Syahidd Al Hatim

Sapiosexual

[Arsenal @Arsenal]

This belongs to all of us.

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

💉🩺Rapid sequence intubation in 2026: we are no longer “protecting the airway.”
We are managing physiology under extreme stress.

The latest evidence challenges one of the oldest dogmas in critical care.

RSI was designed to prevent aspiration.
But today, the real enemy is often hypoxemia and cardiovascular collapse.

1. Aspiration is no longer the central problem

For decades, RSI was built around one fear: aspiration.

But emerging data suggest:

RSI may not significantly reduce aspiration

It may increase hypoxemia and hemodynamic instability

The paradigm is shifting:

👉 From aspiration avoidance → to physiologic optimization

2. First-pass success is everything

Every additional attempt increases:

Hypoxia

Hemodynamic collapse

Mortality

Modern RSI is built around one goal:

Get it right the first time.

That means:

Videolaryngoscopy first-line

Stylet routinely

Team choreography, not improvisation

3. Preoxygenation is now a therapeutic intervention

Not just a step—a determinant of survival

NIV > face mask

HFNO as adjunct

Semi-upright positioning

And one key shift:

👉 Gentle ventilation is no longer taboo

Done correctly, it reduces hypoxemia without increasing aspiration risk.

4. Hemodynamics matter more than ever

Up to 40–50% of patients experience peri-intubation instability.

The modern approach:

Avoid propofol in unstable patients

Favor etomidate or ketamine

Consider prophylactic vasopressors

Fluid loading?
Not routinely beneficial.

5. Cricoid pressure: from dogma to doubt

No clear benefit in preventing aspiration

May worsen laryngoscopy and ventilation

Current thinking:

👉 Use selectively, or not at all

6. RSI is no longer a rigid protocol

It is now:

Patient-specific

Physiology-driven

Team-dependent

With tools like:

Gastric ultrasound

POCUS-guided decisions

Structured airway protocols

7. The real determinant of success: human factors

Preparation, communication, and coordination matter as much as drugs.

Because in critical care:

The airway is not just anatomy.
It is a moment of systemic vulnerability.

🤓Final message

RSI has evolved:

From speed → to precision

From protocol → to physiology

From individual skill → to team performance

And ultimately:
The goal is no longer just to intubate.
It is to intubate without killing the patient.

📃Reference
Boulos NM et al. Anaesth Crit Care Pain Med. 2026. https://t.co/KWUfUtAMyP

[Don Pettit @astro_Pettit]

Star trail exposure from the ISS, marked by the thick white path of the Moon, Starlink satellites flashing far right, golden city lights streaking across Earth, and arcing stars.

[Bayt Al Fann @BaytAlFann]

When Muslims pray, they turn towards Mecca. The Islamic term for this direction is qibla.

Islamic astronomers created Qibla Finders to indicate the direction prayer. They were objects of function as well as beauty.

Here are 17 exquisite Qibla Finders

A thread…

[Syahidd Al Hatim @Syahiddhatim]

@botetology Asyukkkkkkk alhamdulillah

[Syahidd Al Hatim @Syahiddhatim]

Declan Fried Fokin Rice

[Abdul Muqtadir Abbasi @AbbasiMuqtadir]

Hesitate when you hear methemoglobinemia??

I promise, I ll make it a piece of cake for you.

Here you go. Learn and live , students and residents.

Easy peasy😇

#MedTwitter

[ًِ @bckupacc99]

@localrkyt proton saga for life.

[Syahidd Al Hatim @Syahiddhatim]

@Tapatalam @azizzman Tak sesuai untuk kanak kanak

[Sam Ghali, M.D. @EM_RESUS]

Hi, ER Doc here.

I don’t know who needs to hear this but New York Presbyterian Hospital keeps an actual @Spotify playlist of “Songs to do CPR to” for timing chest compressions during CPR

https://t.co/hOSvWpD5vo

Repost to save a life!

[Syahidd Al Hatim @Syahiddhatim]

@piannordin @azizzman @HazrimYunus Garing

[Syahidd Al Hatim @Syahiddhatim]

@botetology Come to the dark side

[Syahidd Al Hatim @Syahiddhatim]

@HazrimYunus @azizzman @Yoda4ever @piannordin Ada empat kat situ lagi sorang siapa

[Syahidd Al Hatim @Syahiddhatim]

Core memory

[Syahidd Al Hatim @Syahiddhatim]

@Tapatalam Double tambah telur mata

[Syahidd Al Hatim @Syahiddhatim]

@azizzman @HazrimYunus @botetology lawa do

[Pascal @PascallllSGE]

Eintracht X Marlboro in 2024📈

[Syahidd Al Hatim @Syahiddhatim]

@azizikhalik Thanks bois 🫶

[Mica Schachter, MD @neurona_critica]

🧠🩸Blood pressure management in ICH Infographic

https://t.co/wnXM7jvCgS

#NeuroTwitter #Neurocriticalcare

[Dr. AK 🇮🇳 @docakx]

American Heart Association proposes to omit the following terminologies in it's latest scientific statement (May 2014)

❌️ 𝙃𝙮𝙥𝙚𝙧𝙩𝙚𝙣𝙨𝙞𝙫𝙚 𝙪𝙧𝙜𝙚𝙣𝙘𝙮

❌️ 𝙃𝙮𝙥𝙚𝙧𝙩𝙚𝙣𝙨𝙞𝙫𝙚 𝙘𝙧𝙞𝙨𝙞𝙨

Use of subjective emotive language such as 𝙘𝙧𝙞𝙨𝙞𝙨 and 𝙪𝙧𝙜𝙚𝙣𝙘𝙮 fail to acknowledge the nuances of treatment decisions and may encourage unnecessary antihypertensive treatment.

Therefore in a statement paper from AHA in May 2024, it is proposed the following objective terminology:

✅️ 𝙃𝙮𝙥𝙚𝙧𝙩𝙚𝙣𝙨𝙞𝙫𝙚 𝙚𝙢𝙚𝙧𝙜𝙚𝙣𝙘𝙮
🔸️SBP/DBP >180/110–120 mm Hg with evidence of new or worsening target-organ damage

✅️ 𝘼𝙨𝙮𝙢𝙥𝙩𝙤𝙢𝙖𝙩𝙞𝙘 𝙢𝙖𝙧𝙠𝙚𝙙𝙡𝙮 𝙚𝙡𝙚𝙫𝙖𝙩𝙚𝙙 𝙞𝙣𝙥𝙖𝙩𝙞𝙚𝙣𝙩 𝘽𝙋
🔸️SBP/ DBP >180/110–120 mm Hg without evidence of new or worsening target-organ damage

✅️ 𝘼𝙨𝙮𝙢𝙥𝙩𝙤𝙢𝙖𝙩𝙞𝙘 𝙚𝙡𝙚𝙫𝙖𝙩𝙚𝙙 ���𝙣𝙥𝙖𝙩𝙞𝙚𝙣𝙩 𝘽𝙋
🔸️SBP/DBP ≥130/80 mm Hg without evidence of new or worsening target-organ damage.

Source : The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association

https://t.co/LCXjHA2nE6

[Syahidd Al Hatim @Syahiddhatim]

Pibedey bebey @azizikhalik