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Kevin López Suárez @Kevinls18

Médico Marista, R3 de pedialove 👶. Joined June 2011
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Kevin López Suárez retweeted
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Dr. Chacón-Lozsán F .'. @franciscojlk

3 months ago

More about VAC in sepsis... 🤓 🫀 Why do some septic shock patients respond to treatment… and others don’t? We often blame: • “Refractory shock” • “Severe sepsis” • “Late presentation” But physiology tells a different story. ⚙️ The real problem: ventriculo-arterial decoupling Septic shock is not only vasodilation or myocardial depression. 👉 It is a failure of interaction between the heart and the arterial system This interaction is called: ➡️ Ventriculo-arterial coupling (VAC) And it defines: ✔️ Cardiac output ✔️ Arterial pressure ✔️ Perfusion efficiency 🧠 What can be often ignored in daily ICU practice You can have: ✔️ Normal cardiac output ✔️ Acceptable MAP ❗ And still have inefficient circulation Because: 👉 Energy transfer from the ventricle to the arterial system is impaired 📉 What happens in septic shock? • Decoupling is common • LV ejection becomes inefficient • Cardiovascular treatments become less effective 💉 Clinical paradox Same intervention. Different outcomes. Example with norepinephrine: 🔵 Patient A → Adequate contractility (Ees preserved) → ↑ arterial tone → VAC improves → ↑ CO 🔴 Patient B → Depressed contractility → ↑ arterial tone (afterload) → VAC worsens → ↓ stroke volume 🔥 This explains a lot of what we see • Why MAP increases but CO drops • Why some patients “fail” vasopressors • Why fluids work in some and not others • Why lactate persists despite “normal numbers” 🧬 Even more important VAC is: 👉 A determinant of treatment responsiveness, not just a descriptor of physiology 📊 Bedside implication We should stop asking only: ❌ “What is the MAP?” And start asking: ✅ “Is the system coupled?” ✅ “Are we improving efficiency or just pressure?” ⚡ Practical shift Instead of protocol-only resuscitation: ➡️ Move toward physiology-guided resuscitation Using: • Ea (arterial load) • Ees (contractility) • VAC (their interaction) 🧠 Final thought Septic shock is not just: ❌ A pressure problem ❌ A volume problem 👉 It is an interaction problem And until we treat it as such: ➡️ Some patients will continue to “not respond” 📚 Pinsky MR, Guarracino F. (2023) Intensive Care Medicine Experimental doi.org/10.1186/s40635…

Kevin López Suárez retweeted
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Diego Ketamino @DiegoEscarraman

4 months ago

BURP vs Sellick en el manejo de la vía aérea #AventhoAnestesia #Aventho #SMMCE #SAML En laringoscopia, no toda presión cervical es igual. Dos maniobras clásicas, distintos objetivos: 🔹BURP (Backward-Upward-Rightward Pressure) Presión sobre cartílago tiroides: posterior, cefálica y hacia la derecha ✅ mejora la visualización glótica (↑ Cormack-Lehane), útil en vía aérea difícil ✅ dinámica (ajustable en tiempo real) ❌ depende del operador ❌ mal aplicada puede empeorar la vista 🔹 Sellick (presión cricoidea) Compresión del cartílago cricoides contra C6 ✅ busca reducir insuflación gástrica y riesgo de aspiración ✅ históricamente en secuencia rápida ❌ evidencia controversial en prevención de aspiración ❌ puede dificultar laringoscopia/intubación ❌ requiere fuerza adecuada (≈30 N tras inducción) Si empeora la visión o el paso del tubo → reduce o libera Sellick. BURP es para ver mejor; Sellick es para “proteger”… pero no siempre ayuda. Conclusión * Usa BURP como herramienta de optimización visual. * Aplica Sellick con criterio crítico y reevaluación constante.

Kevin López Suárez retweeted
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Medicina Crítica Pediátrica @MedCritPed

9 months ago

Guías del Consejo Europeo de Reanimación 2025: Soporte Vital Pediátrico - Reanimación ERC Guidelines 2025 Paediatric Life Support - Resuscitation No sólo es el PALS de la AHA. Amplia tu visión, existen diferencias. Usa lo que mejor le ayude al paciente. resuscitationjournal.com/article/S0300-…

Kevin López Suárez retweeted
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POCUSmedicine @POCUSpeek

10 months ago

🔍 Ultrasound-Guided Peripheral IV Cannulation → key POCUS skill for difficult venous access in ED/@acutemedicine /ICU patients with ↑BMI or dehydration, boosting first-pass success >90% to ↓ complications and delays 👇images from @Pocus101 Cannulation with @5MinSono 👉🔗youtube.com/watch?v=4Znd21… ⚡ Use linear probe in short/long axis; target superficial veins >3mm deep to avoid arteries/nerves 📏 Angle needle 30-45°; confirm tenting, flash, then advance catheter while withdrawing stylet 🚨 Sterile gel/cover essential; tourniquet boosts vein distention for >90% success in tough cases 🔍 Doppler differentiates vein (compressible) from artery; reduces tries in BMI>30 patients 🤝 Evidence shows fewer infiltrations/headaches vs blind; ideal for pediatrics/oncology. #POCUS #Cannulation #FOAMed #MedEd #EmergencyMedicine #CriticalCare #Ultrasound #POCUSenthusiast #MedTwitter #FOAMus #MedStudent #POCUSeducation #UltrasoundTips

Kevin López Suárez retweeted
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Medical Info @Medicalinfo111

10 months ago

POCUS pocket cards

Kevin López Suárez retweeted
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Ashley Miller @icmteaching

10 months ago

1️⃣ Some patients with severe venous congestion have almost no oedema — and that’s confusing at first. It only starts to make sense once you unpack the physiology. 👇

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NephroPOCUS @NephroP

10 months ago

One picture, enough said. This is why 👨‍⚕️👩‍⚕️ "feelings" about congestion don’t cut it. #POCUS #Nephpearls #VExUS #FOAMed

Kevin López Suárez retweeted
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Fco AYUSO (Intensiviridae) @FcoAyusoMC

12 months ago

-Resistencias vasculares, sistemas #RVS. - El 80% de las RVS corresponde a la microcirculación. Formula:RVS= ((PAM-PVC)/ GC)) x 80 Normales: 700 a 1500 dinas.seg. - Resistencia al flujo sobre un circuito. -#Flujo: Representado por el gasto cardiaco #GC, movido por un gradiente de presión PAM-PVC. -#Resistencias: vasos sanguíneos: dependiendo de su elasticidad, presenta o no de estenosis, ateroesclerosis, etc. #80 : convierte mmHg a Dinas. Segundo. Descarga: ⬇️⬇️⬇️⬇️ t.me/UCIJOYA/43

Kevin López Suárez retweeted
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Dr. Jair Vargas @DrDeLaUCI

12 months ago

ASINCRONIA PACIENTE - VENTILADOR ABORDAJE CLÍNICO PRACTICO 🫁‼️ Este artículo facilita la identificación de asincronías y permite la evaluación de la respuesta a las intervenciones establecidas ‼️

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Kevin López Suárez @Kevinls18

3 years ago

Ahora si con todas las de la ley, futuro residente de urgencias pediátricas 💪🏻

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Kevin López Suárez @Kevinls18

4 years ago

Wa iorar ptm

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Kevin López Suárez @Kevinls18

4 years ago

@dianittalara Cuánto ofreces

Kevin López Suárez retweeted
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𝕰𝖑 médico 𝖆𝖒𝖆𝖗𝖌𝖆𝖉𝖔 @med_amargado

4 years ago

Kevinls18 Profile Picture

Kevin López Suárez @Kevinls18

4 years ago

@Alevillanueva10 Sin llorar.

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Kevin López Suárez @Kevinls18

4 years ago

Mi cuerpo ya no está hecho para 2 días de cruda seguidos.

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Kevin López Suárez @Kevinls18

4 years ago

@FabyDoporto Aberrrrr cuando tienes días libres

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Kevin López Suárez @Kevinls18

4 years ago

Se busca amistad sincera para ir a la playa

Kevinls18 Profile Picture

Kevin López Suárez @Kevinls18

4 years ago

Cómo que el PUEM es en 1 mes para los de último año, sino no nos títulamos. Perenme no mamen. 🥴🥲

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Kevin López Suárez @Kevinls18

4 years ago

Que inmamables son algunas personas en los aeropuertos.

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Kevin López Suárez @Kevinls18

4 years ago

@AlanDuarteJ Skechers

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Kevin López Suárez @Kevinls18

4 years ago

@itzcaballero Me urge

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