What is the 4-step cricothyrotomy method? This method uses... 4 steps: Scalpel-finger-bougie-tube 1. Scalpel to the cricothyroid membrane 2. Finger insertion into the trachea with downward traction 3. Insertion of a bougie into the track with the finger it in feeling for the tracheal rings 4. Insertion of the tube over the bougie It is a simplified method for performing the procedure that eliminates steps such as the use of trach hook. While this procedure was popularized by the US military through the Tactical Combat Casualty Care guidelines, it has been described for many years before the recent wars in Iraq and Afghanistan. There's obviously no RCT data on this method in humans, but cadaver, mannequin, and case series data demonstrate reliability and efficiency. PMID: 9950380, 8922017, 9774928 #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #trauma #airway #military #tccc #navy #airforce #marines #medx #medtwittershow more

Essential microskill for airway assistants! When intubating over a... bougie, the bougie is placed into the trachea and the assistant places the tube over the bougie Because bougies are straight and tracheal tubes have a curve, there is a tendency for the bougie to hit against the inside of the 15 mm connector on the end of the tube An essential microskill for airway assistants is to gently straighten the tube so the bougie goes through the connector rather than hitting against it (Video best with sound on)show more

"Don't give nitrates to right-sided 🫀myocardial infarctions" This is... a myth that continues to get taught due to the theory that right-sided MIs are sensitive to preload, which nitrates reduce. A recent systematic review (n=1113) failed to substantiate this purported risk. #emergency #emergencymedicine #foam #foamed #foamcc #army #armymedicine #armyemdoc #meded #icu #criticalcare #meded #science #research #data #medx #medtwittershow more

ED boarding is when a patient is admitted but... physically remains in the ED. Unlike the floors or ICUs, there is no "capacity" in the ED. While nursing ratio recommendations exist, there is no method to enforce it given the nature of EM workflow. Is ED boarding really as big of a deal as he says? The short answer is: yes. My record for ED LOS exceeds a month, and the worst nursing ratios were 13 patients per nurse. The latter was in early COVID. One systematic review included 7 studies and over 75,000 patients. Here’s the gist of what they found: -higher rates of missing treatment interventions (9%) -higher rates of missing home medications (18%) -higher rates of missing lab studies (3%) -higher odds of orders not being filled on time (OR 1.84, 1.46-2.30) -higher odds of orders not being filled altogether (OR 2.58, 1.94-3.42 -higher odds of delirium in the elderly (OR 2.23, 1.13-4.41) -higher odds of drug-related adverse events (OR 1.04, 1.01-1.08) Another systematic review included 13 studies and focused on the elderly. Here’s the gist of what they found: -increased odds of death at 6 months (2.18, 1.10-4.31) #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #medx #medtwittershow more

Cuff mediated airway alignement 🎥👇🏼 Paediatric nasal intubation, tube... 4.5 RAE. McGrath VL. Tube impingement on arytenoids, easily fixed by airway alignment. An “old airway trick revisited” Cuff-mediated airway alignment is an advanced intubation technique where the cuff of a tracheal tube (TT) is temporarily inflated to mechanically adjust and center the tube tip with the glottic opening. This maneuver is primarily utilized during difficult intubations—such as when utilizing a videolaryngoscope in patients with restricted mouth opening or an anteriorly positioned larynx—to lift the tube off the posterior pharyngeal wall and direct it smoothly into the trachea. How the Procedure Works: The technique relies on a structured, step-by-step sequence to prevent tissue trauma: [1] Initial Advancement: The clinician advances the TT into the oropharynx using visual guidance from a device like the C-MAC Videolaryngoscope. [1, 2, 3] Cuff Inflation: If the tube tip hinges on local anatomy or misaligns with the glottis, air is gradually introduced into the cuff. Alignment: As the cuff expands against the surrounding pharyngeal structures, it physically pushes and centers the tube shaft, aligning the TT tip directly with the laryngeal inlet. Deflation and Passage: Once optimal alignment is achieved, the cuff is completely deflated so the tip can safely pass through the vocal cords without causing mucosal tearing or laryngeal injury. Final Positioning: The tube is advanced to its proper tracheal depth, and the cuff is re-inflated to establish a definitive ventilatory seal. Clinical Advantages: Navigates Difficult Anatomy: It overcomes "extreme anterior" laryngeal positioning where standard stylets or maneuvers fail to center the tube. Reduces Posterior Hinging: It stops the ETT from getting trapped or scraping against the posterior pharyngeal wall during nasotracheal or videolaryngoscopic intubations. Disadvantages & Safety Risks: Visual Obstruction: Overinflating the cuff within the upper airway can expand the balloon so wide that it completely blocks the clinician's view of the TT by the uvula or cuff. Blind Advancement Risk: If the clinician attempts to push the tube forward before deflating the cuff, it can cause severe friction, mucosal trauma, or nerve compression within the laryngeal space. First publication In Ghana medical Journal in 2011 📖 📖 #airway #nasalintubation #airwayalignement #foamedshow more

Sharpa Robotics Sharpa observed that teleoperating a dual hand... robot offering a combined 63 DoF is a nightmare, even for an experienced operator. They offer a two fold solution: - a VLA that handles "in hand rotation" (like the apple in video below), that the operator can trigger using a foot pedal. - a Mixture-of-Dexterous-Experts that fuses tactile sensing data. Interestingly enough, the first model handles the apple peeling end-to-end, tactile data does not help here. However, it greatly enhances the insertion and grasping of the apple. This research makes use of the SharpaWave 22-DoF dexterous hand, with force and tactile feedback on all ten fingertips. I find it interesting that is now possible to delegate complex low-level finger coordination tasks to RL-trained atomic skills. Optimizing such steps that are difficult to reproduce in teleoperation significantly helps overcoming the data acquisition bottleneck.show more

Strait of Hormuz over the last 48 hours: tanker... attacks continue Iran's demands for opening the Strait of Hormuz are a nonstarter for the US. As I covered over the weekend, Iran has now added Palestine, Yemen, and Iraq along with Lebanon for a complete ceasefire as a condition. In addition, it also wants compensation for the war damages and the MOU violation. On the shipping front, Oman lane transits continue, but here's the catch. ADNOC (UAE) ships are being attacked with 4 of them getting hit last week and another possible attack today. ADNOC's rescue boat was sent out, but no other confirmation on the attack has been announced so far. What is interesting is this. Iraqi crude is getting through the Oman lane. Prosperity tankers carrying Iraqi crude have not been hit. Why? Simple. In the past, Iran has exported some of its oil through Iraq to evade sanctions. This is one of the main reasons why we are not seeing all the tankers get hit through the Oman lane. But it seems clear from the recent escalation patterns that whatever secret deal Iran had with UAE is all but over. Video from MarineTraffic.show more

The United States Military is using Shield AI to... track people who are calling out this biological convergence of humans and electronics/synthetic biology (human embedded system) in real-time from drones, turning raw data into actionable intelligence with speed and efficiency. The company Shield AI was founded by Brandon Tseng (a former Navy SEAL), his brother Ryan Tseng (a former entrepreneur and Qualcomm executive), and Andrew Reiter (an engineer who had worked on computer vision applications for Draper Labs, a non-profit advanced engineering company). The company has contracts with the Department of Defense and the Department of Homeland Security.show more

DIY Drawknife from an Ordinary Knife and Stick 🌲🔪... #camping #survival #bushcraft #outdoors What you’ll need: • Your favorite knife, the longer, the better • Any stick you like that is comfortable to hold in your hand Steps: 1. Insert the Knife: Hammer your knife into the stick at the spot where the rings are located. This spot is typically stronger and prevents the stick from splitting in half. 2. Reinforce if Needed: If the wood isn’t very sturdy, wrap it with rope to prevent splitting and ensure the knife doesn’t slip out. 3. Safety First: Using this method keeps your hands safe at all times. Give it a try and let me know how it works for you!show more

An orogastric (OG) tube is a thin, flexible tube... passed through a baby's mouth, down the esophagus, and into the stomach for feeding, medication administration, or gastric decompression. It is commonly used in premature infants (28-31 weeks) or newborns needing respiratory support (e.g., CPAP) where nasal tubes are impractical. Key Aspects of Orogastric Tubes in Babies: Uses: Provides enteral nutrition to infants with immature sucking/swallowing skills, delivers medication, or vents air/fluids to reduce stomach distention.OG vs. NG Tube: While Nasogastric (NG) tubes are preferred for stability and allowing oral feeding, OG tubes are necessary when CPAP prongs occupy the nostrils. Insertion Method: The tube is measured from the mouth to the tragus of the ear and down to the xiphoid process.Confirmation: Proper placement is verified by checking the pH of aspirated stomach contents .Complications: Risks include bradycardia, oxygen desaturation, gagging, vomiting, nasal irritation, and rarely, perforation of the esophagus or gastric mucosa. Maintenance: OG tubes are typically replaced periodically and secured to the baby's face to prevent accidental removal. Curating a life of compassion, competence, and curiosity 🧠 Scribbling notes and saving lives, one diagnosis at a time 📝 LIKE 👍 REPOST 🔁show more

What is coming out of Iran is not just... brutality. It is the importation of battlefield violence into city streets by men who have done this before. The videos now circulating show armed men firing on unarmed civilians without distinction. In some clips, shooters sprint while firing automatic rifles. In others, men stand upright on a moving motorbike and fire handguns. There are also scenes of heavy weapons mounted on pickup trucks, with armed men standing in the back and firing into streets and crowds. What stands out is not only the firepower, but the method and the mindset. This is not crowd-control policing. It is combat-style action: coordinated movement, practiced weapon handling, and lethal force used without hesitation. These are men who have killed before, repeatedly, in war zones, and they are used to it. For years, the IRGC’s Quds Force built proxy forces across the region—recruiting, funding, training, and deploying fighters into war zones in Iraq, Syria, and Lebanon. Now the regime is bringing those same proxies home and using them inside Iran. In plain terms, it has imported the habits of foreign battlefields and turned Iranian cities into killing grounds.show more

Tonight I left my laptop turned on, and woke... up in the morning with a $7,000 profit. While I was sleeping, my cloud second brain was analyzing trends and running funnels on autopilot Famous investor Naval Ravikant once brilliantly noted: AI brains are meant for coming up with ideas, not clogging bio-servers with gigabytes of other people's garbage The main point Point Claude at a local folder and feed it all the accumulated digital junk files, articles, reports, notes. The artificial intelligence absorbs this chaos itself, builds ironclad logic, and turns a pile of files into a single, living knowledge base. The system works on the principle of compound interest: the more data you feed it, the more accurately it predicts your next steps and generates ready-made solutions Step-by-step process: Choose a base, either Notion or Obsidian, as long as the cloud is accessible from any device 24/7 Implement the CODE method by saving all the chaos to your inbox, sorting it out, extracting the essence, and monetizing your knowledge Connect AI agents by setting up automation via API so the AI sorts data and generates content on its own while you rest A more detailed guide is described in the article. I highly recommend adding this to your bookmarksshow more

this is more useful than my entire degree Elon... Musk's rocket company signed a $60,000,000,000 deal for Cursor in June, and eight days ago the two of them put a worker on sale for $200 a month: it gets its own computer in the cloud, signs into your accounts, clicks through your real apps, and hands back finished work instead of a draft for you to paste i ran one against my receipts folder on sunday and got back 14 filed, 2 it held because they needed a card number, and a saved method i never wrote myself Grok Bot is the one you train by doing your own job in front of it, and the whole handover fits in four messages tonight: 1. write out one job you did today the way you would brief a new hire: what has to be finished, which sites and files to work from, what to hand back, and where it stops and asks you 2. let it run once on something safe to get wrong, then correct the result until it is worth your name 3. say "save what we just did as a skill", and add the one rule about what always needs your approval 4. say "run that skill every weekday at 8 and post the result here. if the source is missing, tell me instead of using yesterday's numbers" xAI wrote that order into its own manual: one real job, then the saved method, then the clock. a schedule sitting on top of a method nobody checked replaces two hours of your clicking with two hours of your mistake turns out you never get to pick the brain, and that is the part i would argue about: the manual says there is no model picker for members or admins, no plan to add one, and the bill follows whichever model answered bookmark this, then open the piece below: which jobs deserve a worker of their own, and which ones quietly burn the seat ↓show more

Once again, the Black Skimmer is demonstrating the wonders... of aerodynamics. Each twist of the body, each individual feather helping steer while a wall of crashing white water rumbles just behind the bird’s outstretched tail. Like a surgeon’s scalpel, the bird’s lower beak surgically slices through the water with utmost care and precision in hopes of coming into contact with a poor, unsuspecting fish. This attempt might have been unsuccessful, but it doesn’t seem like the bird has a care in the world. It just keeps skimming through the shallows, waiting for that tasty morsel to graze its outstretched beak. So remember, when failure raises its head and stares you in the eye. Just keep skimming because eventually you’ll succeed just like the magical Black Skimmer.show more

This workflow is perfect for creating short fashion-style cinematic... videos. I simplified the original prompts based on willie’s method, and the whole process is now much faster and more stable: 1. Generate a 3×3 keyframe grid (Nano Banana Pro only) Use this simple prompt: “In a 3x3 grid, show this character in different angles, keep the scene the same, random poses. This is far simpler and more efficient than my old prompts. You can generate multiple times and just pick the keyframes you like most. 2. Extract a high-res keyframe (Super stable trick) Take a screenshot of the keyframe you want from the 3×3 grid, send it back to Nano Banana Pro, and simply say: “Give me a high-resolution version.” This method is much more stable than relying on complex upscaling prompts. 3. Generate the video with Kling 2.5 Turbo Upload the first and last frames to Kling 2.5 Turbo and use this prompt: “The camera very slowly and smoothly lowers on a boom.” From my testing, Kling 2.5 Turbo offers the best balance of stability and cost — other models are either less consistent or noticeably more expensive. 4. Final speed adjustment with willie’s tool (Critical step) Use the tool built by willie to fine-tune the playback speed of each clip. This step is essential for getting that premium cinematic feel. I’ll drop the tool link in the comments.show more

Yesterday at Brown University ICERM's workshop on “Agentic Scientific... Computing and Scientific Machine Learning” I spoke about “Adaptive Swarms Across Scales”, making the case for scientific AI as systems that can create representations, stress them, fracture them, and enlarge the category in which future representations live. The category here is a composable and breakable working universe of science: data, hypotheses, simulations, measurements, tools, failures, figures, papers, provenance, and the transformations that connect them. Discovery happens when those transformations become executable, inspectable, composable, and capable of changing the world model they operate within. Atomistic modeling gives one category - states, forces, trajectories, observables, boundary conditions, conservation laws. Neural surrogates learn fast morphisms inside or between such categories. But discovery is higher-order: it changes which objects and morphisms are available in the first place: what variables exist, what operations are allowed, what evidence counts, what scale is active, what invariant is being preserved, and what kind of explanation the system is even capable of forming. This is scientific method as adaptive architecture: compression, stress, fracture, recomposition. Fracture matters here because it makes the logic physical: a non-commuting diagram realized in matter. The imposed load, material hierarchy, defect field, and assumed continuum description no longer map cleanly into the observed outcome. The crack is the obstruction and it identifies where the old morphism failed and where a new representation must be introduced. The physical crack and the categorical obstruction are the same event viewed in different substrates. ScienceClaw × Infinite is a machine for constructing and transforming a category of scientific artifacts. Each artifact is typed. Each operation has lineage. Each failed branch remains in the category as reusable structure. The “paper” is no longer the terminal object of science; it is one projection of a larger compositional trace, and it can be generated at any time for consumption by a human or an AI. With that the unit of scientific labor is changing. For most of the twentieth century the unit was the result (a measurement, a theorem, a synthesized molecule). It is now becoming the algorithm that produces results, and after that, the substrate of discovery itself. The static PDF is the wrong terminal object for this regime, and the role of the scientist with it. We now design algorithms that build algorithms, and eventually substrates in which such algorithms compose themselves. At that point, the scientist is no longer outside the discovery system. The scientist becomes one of the representations the system can transform. In that sense, the systems will eventually do science to us, and that is the structural consequence of the principle they are built on.show more