Internist & intensivist made @incmnszmx | 🫀CV critical care fellow @hbellvitge. Interested in hemodynamics, ECMO, advanced MV and #POCUS.
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Joined August 2013
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Paco Dardón retweeted
Este artículo presenta el caso más joven reportado de Alzheimer probable (19 años) sin mutaciones genéticas conocidas, respaldado por deterioro de memoria, biomarcadores compatibles y neuroimagen.
Sin embargo, el diagnóstico no es definitivo debido a limitaciones importantes como la ausencia de confirmación histopatológica (se necesita para el 100% de fiabilidad), la negatividad del PET, la falta de especificidad absoluta de los biomarcadores y la posibilidad de que se trate de una entidad aún no identificada...
Paco Dardón retweeted
Among patients with high-grade stenosis without recent symptoms, the addition of stenting led to a lower risk of a composite of perioperative stroke or death or ipsilateral stroke within 4 years than intensive medical management alone. Carotid endarterectomy did not lead to a significant benefit nejm.org/doi/full/10.1056/NE…
Paco Dardón retweeted
1️⃣
We can remove fluid at rates up to 12 mL/kg/h and blood pressure often holds.
That limit isn’t arbitrary – it comes from dialysis data showing steep rises in hypotension and mortality above it.
It marks the upper boundary of how fast plasma can be refilled from the interstitium and lymph 👇
🤖 Made with AI
— So, your grampa's lungs are severely injured, we're not achieving our targets with the ventilator and it seems we'll have to connect him to an ECMO machine.
– OMG, that sounds dangerous! Are there any other options?
– Well...
Paco Dardón retweeted
🧵 "What really determines tissue perfusion?"
– and why most explanations get it wrong.
Let’s sort out MAP, CVP, CCP, autoregulation, vasopressors, and the flow that actually reaches your organs.
👇
Paco Dardón retweeted
a NAVA catheter in place, to monitor the diaphragm's electrical activity (Eadi), while another mode is being used. What is going on? What mode do you think it is being used? @DrMiguelIbarra1 @emireles_c @CCF_PCCM @MegriMohammed @DrSateeshPCCM @critconcepts @IM_Crit_ @SaudiRTs
Paco Dardón retweeted
Important pushback on the Anderson/Guyton model: is pressure really a driver, or just a consequence of volume and compliance? A quick thread to unpack the physiology (and clinical relevance) 🧵👇
It is interesting to recognize that this is not the only model attempting to explain our major uncertainties regarding venous return.
It is useful to begin by revisiting the fundamental relationship between flow and volume:
V(t) = ∫Q(t) dt and Q(t)=dV(t) / dt
However, pressure is not a primary driver of flow, but rather a dynamic consequence of the interaction between flow, volume, and vascular compliance. In a compliant system, the rate of change in pressure can be expressed as:
dP(t)/dt = Q2 - Q1 / compliance
This formulation stands in contrast to the Guytonian model, which expresses venous return as a pressure-driven phenomenon:
Q = P1-P2 / R
However, such a model is conceptually incomplete. Vascular pressures do not actively drive flow; rather, they arise as a consequence of redistribution of volume. Pressure should be viewed as an emergent property of the energy state of the system, shaped by volume displacement and the compliance characteristics of each compartment.
Furthermore, from a thermodynamic perspective, assigning the role of flow driver to the static pressure gradient dP=Pms-RAP, is inconsistent with the first law of thermodynamics. The Guytonian formulation does not identify an active energy source that could account for the continuous movement of erythrocyte mass through a vascular network that is resistive, viscous, and inertial by nature.
Kind regards, and excellent post
Paco Dardón retweeted
Vesícula en porcelana
La calcificación de la pared vesicular produce una línea semilunar hiperecogénica que produce una densa sombra acústica posterior.
@JMMR83 @ABCDEcografia @PacoDardon @EchoTech_4 @EcosemfyC @TaotePOCUS
Paco Dardón retweeted
POCUS glotis.
Cuerdas vocales.
@ABCDEcografia @JMMR83 @curromir @y_interna @PacoDardon @NephroP @Pocus_PR @OrlandoRPN
Paco Dardón retweeted
This might be a simple way to (dramatically) improve outcomes in patients awaiting thrombectomy (mechanical clot removal) for ischaemic stroke in a large artery
Put the head of the bed at 0°:
Paco Dardón retweeted
Top 5 advances in medicine this week (🧵)
1. A drug that beats chemotherapy in a subset of lung cancers
Small cell lung cancer is usually treated with chemotherapy, but resistance is common, and side-effects can be severe
Tarlatamab is a bispecific antibody: it recruits T cells directly to cancer cells - via a protein expressed by ~90% of small cell lung cancers (called DLL3)
Tarlatamab has accelerated approval to treat small cell lung cancer as second line after platinum chemotherapy - this phase 3 trial provides the data to (potentially) upgrade this to full approval
Tarlatamab improved overall survival vs. physician’s choice of chemotherapy, with fewer grade 3 adverse events (though with a new side-effect - cytokine release syndrome)
Ongoing phase 3 trials are testing Tarlatamab as part of first-line combinations
nejm.org/doi/full/10.1056/NE…
2025 and 30 mL/ kg is still a thing...
The very 1st line of a recent @BJAJournals states:
'In early critical illness, intravascular volume depletion secondary to capillary leak is common & requires aggressive fluid resuscitation to improve cardiac output & tissue perfusion'
Why are we still propagating these myths? 🧵
Paco Dardón retweeted
1/10
A 70-year-old man presents with dyspnea. What do you notice when you first meet him?
This finding should generate a hypothesis, which we will circle back to eventually.
Veo que las Universidades del Bienestar ya empiezan a tener egresados en medicina, ¡enhorabuena!
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Seen it many times. Totally real.
We had an unusual phenomenon in the ICU today. An elderly 👩🦳 who was stuporous for the past week, suddenly woke up and started obeying commands and talking after being administered her last rites. Her blood parameters which had been improving, took a turn for the worse and her Hb went down to 6 gm. On discussing this with her son, he emphatically stated that his grandmother had similarly had a lucid interval after a prolonged illness. She regained her mental clarity for a couple of hours and was able to talk with her children before she suddenly took a turn for the worse and passed away.
We were sceptical, but shortly afterwards the lady deteriorated again and passed away. Were we witnessing the apocryphal‘terminal lucidity’?
Paco Dardón retweeted
LV Torsion: A Powerful Marker of Systolic Function
Definition
Left ventricular (LV) torsion (or twist) refers to the wringing motion of the heart during systole, apical counterclockwise rotation vs basal clockwise rotation.
It results from the unique helical arrangement of subendocardial and subepicardial fibers.
How is it measured?
Using speckle-tracking echocardiography, torsion is calculated as the net difference in rotation between apex and base, typically in degrees.
We can also measure the rate of rotation (deg/sec), offering further functional insight.
Why does it matter?
Torsion reflects myocardial efficiency and contractile function.
It is sensitive to:
🔵 Early systolic dysfunction (even with preserved EF)
🔵 Myocardial ischemia and infarction
🔵 Cardiomyopathies (HCM, DCM)
🔵 Heart failure (including HFpEF)
Reference:
Modified from Bulwer BE, Solomon SD. In: Atlas of Echocardiography, 2nd ed. Springer; 2009:63.
#Cardiology #Echo #LVFunction #StrainImaging
ALT Diagram and echo images illustrating left ventricular (LV) torsion. The top half shows how subendocardial fibers cause apical counterclockwise rotation and subepicardial fibers cause basal clockwise rotation during systole. The center section explains net systolic twist (torsion) as the angle difference between apex and base. The bottom half includes echocardiographic speckle-tracking images and graphs showing LV rotation (in degrees) and rotation rate (degrees/sec) during the cardiac cycle.
Paco Dardón retweeted
No DM in Critical Care. We're always underrated 😢
You’ve got to hand it to India. Homeopathy starts DM degrees in super specialties in India.
Can our collective IQ go any lower than zero ?
I think not.
There are zillions of superstitious ignorant desperate patients in India just waiting for this kind of horseshit to be endorsed by some national body as an option to modern medicine.
Welcome to Amrit kaal…
Paco Dardón retweeted
Can a patient be fluid responsive and venously congested at the same time?
Yes — and this changes everything.
Our recent study shows how bedside ultrasound can reveal what clinical signs often miss.
Let’s break it down:
#POCUS #VExUS #CriticalCare
🧵