Rafael von Hellmann

ICU Registrar @MonashHealth | MBBS @hupe_uerj | Emergency Medicine Residency @hcpa_ and @_HPS_POA
Ultrasound, Airway, and Patient Safety | Opinions are my own

[Rafael von Hellmann @hellmann_von]

Resolvi compartilhar através do youtube as aulas de ultrassom à beira do leito que eu dou para a residência de Brasília e do HCPA/HPS. Espero que gostem!

I decided to share on YouTube the bedside ultrasound classes I give to the residency program in Brasilia and at HCPA/HPS.

[Rafael von Hellmann @hellmann_von]

@pedrotrossi1 Entendi. O que acontece muito nas emergências brasileiras é haver pedido de internação, mas, por os leitos serem muito escassos, esse paciente permanece na emergência e acaba não sendo transferido. Lembro que quando estava no HCPA durante a pandemia part da emer eram uma "UTI"

[Rafael von Hellmann @hellmann_von]

@pedrotrossi1 Super interessante, Pedro. Uma pergunta: quando voce diz ICU admission, e' o pedido de internacao em UTI, ou de fato a entrada desse paciente na UTI?

[Rafael von Hellmann @hellmann_von]

@DrewPavlou You might wanna check https://t.co/Od4kZ4fr2M as well

[Rafael von Hellmann @hellmann_von]

@PulmCrit @rmohty @IM_Crit_ And they will fail, because it should not be a rescue device as people thought the bougie should have/has been.

[Rafael von Hellmann @hellmann_von]

@PulmCrit @rmohty @IM_Crit_ Use HAVL for easy airways; train on manikins; train in the OR/OT. If you're still not confident enough, not nailing it in easy/stable ones, stick with SGVL for the critically ill. My concern is that people will read the study and will adopt it in their first intubation

[Rafael von Hellmann @hellmann_von]

@ClaudeDevs Till today I am still hitting limits, unable to send a feedback message, because the chat does not load.

[Rafael von Hellmann @hellmann_von]

@ClaudeDevs I am still facing issues with limits...

[Ronaldo Nazário @Ronaldo]

As probabilidades podem estar contra a gente… mas nós já vencemos elas cinco vezes e fomos campeões do mundo. Tá liberado acreditar na sexta. 🤞🇧🇷🍻

[Rafael von Hellmann @hellmann_von]

@pKariova @mathalveslim https://t.co/oLEjxsTxY1

Nao existe nenhum trial comparando HAVL vs SGVL em doentes criticos....

[Rafael von Hellmann @hellmann_von]

@YukiKotani5 @takatoshikoroki @yoshirohayashi @kameda_icu I totally agree with you. I am biased on this discussion because we recently published this one: https://t.co/NRNf6jAOzM
We had the opportunity to do something similar, but we opted to use control as a placebo, e.g Fergusson 2022

[Rafael von Hellmann @hellmann_von]

@pfnery Pedro, você poderia explicar um pouco melhor seu ponto?

[Ian Ward A. Maia @ianwardd]

New observational study using Target Trial Emulation compares Etomidate vs. Ketamine for ED intubations. Cohort: 1,810 patients (BARCO registry). Design: Inverse probability of treatment weighting (IPTW). Primary Outcome: 28-day mortality. -https://t.co/yKyz9rKDrW -

[Flamengo @Flamengo]

Oi oi oi…

[Flamengo @Flamengo]

NO BRASIL, NÃO TEM OUTRO IGUAL! 🏆🏆🏆🏆

#arteespecial

[Rafael von Hellmann @hellmann_von]

@Magalhaes_Bruno Agonia é ter o Allan em campo 90 minutos. Roda em cima da bola e toca pra trás.

[armyemdoc @armyemdoc]

Should we be reaching for hyperangulated or standard geometry VL blades?

Much to my dismay, a systematic review with meta-analysis of 25 studies and 39k patients published this month found that hyperangulated blades had 4% lower first-pass success with higher risk of airway trauma. However, a few things worth noting before the HAVLs are taken behind the barn...
-The majority of the RCTs (n=16) were in the OR, not the ED or ICU
-Most of the RCTs were relatively small (<200 patients total) so they placed relatively low weight into the pooled outcome
-Unclear what to make of the signal of potentially higher risk of injury without a large RCT in the mixed ED/ICU population
-The large number of observational data included are obviously confounded by unmeasured effect modifiers (remember... no level of statistical slicing and dicing will ever provide the balance that an RCT will)

So, I do not think it's time to throw our hyperangulated blades in the trash, but thus far, the data does not support them being the amazing tool we initially thought they would be.

https://t.co/AC1TV2o5pq

PMID: 40939241

#emergency #emergencymedicine #criticalcare #icu #science #data #research #army #armymedicine #armyemdoc #airway #medx #medtwitter