Mike Holmes

Cardiac anesthesiologist. Intensivist. Seeker of snow. Rider of wind.

[Mike Holmes @MikeHolmesMD]

@critconcepts @ben_millette @PulmCrit Truth. I usually just bail and repuncture somewhere else if multiple j tip reorientations don't work. Though I've had success with a glidewire and fluro when it was lucky enough to happen in a hybrid room.

[Mike Holmes @MikeHolmesMD]

@critconcepts @ben_millette @PulmCrit If you mean wire: I use a cannula if the vessel is shallow enough. If not generally try to just withdraw the wire and and advance with the j tip in a different direction. If you mean the catheter itself: generally calculate distance to SC and withdraw to there.

[Mike Holmes @MikeHolmesMD]

@ben_millette @PulmCrit @critconcepts Usually its obvious when it goes that way (or shall i say, any wrong way as could be down contralateral arm), as the wire stops early. I clearly remember one awake patient saying her ear felt funny as my resident was teying to advance the wire. Scanned the IJ, and there it was!

[Mike Holmes @MikeHolmesMD]

Great review. Plane blocks have become a large part of my cardiac anesthesiology practice to reduce pain, improve respiratory parameters, and facilitate early extubation (often in OR).

[@SCVA @SCVA1997]

#RegionalAnalgesia for Cardiac Surgery. Part 2: Peripheral Regional Analgesia for Cardiac #Surgery
Reviews the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.

https://t.co/vjtssXaWJ8

[Alin Gragossian, DO, MPH @AG_EM33]

So beautiful. 🥺

[NephroPOCUS @NephroP]

Now that we have several #VExUS #POCUS resources from different educators, I'm going to put them together as a thread and pin to my profile #IMPOCUS #FOAMed
1/ Recent case showing improvement in Doppler indices (helped guiding decongestive therapy in a pt. with minimal symptoms)

[Mike Holmes @MikeHolmesMD]

@nickmmark Can't win against crazy.

[Mike Holmes @MikeHolmesMD]

@chrisryanburke Time to change that!

[Mike Holmes @MikeHolmesMD]

@EmergPharm And as others have said, into the OR you go!

[Mike Holmes @MikeHolmesMD]

@EmergPharm Making sure she doesn't have a raging effusion or coronary ischemia explaining the tachycardia would be wise.

[Mike Holmes @MikeHolmesMD]

@RichardSheuMD @gb_mackensen @srdjanjelacic @Behrens_MD @nicoa002 @charles_nyman @mswami001 @fmahmood543 @DouglasShookMD "MAC"

[Mike Holmes @MikeHolmesMD]

I'll admit to finding it weird that my group frequently does sevo plus prop anesthetics. This article is making me think about it more. I still think that BIS (or other depth of anes monitor) is a requirement when not doing straight volitile.
https://t.co/BkDZ7i1RD8

[SpaceX @SpaceX]

Live feed of Starship SN9 flight test → https://t.co/Hs5C53qBxb https://t.co/ioM0D5J91I

[Mike Holmes @MikeHolmesMD]

@nurseriv22 @concernecus Maybe your auto lane centering doesnt suck as much as mine. I turned it off after enough times the car actively tried to suicide itself off the highway (on straightaways). Loved it when the light was right for it to work, but very very glare sensitive.

[Mike Holmes @MikeHolmesMD]

@concernecus I've got one. Great mileage for size, reasonably quick, plenty of space for gear, and gets me up any washed out dirt road that's still considered a road around here. Gas tank issue is annoying though. Should have waited for the Prime though to cover gas free commuting.

[Mike Holmes @MikeHolmesMD]

@jmugele Time is a luxury and makes all diagnoses eventually. Being the first line in the chain of care means information is incomplete. Ergo it often looks like you missed something even if you 're the smartest, most through doc in the house

[Mike Holmes @MikeHolmesMD]

@cchildersmd Doesnt stop when training ends! Minor phantom symptoms on and off for the past 9 months right here. Directly correlated to how much COVID was treated.

[Mike Holmes @MikeHolmesMD]

@BobLeeMD Every time I see some variation of the phrase "doctors have much better treatments than during the spring " all I can think is WTF is this talking about? And every illness/death now is literally within sight of a vaccine.

[Mike Holmes @MikeHolmesMD]

@IM_Crit_ @nickmmark Agreed, but moderate to severe RV dysfunction on echo (with normal LV function) certainly warrants more investigation.

[Mike Holmes @MikeHolmesMD]

@DrLongissimus Dream job: backcountry ski guide in the winter, Grand Canyon river guide in the summer.