Josh Dail

Flight/ Critical Care Paramedic

[Massimo @Rainmaker1973]

Models of real dredging vessels

[Haney Mallemat @CriticalCareNow]

You intubate an ARDS pt, PF comes back under 150 — how are you setting PEEP now?

Melody Bishop, RRT (@melodybishop_rt) from ResusX:2026:
The EXPRESS trial has a clean protocol for this exact moment. Does it match what your unit actually does? Drop your approach in the comments.

[Haney Mallemat @CriticalCareNow]

Your patient is crashing and you need a tube — now.

Steve Haywood, MD (@heystevemd) from ResusX:2026:
Is your emergency airway setup identical to your routine one? If not, that gap is where first-pass failures happen. What's your protocol? Comment below.👇

[Michael T. Lawton, MD @mtlawton]

Brain AVM surgery is like soccer: you enter the game with strategy; momentum shifts and swings; at times you may fall behind; but great players find a way to make big plays and lead their team to victory. Sports remind surgeons that skill, confidence, and determination matter too in the operating room…

[Haney Mallemat @CriticalCareNow]

Pressure is climbing and you're hitting your limits — do you drop the PEEP or hold?

Melody Bishop, RRT (@melodybishop_rt) from ResusX:2026:
The data backs holding high PEEP until the P/F ratio clears. What's your bedside protocol when pressures push back? Comment to discuss.👇

[Haney Mallemat @CriticalCareNow]

FiO₂ is maxed and the PF ratio still isn't moving.

Melody Bishop, RRT (@melodybishop_rt) from ResusX:2026:
At that point, are you adjusting PEEP, proning, or something else first? What's your bedside algorithm — comment to discuss.👇

[Airway of the Month @AirwayOTM]

The July 2026 Airway of the Month is here! 🫁 (2nd try the first seemed out of order)

The cords are visible. The ETT is…less convinced. 😅

This case shows why laryngoscopy must be optimized not only to see the glottis—but to create a path for tube passage.

🎥 https://t.co/5zZ3xEZaSR⁠�

A glottic view can look “good” and still be poor for tube delivery. 👀

Here, a right-lateral, oblique blade position creates competing angles between the blade, glottis, and ETT.

First optimize the laryngoscopy. Then troubleshoot the tube.

The ETT stops.

That’s feedback—not a challenge to push harder. 🛑

After 1–2 gentle attempts, withdraw and change something meaningful: re-center, suction, rotate, restyle, use a bougie, downsize the ETT, or reset

Repeated pushing can turn a geometry problem into a trauma problem: bleeding, less working space, a contaminated view—and then a “sundowning” epiglottis. 🩸🌅

When the view deteriorates, pause and rebuild the pathway.

July’s airway sequence:

CLEAN → CENTER → ALIGN → PASS → PIVOT 🔄

A view is not a pathway.

Keep pushing airway education forward—just don’t keep pushing the ETT. 😉

#DifficultETTpassage #Sundowning #LeadWithSuction #FOAMed

[CardiovascularCorner @TrackYourHeart]

An end-to-end vascular anastomosis is a surgical technique used to reconnect two blood vessels after a segment has been removed or damaged

[Haney Mallemat @CriticalCareNow]

Your resident says "first-pass success is higher with the bougie." How do you respond?

Rich Byrne, MD (@positronisomer911) from ResusX:2026:
Operator experience changes everything in airway research — and at the bedside. What do you teach your trainees? Comment to discuss.👇

[Matt Devitt @MattDevittWX]

POWERFUL STRIKE! ⚡️😳 Wait for it...boom! Incredible video showing a huge bolt of lightning striking a tree in Jensen Beach, Florida. Credit: Stephen Anstensen @spann @stormhour @JimCantore

[Haney Mallemat @CriticalCareNow]

Norepi at 0.3 and you're reaching for a second pressor — did you give hydrocortisone yet?

Anand Swaminathan, MD (@emswami) from ResusX:ReUnion:
Don't wait on electrolytes to make the call. The trigger is the vasopressor requirement, not the labs. When do you consider steroids?

[Haney Mallemat @CriticalCareNow]

You're starting combo therapy in a myxedema coma patient — but have you given stress-dose steroids yet?

George Willis, MD (@DocWillisMD) from ResusX:2026:
Thyroid hormone burns through cortisol fast. Order matters here. What's your bedside protocol? Drop it in the comments.👇

[Haney Mallemat @CriticalCareNow]

Your septic patient isn't turning around. Bradycardic. Hypothermic. Altered.

George Willis, MD (@DocWillisMD) from ResusX:2026:
When do you start thinking thyroid — and would you treat empirically? Tell us how you approach this at your institution.👇

[Haney Mallemat @CriticalCareNow]

You're at the bedside. Bilateral chest tubes placed, 100% FiO2, PEEP 10 — patient still satting 72% and hypotensive.

Sara Crager, MD (@teachicu) from ResusX:2026:
What do you do next? Have you managed a case like this? Comment to discuss.👇

[Haney Mallemat @CriticalCareNow]

Bradycardic. Hypotensive. Hypothermic. Pressors aren't working.

George Willis, MD (@DocWillisMD) from ResusX:2026:
You give T4 — but it won't help fast enough. What's your next move in myxedema coma? Drop your approach below.👇

[Danilo Evangelista @daniloevan11]

The AI model is starting to come on a little more aggressively to a potential signal off the Southeast coast in the next few days. Quite a few ensembles stay offshore, and as a result, development occurs.

[Haney Mallemat @CriticalCareNow]

You're pushing 500 cc’s through the ET tube and the lung isn't getting it — it's exiting the chest tube instead.

Sara Crager, MD (@teachicu) from ResusX:2026:
Low peak / plateau / tidal volumes, chest tube in place. What's your next move at the bedside? Comment below.👇

[NWS Raleigh @NWSRaleigh]

11:25PM Radar Update: A brief lull in rainfall is expected over the next few hours, but we're not done yet! Overnight and into the morning we are expecting areas of heavy rainfall and gusty winds. An isolated tornado threat may also be possible in the early morning hours. #NCwx

[Mitch West @SCweather_wx]

You can see below on the overnight 00z how many members begin to feel the boost from the upper levels over GA & the Carolinas. This allows for the scenario of a strengthening low pressure over land. Tropical characteristics will be lacking at this point, but it could still be an impactful scenario & wild to watch unfold. Thursday night into Friday should be an interesting period across the Southeast.

[PC Weather Boy @PC_WeatherBoy]

NBM (National Blend of Models) from NOAA showing the potential for a wet weekend loading for much of the SEAST thanks to this developing low pressure system off of the Tx coast.

Per the latest model guidance and NHC track, this system. regardless of development, looks to track into the upper Gulf coast this weekend, attached to a late season cold front, and is set to be a rain maker for many from Tx and well into the Ga area.