Joshua Madden, MD

Midwest gent
UPenn NCC Fellow 25-27
Penn Medicine
#NeuroEMScholars
#EM #EMNCC #NeuroCrit #Sim #MedEd #POCUS

[Joshua Madden, MD @josh_emncc]

@esquire Damn 😬

[Joshua Madden, MD @josh_emncc]

@IM_Crit_ I guess that's how they realized it's ok if you inadvertently puncture the artery; just don't dilate. Lol. Someone had to mess up countless times blindly.

[Critical Care @Crit_Care]

New Open Collection in #CriticalCare:

🏥The Logic of Critical Care: Integrating Physiology and Evidence
📚Guest Edited by Dr Luigi Camporota and Dr Francesca Collino
➡️https://t.co/gMv4XjuNtJ

#CritCare #OpenCollection

[Joshua Madden, MD @josh_emncc]

@swdhldr Focus should be on competence and compassion. I've seen non prestigious docs fumble with sick complex pts and I've seen prestigious docs fumble with urgent care stuff. Both trainees have something they bring to the table. Both have good/not so good docs.

[Joshua Madden, MD @josh_emncc]

@swdhldr Disagree. I don't think ppl can speak on places they haven't trained. Tons of procedures at my prestigious institution. Saw tons of LVADs, Cardiogenic shock, Transplants emergencies, onc emergencies, terrible airways with H&N cancers, tons of trauma. You name it we got it.

[Joshua Madden, MD @josh_emncc]

SOB doesn't = PE.

Long ED wait times has led to reflexive imaging. But in EDs with 4–6+ hour radiology reads, scanning everyone isn’t practical. Cardiac US + BLUE protocol + DVT scan can help narrow the differential and better guide who needs CT. #POCUS

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

🫀POCUS is no longer just a bedside imaging tool.

It is becoming real time physiological intelligence.

This excellent 2026 review highlights how modern POCUS is expanding into:
• ultrasound guided regional anesthesia
• shock and cardiac arrest management
• AI assisted imaging
• advanced diagnostics
• governance and medicolegal practice

Some of the most provocative concepts: • “Occult VF” detectable only on echocardiography during cardiac arrest
• Ultrasound guided CPR compression positioning
• AI assisted lung ultrasound acquisition by nonexperts
• Handheld devices approaching cart based diagnostic performance

One important medicolegal message: several lawsuits involved failure to perform POCUS when clinically indicated.

The future of emergency and critical care medicine will likely depend on clinicians capable of integrating: physiology + imaging + AI + rapid bedside decision making.

POCUS is not anymore an “optional skill” but “core clinical infrastructure.”

Mani N, Rao S, Kim DJ. Point-of-care ultrasound in the modern era of emergency medicine: a narrative review of the recent literature. Curr Opin Crit Care. 2026. doi:10.1097/MCC.0000000000001358

[Joshua Madden, MD @josh_emncc]

@Dr_mac2 Nah, lol, I'll stay with Brooks or NB (Philly vibes)!

[Benjamin Abella, MD MPhil @BenjaminAbella]

Amazing work from Drs Devivo, Lavine and others at @MountSinaiEM - first in the nation EM/CC accredited joint residency - this year >100 applicants for 2 spots!

EM & CC are terrific partners.

Read more:

https://t.co/DKkLIU6Ndp

#emergencymedicine #criticalcare #emcc

[Joshua Madden, MD @josh_emncc]

@BenjaminAbella @MountSinaiEM Love this! Wish it were an option when I was applying to residency. I see how my EM training translates to Crit Care.

[Haney Mallemat @CriticalCareNow]

Don’t let a "normal" blood pressure fool you
Early cardiogenic shock (Stage B) is a master of disguise. Watch for a 30-point systolic drop and rising heart rate. Normotensive shock kills—mortality hits 34% even before the patient looks "shocky." #Cardiology #ICU #Shock

[Joshua Madden, MD @josh_emncc]

Starting to explore the 2027 job market in Neurocritical Care. Curious if anyone knows of community ICUs with mixed med/neuro populations or hybrid program Neuro ICU looking for neurointensivists. Would appreciate any leads or connections!
#NeuroICU #NeurocriticalCare #MedTwitter

[Critical Care Reviews @CritCareReviews]

Applied physiology at the bedside: using invasive blood pressure as a true monitoring tool

CCR Journal Watch 
https://t.co/Sp06oA6IDG

[Joshua Madden, MD @josh_emncc]

@CritCareReviews Great review article!

[Joshua Madden, MD @josh_emncc]

@namorrismd any word on the next Mid-Atlantic NCC symposium?? 👀

[Cliff Reid @cliffreid]

🧵 Managing Challenging Behaviours in Resuscitation Teams: A Thread for Team Leaders (1/13)

Every resuscitation team leader can face difficult team dynamics

Here are 6 key challenging behaviours you'll encounter and how to manage them effectively in real-time 🚨

[Joshua Madden, MD @josh_emncc]

@urban_comp Where are the blue pants from or what’s the style/fabric?

[Joshua Madden, MD @josh_emncc]

@IM_Crit_ Can you post a vid of railroading the catheter over the curled end?

[Joshua Madden, MD @josh_emncc]

Having non-EM physicians frequently ask me if the Pitt is a real representation of the ED, followed by man that’s crazy! Lets me know that non-EM docs have zero clue what we do or go through.

The Pitt has opened up consultants minds and is changing consultation culture.

[Joshua Madden, MD @josh_emncc]

@davidcarr333 I think it’s a great medical drama, but agree ER is way better! Finishing residency now and I’ve binged ER 3x. They need to remake scrubs!