Super excited for this. No issues with travel this year, the H&R family all keen on getting together again, the lineup is awesome, most of the OGs able to make it, lots of new additions, and the programme is looking really sweet. Am totally amped to have Katie Wiskar as the Chair of The Hospitalist as she’s putting together a great group with sharp lectures and super interesting workshops. With help from the usual suspects (Rory Spiegel, Andre Denault, Korbin Haycock) we are focusing on some core areas in acute and critical care – sepsis, arrest and respiratory failure are perennials, but this year we are also adding neurocrit as a core component, which I think is a bit underserved and certainly deserving of more.

A message from Katie Wiskar: I cannot express how excited I am to be a part of H&R 2023, and to finally get to experience the magic in person. Building on the energy and ethos that Philippe has curated in the Resuscitation side, I’m thrilled to bring a killer set of on-demand lectures and in-person content delivered by a top-notch, multi-disciplinary faculty. The program is full of hot topics, evidence-based medicine updates, and practical ward pearls. I can’t wait to learn from this group of incredible educators; and I hope to see you all there! 

When? September 27-30 with the core being 28-29 and the pre/post stuff on either side.

Where? Montreal – both at the Heart Institute (core days) and my shop, Santa Cabrini Hospital (pre/post courses).

CME? Of course, should be over 40 credits, watch this space in the next weeks.

What? So you get a bunch (about 50) lectures to watch prior to the conference, then during the in-person part, you get some live lectures followed by group discussions around those topics, as well as hands-on workshops. You can hop between the Hospitalist and the Resuscitationist tracks depending on your interest or mood. Most importantly, there’s plenty of hallway time where you get to hunt down the universally open minded and available faculty members to pick their brains, share ideas, start collaborations and who knows what else you might come up with. This is gold. There’s going to be a buffet of workshops to pick and choose from that we are still putting together, from airway management to bedside procedures, ekg workshops, neuro exam workshop, wound dressing, and of course all kinds of POCUS.

Oh yeah, and the pre/post stuff is pretty fantastic. If you’ve been following acute care and POCUS, you’ve noticed the beginning of an ear where we will focus on fluid tolerance rather than responsiveness, and VExUS is a pretty important part of it. Learn from the originators and other pioneers of the score in this VExUS course with real patients and pathology. If you struggle with refractory hypoxia in acute lung injury, add APRV-TCAV to your armamentarium. Understand the mode, shake off the myths and learn knobology on a couple of ventilators with simulated lungs. You do trauma or medical resus? REBOA is growing in use. Familiarize yourself with the technique using the different available aortic occlusion catheters with the REBOA course. The Resuscitative TEE Course, run by none other than Felipe Teran is back again! If you’re not personalizing your CPR, here’s the place to learn!

The Hospitalist POCUS Course will be split in Basic (AM) and Advanced (PM) and the focus will be on all core skills required at the inpatient level. The faculty is absolutely top notch.

A newcomer this year is the Jr. Doc Procedure Course, aimed at trainees but truly good for anyone entering the hospital arena, regardless of age or training status. Go over and practice intubation and basic airway management, central and arterial line placement, thoracic and abdominal pigtail insertion and more!

And of course, the Introduction to Brazilian Jiu Jitsu workshop is always a blast. Last year, participants were treated to a short philosophical discussion on breathing with guru coach Firas Zahabi followed by a hands-on training session. In previous years we had reviewed basic concepts to stay safe in volatile situations. Always a lot of fun! We are fortunate to have some pretty seriously BJJ-skilled faculty members such as Ashley Miller and Rory Spiegel! Can’t wait!

Who? So the H&R family keeps growing!

On the H side, Katie has assembled an impressive lot that I am really looking forward to meeting and exchanging with, such as Gigi Liu, Michael Fralick, Elaine Kilabuk, Ria Dancel and more to be confirmed!

On the R side, we have many of the usual (awesome) suspects, Korbin Haycock, Rory Spiegel, Matt Siuba, Segun Olusanya, Felipe Teran, Jeff Scott.

Some young guns like Ben Daxon, Trina Augustin, Max Hockstein, Eduardo Argaiz, Vimal Bhardwaj, Frederick Verbrugge and Jay Chatterjee.

Some who joined us virtually last year but whom I am totally psyched about meeting some in person such as Katie Wiskar, Abhilash Koratala, Casey Albin, Neha Dangayach, Ashley Miller, Hatem Soliman, Mourad Senussi and Sara Crager.

Not to mention some icons of emergency and critical care like Scott Weingart, Ognen Gajic, Sheldon Magder, Andre Denault, Ashish Khanna, Jan Bakker and Glenn Hernandez who have contributed so much to the literature.

…and we keep adding talks and faculty! Bookmark this to keep up!

For the preliminary programme and more information,

Registration is open!

See you there!!!


Etomidate: a perspective on a current controversy.

Personally, I’ve never used it, so not really an issue to me. But it seems to generate a fair bit of emotion and debate, and having the pleasure of knowing some really smart and, in this case, highly experienced people, I think we have something good to share here, a story from Thomas Woodcock! This insight may help clinicians currently debating the issue…

Edomidate – A Brief Personal History.

By Thomas Woodcock, MD.

We all want Evidence, good solid peer reviewed communications with verifiable data, ideally randomised and controlled. But we are human, and our practices are also informed by unpublished experience, what used to be cited as “Personal communications”. I acknowledge the dangers of placing too much confidence in such evidence. Our recollections of events may become clouded or unreliable as the years pass. With that caution in mind, I am going to take the final opportunity to offer my unpublished recollections of events surrounding Iain Watt’s fortuitous discovery of the lethality of the intravenous anaesthetic agent etomidate back in 1983; forty years ago, though it only seems like yesterday.

This year our friends at San Raffaele Scientific Institute, Milan, Italy published a meta-analysis of studies reporting the use of etomidate to cover tracheal intubation in critically ill patients and concluded as follows;

We included 11 randomized trials comprising 2704 patients. We found that etomidate increased mortality (319/1359 [23%] vs. 267/1345 [20%]; risk ratio (RR) = 1.16; 95% confidence interval (CI), 1.01–1.33; P = 0.03; I2 = 0%; number needed to harm = 31). The probabilities of any increase and a 1% increase (NNH ≤100) in mortality were 98.1% and 92.1%, respectively.[1]

This came as no surprise to me, and was predictably followed by etomidate anaesthetists explaining that the harm (euphemism for lethal effect) could only be proven by enrolling thousands of participants in a blinded RCT. Imagine the Consent form.

We have a broad selection of intravenous anaesthetic agents to offer for your general anaesthetic, but one of them has had serious concerns raised about a lethal effect. With your permission we would like to randomise you to receive a safe drug or etomidate so that we can learn more about the lethal effect.

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. The Western Infirmary Glasgow (WIG) was a Victorian red brick building on the Byres Road. The Boss was Professor Iain McAllister Ledingham, Editor of the book series Recent Advances in Critical Care Medicine, a founder of The European Society of Intensive Care Medicine and one of its first Presidents. With many original publications on shock and interhospital transfer, in the clinic and in the laboratory, Iain Ledingham was as reverered as Pope John Paul II who had been granted an audience with the Prof during the first Papal visit to Glasgow in 1982. A photograph recording the event was prominent on Iain’s desk. As an American visitor to the Unit observed, this was surely the best Intensive Care service in England (sic)[2]. Up to 1982, intensive care patients at WIG were being sedated with propofol infusions, opioids and benzodiazepines, but by the time I arrived the preferred hypnotic was etomidate with morphine analgesia. It may be that the change was prompted by a 1982 report from Sheffield entitled “Safer sedation for ventilated patients. A new application for etomidate.”[3] The ICU looked to me like something out of the 1978 movie Coma, based on the novel by Michael Crichton. Most patients were sedated to immobility with the new wonder drug that had no histamine release and a stable haemodynamic profile – except, of course, for the patients who were also receiving dopamine. Nursing tasks were thus greatly simplified, and the staff were able to enjoy a post round morning tea break at which everybody was offered an egg “piece”.[4]

The research agenda at the time was broad. Complement activation and histamine release were blamed for capillary permeability changes in shock, and imbalance between the arachnadonic acid metabolites was blamed for arteriolar dysfunction and microvascular coagulation. Adam Fleck had his own team investigating the transcapillary escape rate of albumin in severe disease and injury. To everybody outside Glasgow glucocorticoids seemed to be the answer and Chicago surgeon William Schumer was their chief flag waver, claiming in 1976 that steroid therapy reduced the mortality of saline-treated sepsis in his service from 33% to around 10%.[5]  We had all witnessed the almost miraculous Shock Reversal that often followed the infusion of 30 mg/kg methylprednisolone (Solumedrone in the UK). Upjohn Pharmaceuticals sent their representatives around the country to ensure that every intensive care physician was aware of this. When I told a London Upjohn Representative that I was heading to Glasgow, he warned me that WIG may be the only UK service refusing to treat sepsis with high dose steroids. He predicted that by the time I returned from Glasgow any lingering doubts about the life-saving power of Solumedrone would have been cast off.

When I arrived in Scotland I was tasked with investigating the effects of the thromboxane synthase inhibitor dazoxiben on prostaglandin production in sepsis patients.[6] Once a week, on Dr Winifred Finlay’s ICU ward round, we would be joined by biochemist Dr McKee and patient adrenal function test results were reviewed. These ladies had published their findings on serum cortisol levels in severely stressed patients the year before.[7] Now, hydrocortisone was being prescribed for patients deemed to need it, targetting a “normal” stressed serum cortisol and this seemed to be reducing mortality.[8] I was bold enough to ask Prof Ledingham why he was opposed to “pharmacological dose” steroid therapy, and he merely pointed out that the research evidence was very poor. More studies were needed. Finlay and McKee’s surprising data had been shared with Joe Stoddart, a respected Intensivist in Newcastle, England. Joe replied that he had looked at twenty consecutive “severely stressed” Geordie ICU patients, and without exception they had appropriately high serum cortisol levels. You are giving them something harmful, he concluded.

The surgical Shock Team Registrar was Ian Watt, a rather reserved chap with an Aberdonian sense of humour[9]. The Shock Team day started with an early morning debrief in the Laboratory. The Team was Ledingham, two anaesthetic Registrars, one Surgical Registrar, Technicians Ian and Morag, Secretary Dianne and, quite often, a greyhound. Our clinical responsibilities included the advanced management of shock patients. Only the Shock Team were allowed to do right heart catheter haemodynamic studies, and I was entrusted with Ed Sivak’s double indicator dilution machine that measured the extravascular thermal volume of the lungs. We Registrars were each On Call for two weeks, with one week off. This meant that we could dispatch two Shock Team members to any hospital in Scotland, to stabilise and if necessary bring shocked patients into WIG, any time of any day or night. One of us would be the designated Ambulance driver. But I digress, let’s talk more about Iain and the greyhound. At the end of the debrief the Registrars would head off to the ICU to join their rounds, but on days when Ian was experimenting on a dog one of us might stay behind to help him anaesthetise, intubate, ventilate and catheterise the animal.[10] He was using the Gurll model to investigate hypovolaemic shock. The stabilised animal was allowed to bleed until the mean arterial pressure was around 45mmHg. This hypovolaemic shock state was to be maintained for one or two hours before the shed blood was retransfused and the effect of experimental drugs on resuscitation could be tested.[11] The problem was that Iain’s greyhounds died during the hypotensive phase. I do not recall one experiment getting as far as the resuscitation stage. We pooled our intellects on the challenge, and decided that maybe the choice of pedigree greyhounds was an issue. Glaswegians, after all, are not easily compared to thoroughbreds and so Iain acquired some mongrel dogs. Unsurprisingly they died during hypotension too. Ian was getting desperate. In need of data for a Master of Surgery degree, he decided to change tack and get stuck into some clinical research. An anaesthetic Senior Registrar called Richard Marsh was our computer geek – he kindly took me to an international Computing In Anaesthesia and Intensive Care meeting in Rotterdam, where I think he presented a paper. Richard was constructing a relational database of severity of illness scores and intensive care outcome at WIG. He was alarmed to observe a big step-wise increase in ICU mortality occurring in 1982, and Watt’s new research brief was to investigate. The Shock Team had an office with three desks, one for each of us. My own desk was untidy, but Ian’s desk grew an ever increasing tower of patient records with his own notes and annotations. Then came his Eureka moment. Focusing on the cohort of major trauma patients, for whom one could calculate an expected mortality, he confirmed a very sharp rise in the observed mortality at the time there was a switch to etomidate sedation. Moreover, he found that almost all of the adrenal insufficient patients in the Finlay & MacKee series were sedated with etomidate. I obtained plates with cultures of human adrenocortical cells from Glasgow Medical researchers and added various anaesthetic agents in concentrations approximating therapetic plasma levels, before adding ACTH to stimulate cortisol release. I was sure I would find all sedative or analgesic medicines could inhibit cortisol release, but I was very wrong. Etomidate was a very powerful adrenocortical inhibitor. Perhaps the mystery was solved. Then one morning an investigation team representing Janssen arrived. They took over the shock team office, poring over the patient records and Ian’s research notes. For several days I could not get to my own desk. We reassessed Ian’s abysmal animal research history, and realised he had decided to anaesthetise the dogs with etomidate, in line with local clinical practice. He rushed back to the Laboratory to anaesthetise dogs with other anaesthetics and was relieved to find he could successfully run a Gurll model experiment. He used etomidate again, and found that a shot of hydrocortisone enabled dogs to survive long enough to reach the resuscitation stage. How could the Sheffield team have claimed that etomidate provided safer sedation for ventilated patients back in 1982? The reason became clear. Their case series was just 6 healthy patients ventilated for 24 hours after major maxillofacial surgery, and each had received dexamethasone to prevent surgical swelling.

Iain knew he had a responsibility to communicate his discovery as rapidly and widely as possible. This is why he chose a Letter to the Lancet. Unfortunately this prior publication caused some Editors of scholarly journals to turn down his more thoroughly considered and detailed manuscripts that should have followed. The Scottish national press reported that deaths had been caused by etomidate at WIG, but the anticipated public outcry did not materialise. We were spared the ignominy of an Inquiry. The number of Glaswegians whose lives were lost to etomidate was never ascertained. Experts came forward to claim that etomidate was still a preferred hypnotic induction agent for patients who would benefit from its haemodynamic stability, even though this claimed superiority was never demonstrated in sick patients. In the UK the Committee for Safety of Medicines merely drew attention to potential hazards of etomidate administration. In Denmark, the license to infuse etomidate was limited to 12 hours,

Silly comments from Experts included “it only happened in trauma patients who stayed ventilated for 5 days or more” and “a shot of hydrocortisone will block the lethal effect”. Should regulatory authorities have done more to prevent the continued use of this poison?

There are post scriptums  to this story. In November 1984 Charles Sprung and colleagues published a landmark trial showing that impressive early shock reversal with high dose corticosteroids was NOT associated with increased survival of patients with severe, late septic shock.[12]  I had been offered a critical care research post for 1985-6 at The Victoria Hospital, London, Ontario but Upjohn withdrew their research funding and so I had to seek alternative employment. I went instead to a Fellowship at The University of Western Ontario (UWO) in London.[13]

When Charles Sprung later devised and led an international multicentric study on Hydrocortisone Therapy for Patients with Septic Shock (CORTICUS) I was pleased to be a contributing investigator.[14]

A final PS that I forgot to add is that my notoriety in the adrenal insufficiency arena got me tasked with a Working Party on the topic back in 2012. We did not achieve a publishable consensus until 2020.15 I thought it might be impossible. Anaesthetists in the UK severely underestimate the dangers of poor & inconsistent management in critical care. Many accused us of overstating the danger, while the endocrinologists were dismayed at the lack of commitment to do better.


Co-Published on Osler on May 18th, 2023

[1] J Crit Care 2023 Apr 29. 77:154317. 10.1016/j.jcrc.2023.154317

[2] I asked the distinguished visitor where the best intensive care unit in the world was; The Vic, in London Ontario was his confident answer. Iain agreed. And so I later went on to spend a year in that welcoming town, and met William (Bill) Sibbald).

[3] PMID: 7048991

[4] In Glaswegian, a piece is a toasted slice of bread split into two thin slices. The usual filling was a tiny spread of scrambled egg.


[6] Dazoxiben almost completely blocked the synthesis of thromboxane A2, but there was no discernable change in the patients shock state.

[7] Lancet 1982 Jun 19. 1:1414-5. 10.1016/s0140-6736(82)92531-4

[8] Lancet 1983 Feb 26. 1:484. 10.1016/s0140-6736(83)91489-7

[9] Humour was important in Glasgow at that time, as a young Billy Connolly was making national headlines as an outstanding comedian. I was told that Winifred was the daughter of Scotland’s most famous comedian Alec Finlay.

[10] We each had a Home Office License to conduct terminal animal experiments under anaesthesia. An Inspector called from time to time to ensure our work was humane.

[11] It is an under appreciated fact that much of the post haemorrhagic shock fatality occurs during resuscitation.

[12] N Engl J Med 1984 Nov 01. 311:1137-43. 10.1056/NEJM198411013111801

[13]  I became the first researcher to report measurements of cerebral blood flow and cerebral metabolic rate for oxygen during cardiac surgery with induced hypothermia on cardiopulmonary bypass. I was allowed to spend occasional days at the Vic when my contractual commitments at UWO allowed.

[14] N Engl J Med 2008; 358:111-124 DOI: 10.1056/NEJMoa071366

15Anaesthesia 2020 May. 75:654-663. 10.1111/anae.14963

Venous Congestion Spanish Style: Dr. Curro Miralles-Aguiar! #FOAMED, #FOAMCC, #VEXUS

So I’ve been meaning to put this up for a while, along with many other #FOAMed lectures I want to share and get out there in our neverending quest to cut down on the KT on bedside physiological management. For years now I have enjoyed collaborating with my friend Curro Miralles, who is a fantastic clinician on top of being the latin leading man heir apparent to Antonio Banderas who somehow ended up as a physician instead. Well, medicine should be greateful! Enjoy!

VExUS Demystified: Hangin’ with Korbin & Rory.

It’s always a good time hanging with these guys (@khaycock2 and @Emnerd). Over the years I’ve learned a ton from them. Even if I thought I was pretty solid on something, they almost always have the ability to shed some additional light on it in a particularly useful way. So I always look forward to these discussions. Today we took some time to flesh out some of the questions and statements that came up about VExUS in the last few days on medtwitter.

Hope you all enjoy!

HR2022 Lectures: Casey & Neha on Neuro-Emergencies. #FOAMed

So I’m finally getting around to listening to the #HR2022 lectures I hadn’t had a chance to prior to the conference – it gets busy – that so many are raving about, and this was a really good one. This dynamic NeuroCrit duo hit on a lot of really important principles, including one of my favorite myths, that of neuroprognosticating based on an ICH score. It truly is disenheartening to see, in my experience, how few neurosurgeons either acknowledge or are aware of this, and, particularly in young patients, the self-fulfilling prophecy concept could be making us miss opportunities to save lives.

Anyway, I won’t steal their thunder, so have a listen!

I’ll be releasing select HR2022 lectures every few weeks, and for those interested amazing lectures and in CME, you can find the rest here:



The Return of The Hospitalist & The Resuscitationist: Face2Face (masked faces!) for 2022!

So after much deliberation, we have decided and are excited to bring the fourth edition of H&R back for 2022 – we had skipped 2021 to focus on some research papers and developing some courses (Flipping the Vent and The VExUS Course), but mostly because the virtual conferencing experience simply did not measure up to the live event. What makes boutique conferences like H&R so different (and awesome) is the similar mind-set of the faculty and the participants, the opportunity to interact and network, exchange and build. So much of what many of us have achieved in the last years was built on introductions, discussions and conceptual sparks that have led to publications, projects and most importantly, personal growth. Because at the heart of it, the H&R faculty – and I daresay the majority of the participants – is made up of individuals who are never satisfied with the status quo, and who are always looking to add to their knowledge and skills. It is incredibly stimulating to be surrounded by these people, and it is a growing family.

So due to the limitations and uncertainties of the very much active pandemic, there remain some question marks. One thing, however, that is without a doubt, is that we will put together some amazing content in a unique, hybrid format that will have everyone leave with a few more concepts and skills.

Where & When? Montreal, May 19th-21st, 2022, at the Montreal Heart Institute Conference Center (19th-20th) and Santa Cabrini Hospital (21st)!

Scientific Committee: Dr. Ross Prager, Dr. Carol Zambrana, Dr. Philippe St-Arnaud, Dr. Ian Ajmo, Dr. Philippe Rola, Dr. Andre Denault.

Credit Designation: This event was accreditated for a maximum of 60.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Here’s how it’s gonna go:

Pre- and Post- conference courses will include

(1) The VExUS Course (F2F/Virtual)

(2) The Resuscitative TEE Workshop (May 21 – F2F Only)

(3) POCUS for the Hospitalist (May 18 – F2F Only)

(4) The REBOA Course

H&R Main Conference – will be divided into an online didactic set of lectures (two days worth!) divided into topic tracks such as cardiac arrest, POCUS, advanced hemodynamics, critical care pearls, airway management, sepsis, mechanical ventilation as well as a number of hospitalist tracks (POCUS for the Hospitalist, Spotlight on Nephro, COVID on the Wards, Surgical Issues for the Hospitalist and Hospitalist Pearls) and two live F2F conference days. Live participants will be strongly encouraged to watch the online lectures prior to coming to the F2F conference, which will consist of workshops (60% of the day) and “Long Conversations” (40% of the day) with 2-3 faculty members discussing various topics with the participants. Essentially the F2F conference will be 100% interactive, as the long conversations are meant to address the topics that don’t lend themselves well to, or require hands-on workshops (eg sepsis and complex hemodynamics). In a sense, this is letting the participants into what the most interesting part of past H&Rs has really been – the unscripted faculty behind-the-scenes discussions. I can say that for my part I always learned a tremendous amount in those moments, and always felt it would be fantastic to find a way to share these.

The Online Pre-Conference Programme:

The Live Conference Programme:

Why the Flipped Classroom?

The idea is to maximize the discussion and the workshops, all of whom will be tailored to the different tracks (POCUS, hemodynamics, airway, etc…), so that the participants really get a chance to extract the pearls from the faculty in those two days. Essentially, participants will get double the conference, without having to free up 4 calendar days (unless you plan to attend some of the courses)


Sadly, we are forced to limit the live participants to 80, in order to maintain social distancing for the Long Conversations. The pre- and post- conferences will also have limited participants. Also, in case there is a major wave obliterating travel and hosting capabilities, registrants will only be asked to pay a portion of the total fee in case it must be downgraded to a virtual-only event, so as to avoid the hassle and cost of refunds (we still have nightmares of the 2020 cancellation!). If all goes well the remainder of the live registration cost will be required 4 weeks prior to the event. So the F2F participants will have two sequential tickets to purchase. If you are only going for a virtual conference, there is only one ticket. You will be able to remotely watch the Long Conversations but not participate. Same concept for The VExUS Course, but the POCUS for Hospitalist and Resus TEE Workshop will be all or none for obvious reasons, fingers crossed. PLEASE NOTE THAT PRIORITY FOR COURSES IS GIVEN TO THE FULL CONFERENCE REGISTRANTS!

The Tickets/Prices:

  1. Main Conference F2F (May 19-20)- 1049+tx for physicians (849$+tx for CIUSSS EMTL, ICM Physicians, CISSS Laurentides and RLA Fellows): These are limited to 80 participants. This will give you access to the HR2022 Lectures on May 1st to watch on your own time prior to the live event.
  2. Main Conference Online Only High Income Countries (HIC) – (299$+tx): This will give access to the HR2022 Lectures on May 1st, as well as online access to some of the live material on May 19-20.
  3. Main Conference Online Special Rate (for trainees, allied health and physicians from low and middle income countries – 99$+tx): This will give access to the HR2022 Lectures on May 1st, as well as online access to some of the live material on May 19-20.
  4. The VExUS Course Live (May 21 half-day AM – $399+tx): only 40 spots, reserve yours by emailing, tickets available April 15th.
  5. POCUS for Hospitalists (May 21 full day – 399+tx): only 40 spots, reserve yours by emailing, tickets available April 15th.
  6. The ResusTEE Workshop: please see for information and registration.
  7. The REBOA Course (May 21 half day AM or PM – 349$+tx)- only 30 participants, 15 in AM session and 15 in PM session.

ps we want people to learn – if you have special circumstances, are from very limited resource areas, email and we’ll help you out!


So, more details to come in the next days, with the programme and the faculty, but this is what we have in mind, and we think it will be outstanding, so please wear masks, get your boosters (of course all faculty and participants will require proof of vaccination) and encourage everyone around you to do so in order to make this event and countless others happen!

Program & Faculty

Really excited about the preliminary programme that is growing day by day. Participants will get to see familiar faces and amazing educators such as grandmaster Andre Denault, Kylie Baker (@kyliebaker888) Korbin Haycock (@khaycock2), Rory Spiegel (@EMNerd), Peter Weimersheimer (@VTEMSONO), Felipe Teran (@FTeranMD), Lissa Ajjamada, Marco Garrone (@drmarcogarrone), Robert Chen (@ottawaheartrob), Scott Weingart (EMCrit himself!), Haney Mallemat (@criticalcarenow), Matt Siuba (@msiuba), Joe Nemeth, but also really excited to add some new faces like Katie Wiskar (@katiewiskar), Eduardo Argaiz (@ArgaizR), Neha Dangayach (@drdangayach), Abhilash Khoratala (@NephroP), Renee Dversdal (@DRsonosRD), Ashley Miller (@ICMteaching) and on top of it all, some critical care legends such as Glenn Hernandez (@AndromedaShock), Jan Bakker and Sheldon Magder…and more to come, got my fingers crossed!


Philippe & The H&R Team

…and a big thanks to our sponsors!

VExUS Pearls Q&A

So we had a blast with the VExUS Course a few weeks ago, it was really great to see how much enthusiasm and actual clinical use it is getting all over the world. Humbled, grateful and certainly feeling like the hard work was worth it to have this impact. So even after the workshop, there was a lot of questions, and some take more than a few lines to dig into, and since one participant, Dr. Rajiv Sinanan, a nephrologist, was so organized in his case questions, including a powerpoint with cases, I thought it was worth sharing. My life being busy and chaotic, I unfortunately had to do this on the way to work, so apologies for the audio and video quality! But I think there are some good pearls in there for those starting to use VExUS out there!

For those of you interested in learning more, we are hoping to soon have the ability to hold an in-person workshop, so we do not yet know when the next VExUS Course will be offered, but the online material is available here, and the cost of the online material + later workshop is the same as the full course. Going thru the material and getting some practice in may also help you by providing you with cases to discuss during the workshop.

cheers and scan on!


Emergency Late Breaker! Flipping the Vent: The APRV-TCAV(TM) Course, September 23rd, 2021, 1200-1500 EST.

While the last few months had quieted down, the last few weeks have seen a serious resurgence in COVID cases, particularly in the southern US and in south and southeast Asia. I cam across several really disturbing posts and tweets across medical SoMe about the lack of ECMO beds and cases of refractory hypoxia.

While TCAV(TM) will not save every COVID ARDS patient, in our experience it helps significantly, ideally from the get-go, but also in rescue after failure of traditional modes.

This is why we decided to add this date – sooner than planned – as it seems it may have clinical impact in the current pandemic.

I offered to share in a #FAOMed fashion the online portion of this course with anyone interested and currently struggling with COVID ARDS, but as a faculty we all feel that it is only a basic introduction, and that two other elements are ideally needed, the workshop (included in this course) and some case mentoring for the first few cases, which we are working on.

As in the previous two iterations of this course, we are strongly favouring teams, as the biggest practical hurdle is getting team buy-in, but will also accept individuals. For more information, testimonials and for the schedule please refer to the last course’s page:

Registration fee will be waived for physicians from low-resource settings, please explain this in the email to to obtain the registration link. Registration will be stretched to 30 participants in order to maintain a good level of interaction during the workshop.

To register: email hospresusconference@thinkingcriticalcare

See you there, stay safe!


THE VExUS Course. Period.

So it is with gradual amazement and a great sense of accomplishment that we have witnessed the remarkable interest that our field of acute care has taken in VExUS. This has also been tempered by the humility of experience, as all of us have seen fads come and go, and also because an interventional approach based on VExUS is not yet evidence-based, as the studies remain to be done, some being underway. At the same time, it has been a good 4-5 years that most of those involved in the VExUS papers have been using Doppler-enhanced POCUS assessment of venous congestion. Our pragmatic and empiric experience has solidified in our minds the importance of venous congestion and the pitfalls in being oblivious to it. At the same time, we have some reservations about seeing it be used in a recipe form, with a “VExUS-furosemide reflex” which would NOT be how a bedside physiology tool should be used.

Hence, we decided to put this together, to be much more than a “how-to” – which to us has the risk of giving a tool without good instructions – but to be comprehensive in it scope, to take participants from pathophysiology thru ultrasound assessment and finally potential clinical application.

After the success of The APRV-TCAV(tm) Course, we have decided to follow the blueprint and make this a 6 hour, two part course, with a didactic online portion which participants are asked to complete prior to the live workshop, where we will present and discuss cases and the nuts and bolts of clinical management integrating VExUS to the global clinical assessment, POCUS and otherwise, which is how it should be used.

The idea is to come out of this with a solid understanding of venous congestion, the various means to assess it, and a clinical framework to implement into the management of these patients on a daily basis.

The Pilot Course (virtual): September 21, 2021, 1pm eastern time.

The first one, to work out the kinks, will have a token registration fee and limited to 40 participants. If you are a trainee or from a resource-limited area please let us know, we are reserving some complimentary spots. Registration will open at the end of July, so email to be considered for a spot! Please include a short description of your practice to be considered for a spot. We are favouring acute care clinicians with POCUS experience as this is not a basic POCUS skill, and we want participants to be able to start using VExUS following the course.

Due to current travel restrictions and the uncertainty related to quarantine, this event will be virtual. We anticipate that further events will likely be live, and this course will likely be given during BeachResus and H&R2022.

The Faculty

Dr. Korbin Haycock (@khaycock2) – Riveside Health & Loma Linda University, CA, USA.

Dr. Rory Spiegel (@EMNerd) – Washington Medical Center, DC.

Dr. Philippe Rola (@ThinkingCC) – Santa Cabrini Hospital-CIUSSS-EMTL, Montreal, QC.

All three of us were part of the original VExUS study and have continued to expand the literature on the topic. We use POCUS and assess venous congestion on a daily basis. We have all been teaching via #FOAMed and live conferences for several years. We’re looking forward to share our experience with each participant.

Some VExUS references: