Robin Cherian

Cardiologist, Cardiac Intensivist, Clinician first, views personal

[Ashley Miller @icmteaching]

1/21
Acid–base interpretation often feels like a maze.
But there’s a simple way to make sense of it at the bedside.
It starts with pH, strong ions, and base excess.

[IMCrit @IM_Crit_]

(Basic) ICU Hemodynamic “Secrets” - Part1:

I know you know them, but let’s remind ourselves of some basic hemodynamic "secrets":

[Ashley Miller @icmteaching]

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.
🔗 https://t.co/8xxEcdzYUw

[Ashley Miller @icmteaching]

🧵 Starling’s Law: Misunderstood, Misapplied, and Still Misleading
1
🚨 “Starling’s Law explains how the heart increases cardiac output.”

You’ve probably heard this a thousand times.
But it’s wrong.
Or at least - very incomplete.
Let’s fix it.
Because this matters - for heart failure, fluids, vasopressors, inotropes, afterload, and how we think about the whole system.

[NEJM @NEJM]

Presented today at #ACC24:

In the DanGer Shock trial involving patients with STEMI and cardiogenic shock, mortality at 6 months was lower with mechanical circulatory support with a microaxial flow pump than with standard care alone. Full trial results: https://t.co/3625asvzu8

[Vanessa Blumer, MD, FACC, FHFSA @vbluml]

To PAC or not to PAC❓

🔥 PAC ass/w ⬇️ in-hospital mortality in HF-CS, esp if within 6hrs of admission ‼️

@manreetkanwar @NavinKapur4 @ShashankSinhaMD @BurkhoffMd @ReshadGaranMD @Abraham_Jacob
@robmentz @dranulala

https://t.co/FSMkwGUnVq

https://t.co/2PXh9mBcKk for more ❤️‍🔥

[Nicolas Merke @NMerke]

short how to do video on how to do #echofirst 3D with TEE looking at tricuspid valve @FGraziani_Grace @dr_benoy_n_shah Enjoy. C you soon in Berlin

[Mark Belkin @MarkBelkinMD]

@rachkataria @Nikhil15 @docbhardwaj @JTThibs @JACCJournals @ersied727 @KevinShahMD @md_viviana @bhtrachtenberg @EiranGorodeski @justinvadermd @AndrewJSauer @IRajapreyar @RyanTedfordMD @JonathanDavisHF @JJheart_doc @gmac78 @shwinner @ShelleyZieroth @hvanspall @SumeetMitter @MarkDLC_MD @noshreza @LuiseHolzhauser And this one: @tremartyn @rcstarling @JCardFail https://t.co/X6a6QwyKC2

[Tee Joo YEO @TJ_Yeo]

A day in the life of ⁦⁦@drttinglow⁩ who makes multitasking look so easy 💪🏻
Thanks for flying the #NUHCS flag high-we are lucky to have you as a great doctor, amazing colleague & honest friend!
#wic #womeninmedicine #internationalwomensday #iwd2022 https://t.co/3NKZwGQlor

[Robin Cherian @drrobinCCM]

Pleased to share our letter @TheLancetRheum arguing that severe COVID-19 is a virus-independent immunothrombotic process. https://t.co/8qJzFPrgkq describe

[Robin Cherian @drrobinCCM]

@Dr_Tan_BY @StroCarCollab Congrats!

[Robin Cherian @drrobinCCM]

@khaycock2 @ThinkingCC @Thind888 @msiuba @MaxHockstein @OrenFriedman @cianmcdermott @SkylerLentz @siddharth_dugar @iceman_ex @PulmCrit @FTeranMD @TomJelic @viamdinh @mdmdtyler @Manoj_Wickram @RJonesSonoEM @Wilkinsonjonny @icmteaching Fascinating case and great physiology guided approach to Mx!

[Robin Cherian @drrobinCCM]

@khaycock2 @ThinkingCC @Thind888 @msiuba @MaxHockstein @OrenFriedman @cianmcdermott @SkylerLentz @siddharth_dugar @iceman_ex @PulmCrit @FTeranMD @TomJelic @viamdinh @mdmdtyler @Manoj_Wickram @RJonesSonoEM @Wilkinsonjonny @icmteaching Probably also shows the significance of neurohumoral and platelet mediated vasoconstriction in PE. https://t.co/PcRZtEakMx

[Robin Cherian @drrobinCCM]

@Jopo_dr Would argue that it was never silent hypoxia but rather silent hypoxemia. Patient unaware of low O2 sats. No evidence that patients were indeed hypoxic. Commonly seen in pulmonary vaso-occlusive physiology when both SaO2 and SvO2 low, but ⬆️tissue extraction maintains tissue O2.

[Robin Cherian @drrobinCCM]

@farid__jalali @WesElyMD @gattinon @Acute_Pulmo_Med @robertpdickson @ColinRCooke https://t.co/nsj2PnpZ7g this paper showed lack of topological correlation between lung pathology and viral presence in alveoli. Consistent data.

[Robin Cherian @drrobinCCM]

@DrRajeshG1 https://t.co/V4eCJ7kGVy

[Josh Farkas MD 💊 @PulmCrit]

coding department: Could you clarify whether this patient had a STEMI or an NSTEMI? The chart says both.

me: actually the STEMI/NSTEMI pardigm is profoundly flawed, I’d classify this as an occlusive MI

coding: there’s no code for that

me: precisely

coding:

me:

[Robin Cherian @drrobinCCM]

@FrankS1956 @connors_md @PittHealthSci @PACCM @JerryKrishnan Thanks; is it possible that the group was self-selected to have low risk of events due to the time delay involved in randomisation and Rx initiation (median 7+3 days from Dx)? 0.5% event rate appears too low for a mostly non-vaccinated group with median age 54.

[Robin Cherian @drrobinCCM]

@DrRajeshG1 Aortic root abscess with cavitation and rupture, with fistulous connection into LV? Had a similar case recently.

[Robin Cherian @drrobinCCM]

@adj_23 @PSampathkumarMD @VincentRK @dgurdasani1 @VirusesImmunity @cspramesh @paimadhu @MartinLandray @PeterHorby @EngEongOoi @florian_krammer @amymaxmen @DrTedros @edyong209 @ProfPCDoherty @EricTopol @doctorsoumya Congrats on the pub! On therapeutics in COVID, why do you think there is a wide reluctance in using therapeutic anticoag at onset of hypoxemia (moderate ill) to prevent progression? Despite multi-centre trials such as ATTACC and HEP-COVID showing mortality benefit?