@JohnsHopkinsDOM Hospitalist/Proceduralist; #IMPOCUS #EdTech #Simulation #LearningAnalytics #AI CCEeXAM testamur

Baltimore, MD
Joined May 2015
Great case, difficult question: Large RP bleed. Abdomen is rock hard. Ppeak on APV 60 (left pic). Diagnosis? Abd compartment sd. Treatment? Decompressive laparotomy. See Ppeak at 41 on the right after decompression. Something on the pics doesnt fit this scenario. What is it?
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Dynamic LVOTO for the Intensivist: bedside diagnosis, management, and all the nuances including when RV failure is driving it!
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New on pulmonarypocus.com: a live Hepatic Vein Doppler Lab 🫀 Watch ECG, CVP and hepatic vein PW Doppler move together as you change RA pressure, TR and rhythm. S > D, S < D, a + S reversal, AF, plus an estimated VExUS grade. Free, no login: pulmonarypocus.com → Doppler Lab pulmonarypocus.com/cvp-hv #POCUS #VExUS #MedEd #FOAMed #CriticalCare
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Praxis is live. If you’re looking for the H&R26 recordings (and past HRs), this is now their home. But Praxis is becoming much more than an archive: interactive clinical cases, AI Coaches, curated newsletters, live discussions, courses and 1-on-1 or group teaching from an international faculty — built around physiology, POCUS and how we actually reason at the bedside. For Critical Care, Internal Medicine, Emergency Medicine, Anesthesia — and essentially anyone who takes care of sick patients. praxis-project.com #CriticalCare #InternalMedicine #POCUS #Hemodynamics #Anesthesia Ping @TheEMNerd @icmteaching @khaycock2 @FTeranMD @emcrit @PulmCrit @jsemccm @TrinaAugustinMD @katiewiskar @G2Disrupt @Francofoam1 @ArgaizR @NephroP @heart_lung @FH_Verbrugge @IM_Crit_ @edu_kattan @AndromedaShock @TaweevatA @SaraCrager @chatterJ5 @emireles_c @intensivaev
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Opus 5.5 turned my article into a 24s video, and no video model made a single frame one little voxel guy walks through six rooms. every room is a real step of the workflow: > the reference desk “show it, don’t describe it” Claude reads the clip I love: a cut every 2 bars, drop squash settle > the data room “check the number first” the chart comes with its query. bar_3 said 15, the weekend rows were wrong, so it’s 9 > the edit room “write the story first” hook, proof, and holes left for the clips > the motion room “animation is code” Remotion springs, sequences, real values. same input, same output > direct it in words “the bars feel stiff. draw them slower.” linear easeOutBack. a one-line edit, not a re-roll assemble & ship “compiled, not generated” remotion render ffmpeg final.mp4, embedded in the doc, the deck and the short you’re not generating video anymore. you’re compiling it the full studio setup is in the article
most people use Claude to write a smaller group figured out how to turn it into an AI production studio. dashboards, motion graphics, open-source skills, and a full workflow to create exportable videos. one Claude stack. all in here
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We have spent decades drawing a pressure gradient from mean systemic pressure (Pms) to right atrial pressure (RAP) and calling it the driver of venous return. Write the equivalent equation on the arterial side and the same logic says Pms is a back pressure that reduces cardiac output. It can’t be both. The Pressure–Volume State Part 2 is now live. thedependentvariable.com/p/f…
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Can VExUS estimate CVP in ventilated children? A new prospective PICU study looked at 56 mechanically ventilated children with simultaneous invasive CVP and ultrasound of the IVC, hepatic, portal and intrarenal veins. The conventional categorical 0–3 VExUS-style score was only moderately good at identifying CVP >12 mmHg: • AUROC 0.74 • Sensitivity 45% • Specificity 98% They also tested a more granular 0–7 score: • Abnormal IVC = 1 point • Hepatic vein = 0–2 • Portal vein = 0–2 • Intrarenal vein = 0–2 This performed much better: • AUROC 0.94 • Sensitivity 82% • Specificity 91% Intrarenal venous Doppler alone had an AUROC of 0.92. The 0–7 score is not yet an established standard. It was proposed and tested in this paediatric study, although a very similar “extended VExUS” approach has also appeared in recent adult work. The useful physiological message is that a more graded description of venous waveform abnormalities may track RAP/CVP better than the usual coarse categorical system. And the bigger point remains: VExUS is principally a readout of the venous pressure/pulsatility environment, not a volume meter. Same CVP does not always mean the same waveform: intrathoracic pressure, abdominal pressure, tricuspid regurgitation, venous compliance and local tissue pressure all modify transmission. Carioca F de L, Franzon NH, Krzesinski LDS, et al. Pediatric Venous Excess Ultrasound Score (P-VExUS): a novel approach to assess central venous pressure in the PICU. Eur J Pediatr. 2026;185(11):855. doi.org/10.1007/s00431-026-0… Interested to hear the thoughts of @ThinkingCC @khaycock2 @NephroP @ross_prager
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𝗠𝗖𝗣 𝘃𝘀 𝗦𝗸𝗶𝗹𝗹𝘀. 𝗠𝗖𝗣 𝗶𝘀 𝘁𝗵𝗲 𝗰𝗼𝗻𝗻𝗲𝗰𝘁𝗶𝗼𝗻 𝗹𝗮𝘆𝗲𝗿. It gives AI systems a standard way to connect to external systems and capabilities. MCP servers expose tools that the model can discover and invoke, whether that’s querying a database, calling an API, or taking action in another system. Instead of building one-off integrations, MCP gives agents a consistent interface for accessing those capabilities. 𝗦𝗸𝗶𝗹𝗹𝘀 𝗮𝗿𝗲 𝗿𝗲𝘂𝘀𝗮𝗯𝗹𝗲 𝗽𝗹𝗮𝘆𝗯𝗼𝗼𝗸𝘀 for how an agent should perform a task. A Skill packages instructions in a SKILL. md file, alongside optional scripts, references, and other resources. Rather than adding another service or integration, Skills run within the agent’s existing environment and give it task-specific procedures, conventions, and know-how it can load when needed. MCP gives agents reach. Skills give them know-how. Together, they’re part of a broader shift toward AI taking a more active role in engineering work. But building capable AI systems involves more than connecting tools and defining instructions. Developers also need to understand how to work with data, implement retrieval, give AI models the right context, and more. MongoDB's AI Learning Hub helps you build these skills through free, self-paced learning tracks, hands-on tutorials, and practical resources 𝗦𝘁𝗮𝗿𝘁 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴 𝗳𝗼𝗿 𝗳𝗿𝗲𝗲 → lucode.co/ai-learning-hub-mo… Start building AI apps with MongoDB Atlas → lucode.co/mongodb-atlas-z75x… What else would you add? —— ♻️ Repost to help others learn AI. 🙏 Thanks to @MongoDB for sponsoring this post. ➕ Follow me ( Nikki Siapno ) to improve at AI and system design.
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Gigi Liu retweeted
Holy sh*t, Opus 5.5 just f*cking killed the jobs of all motion designers It's f*cking insane… Drop the PDF below into Opus 5.5, thank me later Then read the full guide on Motion Engineering with Opus 5.5 in the article below ↓
Opus 5.5 can run a whole motion design studio Sell a 20-second launch clip built from real product screens Copy the motion engineering prompts and delivery process Build your offer before the next product launch ↓
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Gigi Liu retweeted
Anthropic's biology generator builds a model, then builds the three models that would look identical but mean something different Most generators hand you one structure and stop, so a shape that fits the data and a shape that fits it by accident look exactly the same on screen. This one never ships a single answer, it generates every structure the evidence permits and makes you see how many there were: > Enumerate: it builds all conformations consistent with the measurements > Separate: the ones that differ only in detail get collapsed into one family > Present: each surviving family renders side by side, with what distinguishes it • Why one model was always a lie > A single render implies the data narrowed it down to one answer > Most measurements leave four or five shapes equally alive > The published figure is usually just the one the software happened to output • What this exposes in practice > A binding pocket that's open in two families and sealed in the other three > Two structures that behave identically until the pH changes > A conformation nobody had drawn, sitting in the data the whole time • How a family gets eliminated > The system names the one experiment that would rule each family out > A new measurement collapses the set, visibly, instead of silently > A family with no disqualifying experiment is flagged as untestable A full enumeration runs in about eight minutes from the same input. And the part that broke my brain: The paper's figure showed one confident structure built from this exact data. The generator found five that fit the same measurements just as well. Same evidence. One version made a choice and never mentioned it. The hard part was never generating a structure. It was counting the ones you quietly discarded ↓
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This is f**king gold. Everyone saw the new Tesla Roadster hang upside down last week, and almost nobody knows what keeps it up there. So Opus 5.5 rebuilt it as a machine you can run, and wrote this whole video as code. > take it apart down to the 800-1,000 V pack and the two rear motors > launch it: 0-60 in 0.81 s on 4 cold-gas thrusters, 690 bar draining live > send it up the inverted ramp: 2 floor fans hold all 1,700 kg on the ceiling > switch the fans off and let it break: it falls at 143° > every frame is rendered from code, and the beat hits on the launch, the flip and the crash It took one free skill and no editor. The skill and the playable Roadster are in the reply, the full method is in the article I'm quoting 👇
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🚨PEOPLE ARE USING NOTEBOOKLM TO MASS-PRODUCE SPECIALIZED CLAUDE SKILLS IN MINUTES. Instead of writing the same prompts repeatedly, they use curated knowledge to create reusable "SKILL▪︎md" files that help Claude deliver consistent results for specific tasks. Here's how it works 👇👇
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New on pulmonarypocus.com: 🔊 Doppler Lab: pulmonarypocus.com/new-page-… 🫀 Echo Sim (TTE & TEE): pulmonarypocus.com/tte-tee-s… 📈 Hemodynamic Lab: pulmonarypocus.com/hemodynam… Free to use. Feedback welcome reply here otr email [email protected] #POCUS #MedEd #FOAMed @NephroP @PulmCrit
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Gigi Liu retweeted
I seriously don't understand why schools don't use this yet. I've been working on the same idea with Claude! A skill that builds everyday machines you can take apart and play with. Just built a mechanical watch and added it to the site last night. You can wind it, flip it open and watch the little wheel inside tick 8 times a second, 691,200 times a day. Try it yourself, link in the first reply 👇
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Gigi Liu retweeted
Great discussion by Dr. Grace C Wright, MD, PhD followed by USSONAR presentation by Dr. Mark Matza, MD, RhMSUS! Thank you to Sanofi for sponsoring this #webinar program. #MSUS #PMR #IL6 #ultrasound #POCUS #Rheumatology #rheumatoidarthritis #vasculitis
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A 79-year-old man receiving volume-controlled mechanical ventilation for pneumonia developed sudden oxygen desaturation. The ventilator waveforms clearly demonstrated a significant air leak. However, it also showed technical error in expiratory cassette.
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Gigi Liu retweeted
Come meet @NephroP and the best #POCUS faculty nationwide! Try the latest #Ultrasound machines and #handheldultrasound devices! 3 different courses: Adult Basics, #PedsPOCUS, or Advanced Cardiac. Join us Jan 16-17, 2027, in Austin, TX! pocussa.org
It’s that time of the year again! One of the most well-organized #POCUS courses for internal medicine, pediatrics and subspecialties by @nilamjsoni & team is just around the corner! Register now! This course fulfills one of the program requirements for the SHM POCUS Certificate of Completion. There’s also an advanced cardiac ultrasound course that includes #VExUS! 🙌
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Quick walk-through of echosuite.app This is on desktop, but the UI will automatically adapt to your smartphone as well
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Hospitalization for alcohol withdrawal is a critical opportunity to treat alcohol use disorder—not just manage withdrawal 🔗: doi.org/10.1002/jhm.70201 ✍️: Eden Y Bernstein MD, MPH et al 🖼️: #VisualAbstract @kovalenkojul #SHM #JHM #alcoholusedisorder #addictionmedicine
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