Kenneth Ag

Doctor , Photographer

[Kenneth Ag @Kennth_Aung]

@RobGrieves RHD FSD is better for this 🤫

[Kenneth Ag @Kennth_Aung]

@huangruitao4 Same here and everyday at the same spot

[Kenneth Ag @Kennth_Aung]

@elonmusk Suggestion for Tesla: Equip windshields with adaptive electrochromic tech (like Ctrl Eyewear) so the front camera can selectively dim sun glare areas in real time. Much better than mechanical shutters.

https://t.co/VYWd6MDmG9

[Kenneth Ag @Kennth_Aung]

@Tesla Yes, Australian Tesla users also uploaded TB of Data every month and eagerly waiting for FSD version 14 to arrive Kangaroo 🦘 Land

[Kenneth Ag @Kennth_Aung]

@gbhall 219 GB uploaded over last 30 days

[Kenneth Ag @Kennth_Aung]

@elonmusk The Kangaroo 🦘 Land is also waiting FSF Ver 14….. pls 🙏🙏🙏

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🫀The failing right ventricle:
the most misunderstood chamber in critical care

For years, we focused on the left ventricle.

But in the ICU, the real killer is often the right ventricle.

->What is acute RV failure?

👉 Not just “weak contraction”

It’s a hemodynamic collapse syndrome:

RV dilation

↓ LV preload

↓ cardiac output

↑ venous congestion

➡️ → multi-organ failure

->The key pathophysiology (the vicious cycle)

1. ↑ Afterload (PE, ARDS, PH)
2. → RV dilation
3. → Septal shift → LV underfilling
4. → ↓ CO → hypotension
5. → ↓ RCA perfusion
6. → RV ischemia

👉 And the cycle accelerates

->The most important concept

👉 The RV does NOT tolerate pressure

Handles preload very well

Fails rapidly with afterload

➡️ Even small ↑ PVR → collapse

->Main causes you MUST think first

🔴 Pulmonary embolism
🔴 RV myocardial infarction
🔴 ARDS / mechanical ventilation
🔴 Decompensated pulmonary hypertension
🔴 Post-cardiac surgery

->Diagnosis is NOT obvious

There is no single sign.

👉 It requires suspicion + integration:

Clinical: congestion + hypoperfusion

ECG + biomarkers

POCUS (your best friend 🤓)

Hemodynamics

->Echo mindset (fast ICU approach)

👉 Don’t overcomplicate

Look for:

✔ RV dilation
✔ Septal shift (D-sign)
✔ TAPSE ↓
✔ Venous congestion

The real ICU mistake

❌ Treating RV failure like LV failure

->Management principles

👉 Think in 4 pillars:

1. Preload — “not too much, not too little”

Hypovolemic → small fluid

Congested → REMOVE fluid

👉 CVP is not a target, it’s a warning

2. Afterload, THE key target

✔ Treat PE
✔ Optimize ventilation
✔ Reduce PVR

👉 If afterload stays high → RV will fail

3. Contractility
Dobutamine
Milrinone
Levosimendan

👉 Choose based on context

4. Perfusion pressure

👉 Norepinephrine is your anchor

✔ Maintains coronary perfusion
✔ Supports RV function

->Ventilation: the silent killer

⚠️ Positive pressure = ↑ PVR

👉 Over-ventilate → worsen RV failure

->When nothing works

👉 Think early:

VA-ECMO

RV assist devices

🤓Key insight

This is NOT just a cardiac problem.

👉 It is a ventriculo–arterial coupling failure

When:
Ees / Ea ↓ → RV collapses

🤓Bottom line

✔ RV failure is preload dependent BUT afterload sensitive
✔ Small mistakes → rapid collapse
✔ Early recognition + physiology-based treatment saves lives

->Clinical mindset

👉 Don’t ask:
“Is the RV failing?”

👉 Ask:
“Why is the RV failing and, what is driving the afterload?”

📃Reference
Giannakoulas G. et al. European Heart Journal (2025) 00, 1–16 https://t.co/gri8ZaHHsI

[Suchitha Kuntla @DocPeriop]

How is management of cardiac arrest due to LAST (Local Anesthetic Systemic Toxicity) different from ACLS guidelines and why?

Why is use of "a lower dose" of epinephrine recommended in LAST in ASRA 2020 guidelines?

Why do you run for intralipid (20%) first?

Read a detailed and compiled explanation here:

https://t.co/toJ36tQq0T

#anesthesia
#ASRA
#RegionalAnesthesia

[CJEM @CJEMonline]

How diverse is Canada’s future EM workforce? 🇨🇦
The first national study of Royal College EM residents reveals critical insights into our demographic landscape by Daniel Shi et al.

Check out this 2 minute video (by @NotebookLM) to give you the rundown of the findings and take a look at the original article here: https://t.co/3dRqRE0b4G

@EMO_Daddy @EddyLang1 @PaulAtkinsonEM @CAEP_Docs

[Kenneth Ag @Kennth_Aung]

@TeslaNewswire Are they come with adaptive dumping suspension in new Model Y 2026?

[Kenneth Ag @Kennth_Aung]

@SawyerMerritt @Tesla I rather hire a human driver 😉

[Kenneth Ag @Kennth_Aung]

@TeslaNewswire

[Kenneth Ag @Kennth_Aung]

@Tesla_NL_TR 1. Waze
2. Microsoft Team ( already has ZOOM) why not Team.
3 . Improve Blind spot warning or Notifications

[Kenneth Ag @Kennth_Aung]

@drkeithsiau Is it the same for pediatric?

[Kenneth Ag @Kennth_Aung]

@StateDept @SecRubio Bonger Trump

[Kenneth Ag @Kennth_Aung]

@ALiEMteam @acmtmedtox White PO4

[The Heart @ZHeart11768530]

🔴The Cardiac Action Potential⤵️
🔹️Drugs affecting Cardiac Action Potential

#medtwitterWhat #MedTwitter #CardioEd #medx #medEd #CardioTwitter #cardiotwitter #MedX #MedEd #cardiology #cardiotwiteros #FOAMed #medicine #cardiox #medical #cardiovascular #medtwitter #medtwitter

[U of Maryland Emergency Med @UMEmergencyMed]

Check out The Crashing Patient schedule to see what topics will be presented during the 2-day VIRTUAL conference. https://t.co/8ovP1C2nbh. 10% discount if register before 9/18. Use code: EBTCP2024. And join us for Dr. Callahan's lecture on Brains & Babies, Dec 5.

[Kenneth Ag @Kennth_Aung]

@ALiEMteam @SAEMonline Worm ? Or left guide wire ?

[Kenneth Ag @Kennth_Aung]

@elonmusk 😂🤣