 90-day in-hospital mortality—then dig into the key microbiology findings (bloodstream infections and resistant organisms) and the unit-level ecological assessment where noninferiority for resistance outcomes was not confirmed. Practical takeaways focus on what this means for ICU policy, stewardship, and surveillance if SDD is being considered or already in use. Educational use only — not medical advice.


    PubMed link: https://pubmed.ncbi.nlm.nih.gov/41159880/

    Tags

    #CriticalCare #ICU #FOAMed #MedEd #EvidenceBasedMedicine #JournalClub #NEJM #SuDDICU #SelectiveDigestiveDecontamination #SDD #MechanicalVentilation #AntibioticStewardship #AntimicrobialResistance #InfectionPrevention #VentilatorAssociatedPneumonia #Bacteremia #Microbiology #ClinicalTrials #ClusterRandomizedTrial #Noninferiority
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    39 分
  • S01E17 Bedside Lung Maps: Electrical Impedance Tomography (EIT) for ARDS, PEEP, and Proning

    S01E17 Bedside Lung Maps: Electrical Impedance Tomography (EIT) for ARDS, PEEP, and Proning
    2026/02/22

    In this episode of PRISM Rounds, we walk through electrical impedance tomography (EIT)—a bedside, radiation-free tool that provides real-time maps of regional ventilation. Using a 2022 Critical Care Medicine narrative review, we focus on practical ICU applications: PEEP titration (recruitment vs overdistension), tracking physiologic response to prone positioning, and recognizing effort-related regional phenomena such as pendelluft. Educational use only — not medical advice.


    PubMed: https://pubmed.ncbi.nlm.nih.gov/35607967/



    Tags#CriticalCare #ICU #Pulmonary #ARDS #MechanicalVentilation #VentilatorManagement #RespiratoryTherapy #EIT #ElectricalImpedanceTomography #PEEP #PronePositioning #LungRecruitment #Overdistension #VentilationDistribution #Physiology #FOAMed #JournalClub #EvidenceBasedMedicine #MedEd #CriticalCareEducation
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    51 分
  • S01E16 Dopamine vs Norepinephrine in Shock: SOAP II — A Historical Deep Dive

    S01E16 Dopamine vs Norepinephrine in Shock: SOAP II — A Historical Deep Dive
    2026/02/22
    In this episode of PRISM Rounds, we revisit the landmark SOAP II randomized trial (New England Journal of Medicine, 2010) at the request of medical students who wanted the “how we got here” story behind modern vasopressor choices. We walk through the trial design and results in 1,679 ICU patients with shock, comparing dopamine vs norepinephrine as first-line vasopressor therapy, then layer in the accompanying NEJM editorial’s critique and clinical framing. We focus on what the data support, what remains inference, and why this study became so practice-shaping—especially around adverse events and bedside tradeoffs. Educational discussion only; not medical advice.Sources: https://www.nejm.org/doi/full/10.1056/NEJMoa0907118https://pubmed.ncbi.nlm.nih.gov/20200382/https://pubmed.ncbi.nlm.nih.gov/20200389/Tags#CriticalCare #ICU #Shock #SepticShock #CardiogenicShock #Vasopressors #Norepinephrine #Dopamine #Arrhythmia #Hemodynamics #RandomizedTrial #NEJM #JournalClub #EvidenceBasedMedicine #MedicalEducation #MedicalHistory #MedEd #Sepsis #Cardiology #FOAMed #SOAP-II #MedicalHistory
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    35 分
  • S01E15 Central Sleep Apnea: AASM 2025 Guideline—What to Use (and Avoid) in Real Patients

    S01E15 Central Sleep Apnea: AASM 2025 Guideline—What to Use (and Avoid) in Real Patients
    2026/02/21
    In this episode of PRISM Rounds, two hosts break down the American Academy of Sleep Medicine (AASM) 2025 Clinical Practice Guideline on treating central sleep apnea (CSA) in adults—with a practical, bedside lens and a methods-focused look at evidence certainty. We walk through how the guideline frames CSA phenotypes (e.g., heart failure/Cheyne–Stokes, opioid-associated CSA, treatment-emergent CSA, high altitude), what “conditional” recommendations mean, and how to translate options like CPAP, BPAP with backup rate, ASV (with appropriate caution in select heart failure populations), supplemental oxygen, acetazolamide, and transvenous phrenic nerve stimulation into a patient-centered plan that prioritizes symptoms and underlying contributors—not just event counts. Educational use only; not medical advice. Source: Journal of Clinical Sleep Medicine, “Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline” (2025): https://doi.org/10.5664/jcsm.11858TagsCentral Sleep Apnea, CSA, Sleep Medicine, AASM, Clinical Practice Guideline, Journal Club, Evidence-Based Medicine, CPAP, BPAP-ST, ASV, Adaptive Servo-Ventilation, Cheyne-Stokes Respiration, Heart Failure, Opioid-Associated Sleep Apnea, Treatment-Emergent CSA, High Altitude Periodic Breathing, Acetazolamide, Phrenic Nerve Stimulation, PAP Therapy, Pulmonology
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    42 分