
#zentensivist, EMCrit Teammate, Proud daddy and husband. BJJđȘ. ICU Santa Cabrini Hospital.
Montreal, Canada
Joined August 2013
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Last few days for early bird! Join us in Montreal next september! #HR26 Nothing quite like it... thinkingcriticalcare.com/202âŠ
Philippe Rola retweeted
Benoit Dutrisac a entiĂšrement raison. Alors quâailleurs en France, lâinvitĂ©e au QuĂ©bec de Ruba Gaza, Rima Gaza, est condamnĂ©e pour apologie du terrorisme, ici les nouveaux dĂ©putĂ©s, heureusement peu ont Ă©tĂ© Ă©lus ⊠affichent un symbole qui ne les regarde pas. La porte-parole du groupe, rappelons-le est libanaise.
Pauvre #QuĂ©bec ! Demandez Ă ces 9 de situer sur la carte la Palestine! La Jordanie? La Cisjordanie? LâĂgypte? Demandez-leur de vous raconter lâimportance de 1917, 1939-1945, 1948, 2005, annĂ©e du retrait dâIsraĂ«l de Gaza qui a laissĂ© une industrie de fleurs internationalement reconnue et florissante: des Ćillets, des roses et des chrysanthĂšmes. Une industrie qui rapportait des millions aux Gazaouis qui lâexploitait avec la supervision de la Hollande.
Demandez-leur comment ils ont transformĂ© en tunnel dans le but de tuer, le ciment envoyĂ© par la France pour construire des Ă©coles et des hĂŽpitaux, demandez-leur sâelles savent tout ça. Des rĂ©volutionnaires de salon qui ne comprennent pas mĂȘme les enjeux de ce quâelles dĂ©fendent.
Demandez-leur si elles savent que lâargent envoyĂ© Ă la Palestine (aux philistins) a Ă©tĂ© dĂ©tournĂ© et que la population nâen a jamais vu les couleurs. Sauf quelques familles qui vivent Ă DubaĂŻ ou Ă Paris non loin des champs ĂlysĂ©es⊠qui sâhabillent en PradaâŠ
Ces filles, qui ont été élues et qui portent fiÚrement le keffieh, ne tiendraient pas 10 minutes dans Gaza.
Faites-leur plaisir envoyez-les faire un séjour là -bas.
Elles le mĂ©ritent. Elles mettent tant dâĂ©nergie Ă dĂ©fendre lâindĂ©fendable!
Philippe Rola retweeted
BREAKING: A New York City watchdog group organized by Citizen Journalist Nick Shirley has uncovered a "free grocery store" scam that is raking in millions for the Mamdani family.
According to the group, Mamdani's brother, Eli Mohammed Mamdani, has been buying decrepit old buildings from the city for next to nothing.
"The plan was simple," said local Shirley Watchdog Chapter leader Joseph Barron, "The mayor's brother buys condemned property from the city for pennies on the dollar, then he sells it right back for the 'free grocery store' program at market value."
Once the city has the property it already owned, Mamdani hires his cousin Rufus Theodore Mamdani's construction company to bring it up to code.
"All told, each store could rake in as much as $5 million for the Mamdani family."
That's how communism works.
What's your response to this......??đ
MAKE THIS GO VIRAL ON X. LETâS GO đ
Philippe Rola retweeted
đšđŠ| DEPOIS DA FRANĂA, CANADĂ. Extremistas de esquerda e os seus aliados islamo-jihadistas vandalizam vĂĄrias ĂĄreas de Montreal. Estranhamente, a polĂcia recebeu ordem de nĂŁo intervir.
Bem, sabemos que o governo do CanadĂĄ, atualmente, Ă© de esquerda.
Philippe Rola retweeted
Something historic is happening across the West, and the legacy press can't see it, because the press is part of what is collapsing.
Peoples who were told for forty years that they had nothing in common are converging. Americans, French, Italians, Danes, British, Dutch. Different languages, different histories, and the same conclusion reached at the same time. They have all seen the same thing at work in their own countries: what the French call islamo-gauchisme, the alliance between the radical left and political Islam. And they are all saying no.
To understand why their hegemony is close to total collapse, you have to use their own concept. "Hegemony" comes from Antonio Gramsci, the Italian Marxist who understood that power doesn't rest on force. It rests on consent, on people accepting a worldview as obvious, as the only respectable one. That's why the left spent fifty years on what one German activist called the long march through the institutions. Universities, newsrooms, publishing houses, cultural ministries. Own the narrative and you own the country.
But hegemony has a weakness Gramsci himself understood. It dies the moment consent dies. And consent is dying everywhere at once.
They are losing the media war. In the 1970s, around 70% of Americans trusted the mass media. Today it's less than a third. In France, the gap between what the TV news says and what people see on their own street has become a joke. The gatekeepers lost the gate. An engineer with a phone can now reach more people than an evening news broadcast. The monopoly on the narrative, the foundation of the whole edifice, is gone.
And reality is finishing the job. Look at France. A movement that started in high schools ended on October 17 with city halls stormed, Limoges city hall burning and looting across Marseille, while the radical left blamed the police. The French saw it with their own eyes, without a filter. Today's polls show the radical left's candidate losing a presidential runoff by roughly two to one. You can deconstruct a text. You can't deconstruct a burning city hall.
Then comes the blow they can never recover from: abundance.
Collectivism has always been a politics of scarcity. Its whole logic is that the pie is fixed, so someone's gain is someone else's theft, so the state must take and redistribute, ration and control. That's why its latest form is degrowth. Planners need scarcity the way fire needs oxygen.
What is being built right now makes that logic obsolete. AI is collapsing the cost of intelligence. Robotics is about to collapse the cost of labor. Reusable rockets have already slashed the cost of reaching space. Elon Musk and thousands of builders like him are proving every day that the pie is not fixed. It can grow faster than anyone imagined. In a world of abundance, envy loses its grip and the planner loses his excuse. And AI does one more thing: it ends opacity. When any citizen can trace public money in minutes, the networks that live in the dark have nowhere left to hide.
So what comes next? Two things, in this order.
First, the reckoning, and this is where we have to be better than them. There will be no purges and no lists, and nobody will be prosecuted for having been wrong. Being wrong is not a crime, and we will never become what we fought. But aggravated corruption is a crime. Public money diverted to networks, fraud, abuse of office: those must be investigated, proven and judged one by one, by independent courts, with evidence, due process and the presumption of innocence. We don't jail people for their ideas. We jail people for stealing. That difference is the whole difference between a free civilization and the regimes we oppose.
Second, the reunification of the West. That doesn't mean another supranational empire run by unelected officials, which is the model that failed. It means a West of strong, sovereign nations that choose to work together. Agreements between countries that control their borders, produce their own energy, build their own AI and defend themselves, and that trade and cooperate as equals because they share the same foundations: the free individual, the rule of law, the right to build.
Gramsci's heirs spent fifty years winning the institutions. They are losing them in five, because they forgot that hegemony only lasts as long as reality cooperates.
Reality has stopped cooperating. Now it's our turn to build.
đ€ Made with AI
Philippe Rola retweeted
Jerry wants to do some Q+A! We can be reached through emcrit.org/category/emnerd/ or feel free to DM me directly with questions. Hoping to put together a Q+A episode in the coming months
Philippe Rola retweeted
A former Tehran police lieutenant living in Toronto under a new name is being deported from Canada for his âimportant and critical roleâ in a crime group that helped Iran evade sanctions.
The Immigration and Refugee Board ruled that Amin Yousefijam was âcrucialâ to the sanctions-dodging scheme, according to a copy of the 36-page decision released to Global News on Tuesday.
globalnews.ca/news/12109602/âŠ
Philippe Rola retweeted
Myriam was a 7-year-old French Jewish girl. She witnessed a terrorist break into her school and kill two of her classmates.
She tried to run but tripped while grabbing her schoolbag, causing her ballet slippers to fall out. She stopped to pick them up. He chased her and grabbed her by the hair, shooting her in the head at point-blank range.
The man was Mohamed Merah, and a rap song honoring him and other Muslim terrorists has become the unofficial anthem of the âstudent protestsâ in France.
đš ALERTE - Des Ă©lĂšves ONT BLOQUĂ le lycĂ©e François Villon, Ă Beaugency (45), en Ă©coutant MRH, un titre faisant rĂ©fĂ©rence Ă des TERRORISTES ISLAMISTES.
« Ă la Mohamed Merah, v-esqui' les camĂ©ras. Bataclan, je l'ai shooter Ă l'Ćil, chasse Ă l'homme, Salah Abdeslam »
« Jâai pas peur, jâai pas peur de lâenfer, le pacte est intact, Ă part Allah qui peut mâarrĂȘter. Bataclan, faisaient les morts, allongez-vous, je vais en shooter Ă lâĆil ».
Philippe Rola retweeted
Australian woman admits she used to be a leftist but has since woken up.
âAll I used to do was scream, âOpen the borders! Free the refugees!â But when you import the Third World, you get the Third World. Whatâs happening in France, Milan, and Iran? If you donât draw the parallels and see what is happening at this point, you are absolutely brainwashed.
I was brainwashed for probably the first 30 years of my life, and now Iâve come to realize that that was all part of the plan as well prey on the empathy and kindness of those who care, give them a cause to fight for, and then everything else blindly goes out the window.
You really need to start questioning yourself and your empathy, and ask yourself: Who is co-opting your empathy? Who is taking it for their own regime?â
Philippe Rola retweeted
Liberal mass immigration has contributed to depressed wages, high rents, and massive healthcare wait times.
Conservatives will remove non-citizens who have no legal right to be here.Â
Conservatives will sharply cut immigration so we can hire, train and house Canadians first.
Philippe Rola retweeted
It's striking that London where I've been for the last few days feels like India. It's overrun by low skilled Indians which leads me to believe the West is helping to solve India's massive youth unemployment problem.
At my hotel, everyone on staff were newly arrived from India. Their English was often poor and the service wasn't great. The staff were shouting back and forth to each other in Hindi like you would in a chawl in India. A chawl is low cost housing and densely populated.
All of this is coming to Canada. Canât wait. đ€Ą
âWe do need peopleâ: Immigration minister teases immigration levels will be going up ctvnews.ca/politics/article/âŠ
Philippe Rola retweeted
Des fois, on a envie de se pincer pour vĂ©rifier si on n'est pas dans un rĂȘve (ou un cauchemar).
Un homme a violé puis tué une femme. Puis a paralysé une enfant en tentant de la violer elle aussi.
Or, aujourd'hui, il est étudiant...à la Faculté de droit de McGill.
Et une de ses collÚgues est venue défendre sa présence à l'université cet aprÚs-midi !
youtube.com/watch?v=szTLglb-âŠ
Philippe Rola retweeted
TMU hired a retired judge to investigate antisemitism on campus. The judge found the school has a double standard for Jews, and failed to enforce its own code of conduct. So the same administration that commissioned the investigation hid its conclusion. nationalpost.com/opinion/johâŠ
Philippe Rola retweeted
Replying to @dorcodoc @ThinkingCC
CO2 gap coming soon on thedependentvariable.com PV part 2, then SVO2, then the CO2 gap so around 3 weeks off đ
Philippe Rola retweeted
đš JUST IN: While France burns, Polish Member of European Parliament Dominik Tarczynski is WALKING THROUGH Krakow LATE at night, showing all of Europe it's PERFECTLY CALM
"Look how safe we are. Churches are safe. Because we did not let them in. Zero means zero. 'Be like Poland' means be brave." đ”đ±đșđž
"We know what jihadists are capable of. We do not know what second or third generation of so-called refugees will do. Well, actually we do know... we can see what is happening in France."
There are no riots, no burning buildings and no police lines
Poland refused the EU's migrant relocation quotas, and the EU's top court ruled against it. Poland didn't budge!
In the same 24 hours, France's major streets and businesses are burning and being ransacked by leftists, Islamists and invaders
EVERY NATION CAN BE LIKE THIS. It's a matter of CHOICE
Philippe Rola retweeted
EMCrit 436 - When you RSI Shocked Patients, they Tend to Die
8 years later, we are bringing HNI out of the expert-only realm so anyone can intubate shocky patients safely without causing post-intubation arrest & hopefully not causing any BP/CO drop at all...
[#FOAMed for Now]
emcrit.org/436
All MAP is not created equal. Assess your interfaces by the means youâd like, fix CRT as best you can.
đ«Hemodynamic stability does not necessarily mean adequate tissue perfusion.
A patient with septic shock reaches a MAP of 65 mmHg, cardiac output improves, and vasopressor requirements decrease. Yet capillary refill remains prolonged, lactate is elevated, and organ dysfunction persists.
Has resuscitation succeeded?
Dr. Carlos Sanchez-Escalante and Xavier Monnet propose a fundamental shift: perfusion assessment should focus on physiological coherence rather than normalization of isolated numbers.
The central problem is that macrocirculatory recovery does not guarantee microcirculatory recovery.
CRT provides a practical starting point. It is inexpensive, rapidly responsive, and supported by clinical evidence. However, temperature, sympathetic activity, edema, and measurement technique influence its interpretation.
Lactate remains valuable for risk assessment, but hyperlactatemia does not necessarily indicate persistent tissue hypoxia. Adrenergic stimulation, altered metabolism, and impaired clearance may sustain elevated concentrations after perfusion improves.
Treating every persistent lactate elevation with additional fluids or vasopressors risks producing congestion rather than restoring perfusion.
Venous oxygen saturation and the venoarterial COâ gap offer complementary information.
SvOâ reflects the relationship between oxygen delivery and consumption, but normal values cannot exclude impaired extraction or microcirculatory shunting.
The Pv-aCOâ gap helps assess whether blood flow is sufficient relative to metabolic COâ production. Neither measurement directly demonstrates microcirculatory recovery.
Peripheral perfusion index, obtained through photoplethysmography, provides continuous information about peripheral circulatory changes. Its interpretation requires attention to temperature, vascular tone, and vasopressor exposure.
When uncertainty persists, advanced assessment may incorporate cardiac output, tissue oxygenation, microcirculatory imaging, and venous congestion.
An especially relevant concept is effective tissue perfusion pressure.
MAP alone does not determine regional blood flow. Critical closing pressure, vascular tone, extravascular compression, and venous outflow influence the pressure gradient available for tissue perfusion.
Consequently, increasing arterial pressure may not improve organ perfusion, particularly when vascular resistance or venous congestion is elevated.
The authors propose a progressive approach: begin with clinical examination and basic markers, integrate complementary measurements when signals disagree, and escalate monitoring according to unresolved uncertainty and patient risk.
The objective of resuscitation is not to normalize every variable. It is to restore effective tissue perfusion without creating additional injury through unnecessary interventions.
Reference đ
Sanchez-Escalante C, Monnet X. 2026. Critical Care Medicine.
doi.org/10.1097/CCM.00000000âŠ
Philippe Rola retweeted
đ THIS CHRISTMAS, BE PART OF SOMETHING UNFORGETTABLE.
Join us at Christmas on the Hill for a joyful celebration of heritage, family & community.
Come with friends, invite your MP, and share in the joy of Christmas.
Tap the image to register today.
Philippe Rola retweeted
A Study in Priors Part 3. New Bayesian Analysis looking at TXA in Trauma. Does it actually provide us any new insight? New blog post emcrit.org/emnerd/a-study-inâŠ
Philippe Rola retweeted
đš FINALLY, we have a leader at Quebecâs National Assembly who dares to call things exactly what they are!
Letâs be clear: this has NOTHING to do with students or their rights. Itâs about supporting those who have spent days setting parts of France on fire, destroying property, and spreading chaos!
Stop making excuses for destruction and calling it a student cause!
Hier se tenait à Montréal une manifestation « en solidarité à la mobilisation en France ».
Comment expliquez-vous alors quâon retrouve des drapeaux de la Palestine et mĂȘme un de lâAlgĂ©rie, mais AUCUN de la France, du QuĂ©bec ou du Canada?
Et des affiches et banderoles anticapitalistes, mais AUCUNE en faveur du systĂšme dâĂ©ducation français?
Il faut appeler un chat, un chat.
Il sâagit dâune manifestation de lâIslam politique et de la gauche radicale.
This is one of the funniest things to me. I will often ask someone who tells me that theyâre dry. How is it that they got that way and then thereâs usually a little bit of silence, a mumble about insensible losses, a limited PO intake, despite the 3 L that have been given in the last 48 hours, lol. The reality is that unless you were getting aggressive diuretic therapy or you have severe G.I. losses, your so-called intravascular dry patient likely has a main systemic filling pressure problem and you donât wanna miss the septic source because you thought they were dry.





























