Ryan Sullivan, DO

ED attending. Critical Care fellow. Occasional ultramarathon runner, frequent binge eater.

[Ryan Sullivan, DO @RJS_med]

Some days I really shouldn’t be allowed to be a doctor

I told a PEM attending that “this baby does not pass my vibe check” as justification for wanting bloodwork on them.

[IMCrit @IM_Crit_]

ICU scenarios (and pet peeves):

- Hey doc, this patient with ileus in bed 6 has a blood pressure of 186/68. What do you want me to give?
- Any worrisome symptoms with this BP?
- No, I am just worried she will stroke out
- Don't give anything
- No hydralazine then?
- No, please

[IMCrit @IM_Crit_]

ICU Pharmacology Secrets:

Some drug side effects, even if relatively rare, are well entrenched in our memory. For example, most intensivists & hospitalists are aware of cefepime-induced neurotoxicity or clindamycin’s association w C difficile infection (or even the seemingly

[Ryan Sullivan, DO @RJS_med]

@armyemdoc @11brickbat I think that’s a bit overly reductionist. Mortality is not the end all be all. The IABP itself may not, but the unloaded LV on ecmo won’t develop a thrombus, and the unstable patient with 3x vessel disease will live until their plavix washes out to get a CABG with ⬇️complications

[Sean Dreyer MD 🎮🎹 @SeanDreyer]

An unintended side effect of medical training is accumulating names like this in your phone contacts:

- Alex Surgery
- Pharmacy Joe
- Elise Resident
- Tall med student

[Josh Farkas MD 💊 @PulmCrit]

when you bronch an intubated patient and you’re way too aggressive with the suctioning

[Gerardo Calderon @GCalderonMD]

Attendings keyboard looking like this

[Alin Gragossian, DO, MPH @AG_EM33]

ICU night shifts in a nutshell: closing the a-gaps, giving Lasix to people who got fluids during the day, giving fluids to people who got Lasix during the day

[Josh Farkas MD 💊 @PulmCrit]

Fresh blog: New ARDS guidelines reveal a shambolic state of affairs

🫣 two major guidelines on "ARDS" were released in 2023

🫣 there is ongoing confusion about how to define "ARDS"

🫣 guidelines disagree on basic aspects of "ARDS" therapy

blog:
https://t.co/vDOZSLylhD

[SaltyEM @SaltyEMNY]

If I can't wash it in the washing machine and dry it in the dryer, it's just not an article of clothing that I need.

[Ryan Sullivan, DO @RJS_med]

@MohitHarshMD Funny that people are talking transfer. I’ve had plenty of hospitalists at the tertiary hospital push back on admitting sicker GI bleeds than this because they’re “stable” or not actively bleeding. Have been asked to get a 4 hour repeat hgb and if stable DC for GI follow up.

[Ryan Sullivan, DO @RJS_med]

@reverendofdoubt 48 hours because that’s what I’ve been told is the standard and don’t want to deal with medicolegal risk

More importantly only time I’ve done it is younger people with FIRM onset. IE I woke up from sleep and my heart was racing and I’ve never felt this before.

[Sameer Raniga @samrad77]

The first CT scanner was created by British engineer Godfrey Hounsfield in 1972.

ER physicians before 1972:

[IMCrit @IM_Crit_]

ICU POCUS tricks: POCUS takes time to become good at... Watch this clip to learn a great POCUS trick:

[Ryan Sullivan, DO @RJS_med]

@leah_lovelyy @brandonsomwaru Other hospitals I’ve worked at have all dosed it in mcg/kg/minute with a starting dose of .05 and that’s how it would be reported. We basically never got above doses of 1 or 2 (which would be 70-100mcg) so 5 sounds crazy in that context

[Ryan Sullivan, DO @RJS_med]

At your institution the doses for vasopressors is reported in

[Ryan Sullivan, DO @RJS_med]

@brandonsomwaru The first time someone told me a patient is “only” on 10 of levo here I almost had a stroke

[Ryan Sullivan, DO @RJS_med]

Do you

[Ryan Sullivan, DO @RJS_med]

The troponin is 300 (normal <14). The patient has no chest pain. You repeat the ekg and this is result

[Ryan Sullivan, DO @RJS_med]

You opt to wait 10 mins until the patient is brought back and get a stat repeat EKG. The patient is in his 30s, the pain is a burning sensation and is definitely present at the time of this EKG. Risk factors: family history of CAD in late 40s early 50s, smoking. Does not have PCP

[Ryan Sullivan, DO @RJS_med]

Do you

[Ryan Sullivan, DO @RJS_med]

You opt to wait 10 mins until the patient is brought back and get a stat repeat EKG. The patient is in his 30s, the pain is a burning sensation and is definitely present at the time of this EKG. Risk factors: family history of CAD in late 40s early 50s, smoking. Does not have PCP

[Ryan Sullivan, DO @RJS_med]

You are the ER doc and get handed this EKG. The only info you get is chief complaint of chest pain. Do not know if pain was present at time of ekg. Do you activate cath lab. Will be multi part series with follow up