Mátyás Andorka

some says #POCUS answers (to the basic #FICE #CUSIC #FAMUS questions) are binary: yes/no. but imo there must be 3: - yes - no - i don’t know 3rd is not cool, but absolutely valid and most importantly: safe

Lactate around 20 has everyone flapping but the patient is alert and well perfused Time to use system 2 thinking and understand the causes of elevated lactates This is NOT a patient dying of sepsis or organ hypoperfusion In this case it was an alcohol dependent patient whose…

🧵 "What really determines tissue perfusion?" – and why most explanations get it wrong. Let’s sort out MAP, CVP, CCP, autoregulation, vasopressors, and the flow that actually reaches your organs. 👇

Practicing knot tying is underemphasized in the training of those in non-surgical specialties. Many years of observation has shown that any discomfort in tying knots will add *significantly* to the overall cognitive burden of doing a procedure. The goal is to get rid of this.

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Fluid Accumulation Syndrome (FAS) may be the silent driver of ICU morbidity. Excess fluid isn’t always recognized as harmful—yet it contributes to organ dysfunction, prolonged ventilation, and poor outcomes. 3 Days to Go – Are You Prepared to Rethink Fluid Therapy? This…

1/ IV fluids have two main purposes: 💧 To maintain daily needs 🔄 To replace losses (We’ll come back to whether we should even use the term 'resuscitation' fluid in a future thread). Let’s talk about maintenance fluids – when they’re needed, and when they’re not. 🧵 #MedX…

(3/x) Third: not all urine is created equal. Good urine = sodium rich urine. When we diurese somebody, we often focus on the fluid balance, but the same fluid balance can actually represent different levels of decongestion. T To achieve an effective diuresis, we want to make…

20s♂️ c DM/Lupus failing OP PNA tx-has fever,cp,sob,hypoxia.#POCUS shown. #ultrasound #MedTwitter🧵 @ArgaizR @NephroP @KalagaraHari @msiuba @mount_md @TomJelic @jminardi21 @ACEP_EUS @IM_Crit_ @HoosierPocus @EM_RESUS @pocusmeded @1POCUSFocused @mznljrdy47597 @YubSedhai @zedunow

Highly recommended webinar indeed, thank you! “may the forced diuresis be with you…”* * credit to my great colleague Paul, although I’m sure he meant: “…with your patient” #DiuresisJedi and not Diuresingjedi

What a fantastic #HCP webinar by @ross_prager @ArgaizR and @FH_Verbrugge on mastering diuresis. A few of the many things I learned and need to read up on below!

(1/x) Septic shock is the leading cause of death in most ICUs worldwide. Unfortunately, the hemodynamics of sepsis are still often taught incorrectly in medical school. A 🧵

Today's Paper of the Day is: 𝐀𝐰𝐚𝐤𝐞 𝐭𝐫𝐚𝐜𝐡𝐞𝐚𝐥 𝐢𝐧𝐭𝐮𝐛𝐚𝐭𝐢𝐨𝐧 criticalcarereviews.com/latest-evidenc… Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025

Delighted to see this published Great work by Sam Gunning and David Unwin Does VL assist in teaching DL? A systematic review of sparse & imperfect quality studies TL/DR -VL with a Mac improves teaching of DL (significantly improves 1st attempt success). Time taken and overall…

#FUSIC HD

Pericholecystic fluid present? #POCUS #Ultrasound #MedTwitter @ArgaizR @NephroP @ACEP_EUS @TomJelic @KalagaraHari @msiuba @siddharth_dugar @trigeminy_henry @IM_Crit_ @dan___kim @IMPOCUSFocus @pocusmeded @zedunow @jminardi21 @drshahrul80 @easypocus @Omkolsoumyahoo1 @kyliebaker888

1/ A new meta-analysis just dropped which might lead some to question whether cardiac output monitors are useful in sepsis. 🧵 Let’s look closer. It doesn’t say what some think it does – and it doesn’t mean we should abandon CO monitoring altogether. 📎 doi.org/10.1186/s13054…

💧Fluid creep accounts for more fluid than resuscitation in ICU. But nobody prescribes it — and most don’t even notice it. The truth? 🧨 Most ICU patients don’t need routine maintenance fluids. Here’s what’s really going on 👇🧵

haemodynamic thread to read! @icmteaching this is funny: x.com/icmteaching/st… you got us vote on a better name for preload, then 2days later you “hide” the best one in your thread: tissue afterload

1/ Shock is complex. But our tools are often simplistic. This paper proposes a new model: 🩸 Four circulatory interfaces that must stay coupled to maintain perfusion. Uncouple any one — and shock worsens. #Shock #MedX #FOAMcc Here’s the framework. 🔗 doi.org/10.3390/jpm150…

🧵 Preload is one of the most misleading terms in clinical physiology. It shapes how we think, prescribe, and teach – but it’s wrong in all the ways that matter. This builds on Saturday’s Starling’s Law thread ↓ 🔗 x.com/icmteaching/st… Let’s fix it 👇