👨🏻⚕️ Anaesthesia, Resuscitation and Pain Management 🏥 Personal views 🌈 I write sometimes...✒️
Santa Cruz de Tenerife, España
Joined June 2021
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Rubén retweeted
Continuing #GLP1 or GIP agonists before upper endoscopy increased the risk of clinically significant residual gastric volume, with no additional aspiration events ja.ma/4njbfTj
Rubén retweeted
In loving memory of @AlbertoCalleMd . 🤍🩵
Dr Alberto was an Ecuadorian IMG and anesthesiology resident in the United States 🇺🇸. He worked incredibly hard to follow this path. Even while facing stomach cancer, he studied for the USMLE, earned his certification, matched into anesthesiology, and became a senior resident.
When his illness required him to take time away from residency, he faced uncertainty about his visa. He reached out to me on WhatsApp and @ProjectImg advocated for Alberto and supported his efforts with @ECFMG_J1 to continue his training.
We were grateful to know him and stand beside him. 🙏
Our hearts are with his family, friends, and everyone who loved him. We will remember his smile, his love of music, and the dedication with which he pursued his dream.
We will miss you, Alberto. Rest in peace. 🤍🩵 🇪🇨
Rubén retweeted
Muchas sedes de Residencia Médica dan tristeza…
donde se promueve el “siempre se ha hecho así” y “en mis tiempos era diferente”;
donde se aprende por costumbre (mala, muchas veces) y no por Medicina Basada en Evidencias
donde no se fomenta la Medicina Basada en Competencias
donde no se prioriza que el Residente aprenda pero sí que saque la chamba y los pendientes
donde con lo que menos se enseña, es con el ejemplo…
Los invitamos a leer nuestra más reciente publicación, con muchas estrategias de mejora, con la participación de Maestros en Ciencias de la Educación y Profesores Titulares de Especialidad en Medicina Crítica, Urgencias, Medicina Interna y Anestesiología: nthe.mx/detallesrev.php?id=8…
@E_DeloyaMD @Mermaid_MD @Fermin_UCI @Vader_CC
médicos prefieren mantener prácticas empíricas o basadas en opiniones. La falta de conocimientos en investigación clínica y la carencia de Educación Médica Continua son barreras que impiden que muchos médicos transfieran estas prácticas a los residentes durante su formación."
Rubén retweeted
Si subirle el alquiler a una persona de 87 años de 500 a 2600 euros no es violencia yo no sé qué es violencia.
Rubén retweeted
Don’t confuse guidelines with gold standards.
How strong is the evidence behind the Surviving Sepsis Campaign?
In our new paper, we analyzed more than two decades of SSC guidelines, including 554 statements across seven publications.
The result is striking.
From 2008 to 2026, the proportion of recommendations supported by high-certainty evidence fell from 15.8% to 2.3%, while strong recommendations decreased from 69.7% to 18.0%.
Perhaps even more importantly, in the 2026 guideline, one-third of strong recommendations are still supported by low- or very-low-certainty of evidence. This means we should be very careful about confusing guideline recommendations, implementation priorities, and certainty of evidence.
Guidelines should support clinical judgment — not replace it.
Happy to see this work published in the Journal of Critical Care.
sciencedirect.com/science/ar…
Rubén retweeted
Consell abans d'anar a dormir: Si vols fer una cosa i pots, fes-la sense dependre de ningú. Si vols anar a un concert, hi vas. Si vols anar al teatre, hi vas. Si vols viatjar, ho fas. Així amb tot. Sempre defensaré la gent que vol fer un pla i no té dependència a algú per fer-ho.
Rubén retweeted
A massive new meta-analysis @Nature of 67 datasets and over 8,000 people found that moving 🏃🏾♀️more in daily life is consistently linked to feeling more energetic, positive, and generally good.
Interestingly, #physicalactivity was tied to feeling more energetic and positive but less calm, while it showed no reliable link to negative emotions like sadness or anxiety.
The effects were comparable to other daily activities like listening to music, and they varied between people with older adults and those with higher BMI showing weaker positive emotional responses to activity.
Movement and #mood appear to reinforce each other in everyday life, and understanding this loop could help shape more personalized health strategies.
nature.com/articles/s41562-0…
Rubén retweeted
What makes a meta-analysis believable?
In our latest issue, a new Viewpoint outlines how to identify meta-analyses that merit clinical confidence.
Explore the full issue: spkl.io/60197rxth
ALT Cover of The Lancet September 19, 2026 issue. Quote reads: Meta-analyses are not definitive truths, but rather structured efforts to interpret incomplete, evolving, and sometimes inconsistent evidence.
Rubén retweeted
Ischemic limbs during vasopressor-treated shock are often blamed on drug dose. This review reframes SPG as thromboinflammatory microvascular thrombosis—typically with DIC and shock liver. #ProtectiveHemodynamics #CriticalCare
Rubén retweeted
⚖️ Individualise the dose with ESP blocks. Large volumes and rapid systemic uptake can push plasma concentrations toward toxic thresholds, especially with bilateral blocks or catheters. Never add volume to fix poor placement.
Read more: bjaed.org/article/S2058-5349…
#PatientSafety
Rubén retweeted
Pues ni Dinamarca 🇩🇰 se salva…
los pacientes Intubados y bajo Ventilación Mecánica con menos recursos (pobres y con menor educación) tienen ~50% más mortalidad comparado con los de altos recursos…
doi.org/10.1016/j.chstcc.202…
Rubén retweeted
I’m so tired of these hopelessly confounded mimic-iv observational studies.
Yes sicker patients require CRRT earlier and have a higher risk of death. That’s a latent confounder not causative. That’s why every RCT of CRRT timing has found no effect. (Acknowledged in sentence 2)
🥼New in #SepsisAndSevereInfection:
Overlap-weighted retrospective cohort study of early versus delayed renal replacement therapy in sepsis-associated AKI
doi.org/rn2v
#CritCare #Sepsis #SevereInfection #RRT
Rubén retweeted
HPI may reduce hypotension, but the trials tell a harder story: more treatment, not clearly better treatment. So far, no trial has shown a convincing patient-centered benefit. Hypotension is a marker, not a treatment target in itself. #Hemodynamics
Rubén retweeted
Today at 3 p.m, don't miss the #VallHebronTalks by #VHIR with Prof. Jesús Francisco Bermejo Martín (@usal). He will present 'Revisiting the old paradigms in sepsis: from "phases" to "patients"'. #WorldSepsisDay
Follow it online: gencat.zoom.us/j/88449511660
Rubén retweeted
Perioperative optimization is not only physical. In 306 older surgical patients, integrated psychological care + medication optimization improved depression/anxiety at 3 months. Effects differed across cardiac, oncologic and orthopedic pathways. #PerioperativeMedicine
Rubén retweeted
El tiempo hasta la atención por el equipo de hospitalización en pacientes que permanecen en Urgencias tras decidirse el ingreso debe ser una variable de calidad asistencial a monitorizar. jamanetwork.com/journals/jam…
Rubén retweeted
La unidad de Cirugía Torácica del Hospital La Candelaria supera las 300 intervenciones quirúrgicas anuales para mejorar la salud pulmonar.
Sus profesionales realizan abordajes mínimamente invasivos de vanguardia, como la videotoracoscopia avanzada o la cirugía robótica.
(Va🧵)
Rubén retweeted
🔍 Common pitfall in the ESP block: mistaking the rib for the transverse process. This month’s #BJAEd article walks you from rib to costotransverse junction to transverse process. Sequential identification improves accuracy.
👉🏻 Read more: bjaed.org/article/S2058-5349…
#POCUS #FOAMed
Rubén retweeted
we briefly presented 5 of these RCTs at the monthly Journal club this morning
no vitamin C (in burn injury)!
no restrictive oxygen after cardiac arrest
(no) bicarbonate in metabolic acidosis
yes bicarbonate for in-hospital cardiac arrest
yes early vasopressors in septic shock
#CCR26 is over!
12 outstanding RCTs presented!
😍Save and share this figure to keep a concise overview of the key information!
🎨 Color coding reflects my personal overall interpretation:
🟢 Benefit
⚪ No difference
🔴 Harm
Few practice-changing results but plenty to discuss!
