Discover and read the best of Twitter Threads about #EmergencyMedicine

Most recents (24)

Patient with epig pain and multiple ED visits with neg CT and non-specific labs - but persistent pain. What do you do? GI cocktail + famotidine and discharge? How about a little #POCUS first. #FOAMed #FOAMus #Ultrasound #MedTwitter @mtabbut @laurarbrownmd @RJonesSonoEM
And the transverse view. What do you think now? Poll below in thread. #Whatsthedx #EmergencyMedicine @DianeGramer @SLWerner_EM @ClaridgeJeffrey @vanessapho @ladha_prerna
What do you think?
Read 9 tweets
Every speciality who is on (or wants to be) the ‘Mucor’ team- how many are willing to admit a patient with Mucor under their care and manage (even after surgical debridement). How many were admitting before and will admit after the pandemic? (1/n)#Mucormycosis #COVID19India
Some hypothetical consultations in the emergency before and after the pandemic:

#ENT : We will operate and transfer back

#Ophthalmology : Call us during the Surgey, we will coordinate with ENT in the OT, if needed

#Neurology : Continue Amphotericin (2/n)
#Endocrinology : Send us a consultation after admission under primary, we will control sugars

#Neurosurgery :No active neurosurgical intervention required

#Nephrology :We will do renal modification of Amphotericin

#Medicine/ #Infectiousdisease Admit under any of the above
Read 4 tweets
In light of the Boston police Union leader child abuse, this is very plausible, even probable. I have 2x, on behalf of someone else, reported, via Title IX - the woman or gay man was not feeling safe enuf to report. Yes, there is blowback when one reports. But we can’t be silent.
I am a mandated reporter as a #pediatrician. I *must* report for my patients or face legal consequences. Am same for staff, students, trainees. But in #EmergencyMedicine who do I call if a child may be unsafe at home? Sometimes, cops. Are cops safe?

boston.com/news/local-new…
I have seen #mentalhealth and entire life paths destroyed by abusers preying on children like: This happened to too many people I know. I have seen institutions intimidate, mislabel, bury stories of the victims. (Some predators wait until 18th birthday.)

nytimes.com/2017/08/07/nyr…
Read 29 tweets
We live in an attention #economy & what #Tweetiatricians have known for decades (#Twitter started in 2006): importance of drawing attention to factual science-based information as compared to #misinformation & #disinformation, especially on #vaccines

econreview.berkeley.edu/paying-attenti…
You have to be fast & prolific to play catch up to this. I have 77K tweets, a moderate sized band of 6K followers interested enough to tolerate my volume but use of hashtags allows reach across Twittersphere. Trending hashtags = better for riding a way for that attention economy
If is unclear if we are now so siloed that tweets are ineffective with anti-vaxx. But not all anti-vaxx are QAnon
Read 39 tweets
“QAnon is ...a self-sustaining environment of #disinformation & #misinformation...

.. QAnon hijacks the architecture of social media..

..By controlling acceptable forms of information, QAnon traps its members in a downward spiral of radicalization.”

american.edu/sis/centers/se…
“As P.W. Singer and Emerson Brooking describe in.. book Likewar: The Weaponization of #SocialMedia, this phenomenon of “junk” or “fake news” is not new. In 2016, a similar, but related, conspiracy known as “Pizzagate” resulted in a shooting at a DC area pizza parlor.” #SoMe
Above is not limited to academic articles

There has been an increase in #antiAsianhate crimes
shootings
#xenophobia
targeting of #GOTV by minorities
including this attempt to intimidate me for my GOTV, by armed right wing

There was the #Nashvillebombing (with QAnon beliefs)
Read 19 tweets
Patient with hx ESRD on dialysis and multiple previous central catheters. Needs central line. #POCUS as shown. Go ahead and place the line? Poll in thread. #FOAMed #FOAMus #MedTwitter #EmergencyMedicine @mtabbut @RJonesSonoEM @SLWerner_EM @NephroP @siddharth_dugar
Place the line here?
Answer: This patient with chronic thrombus at the shown location. Best to look for a different location.
Read 4 tweets
Only order tests when it will affect clinical decisions! The routine ordering of tests increases health care costs, doesn’t benefit patients and may in fact harm them.

#FOAMed #MedEd #medtwitter #zentensivist
Transfusing RBCs at a threshold of 7 g/dL is associated with similar or improved survival, fewer complications and reduced costs compared to higher transfusion triggers.

#FOAMed #MedEd #medtwitter #zentensivist
Read 6 tweets
Just finished 7 nights this morning, 4 of which in Resus which became a temporary ICU/HDU for the week due to the surge. People in their 20/30’s no medical history on high flow o2, severe hypoxia gasping for air, retaining carbon dioxide. It’s what I imagine someone... (1/3)
being pulled out of the water after a near drown must look like. Horrific. And the worst yet to come. ED/HDU/ICU is not designed to withstand this pressure. We really need to mind each other, we will overcome this virus & life will return to normal but for the next few..(2/3)
days & weeks we need to make a collective & concerted effort to suppress this surge with social distancing, cough/sneeze etiquette, intensive hand washing & wearing masks as often as possible & protect our loved ones. Big love to all my frontline colleagues (3/3) #WeWillOvercome
Read 4 tweets
#CardioNerds & #EPeeps, ready for an EKG Challenge⁉️⁉️

✍️Answer to follow on Monday 11/23 🗓️

🏥You see this 58 yo🧍‍♂️w/ ischemic CM in clinic.

🤔What's the rhythm❓

Brought to you by EKGaction: ekgaction.com Image
Would you use a CardioNerds EKG Case of the Week - shared weekly?
Read 37 tweets
6yo 👦 presents to your ED with multiple deep lacs after being attacked by the neighbor's 🐕... He's screaming/crying in pain but wont let the RN get near him for an IV, looking at the 💉 makes him 😭 even harder.

How do you treat the pain?

(Josh)
1/...
Consider picking 👃!

How does intranasal drug delivery work?
✅ Capillary rich respiratory mucosa allows 💊 to directly enter the 🩸(systemic circulation)

✅ Olfactory mucosal absorption leads to rapid therapeutic levels in the CSF.

Source:[27397490]
2/ Image
A few nerdy PK pearls below:

💎 Quick onset of action
💎 Lipophilic drugs = better absorbed
💎 Unionized drugs 🔀 BBB more readily than ionized forms
💎 IN delivery bypasses GI & first past metabolism, BUT nasal mucosa contains lots of CYP450 enzymes!

PMID:[30449731]
3/
Read 9 tweets
Check out this great review on BRUE's or “brief resolved unexplained event” @EMBoardBombs by @blakebriggsMD and @Lmellick here, emboardbombs.com/papers/2020/9/…

Or follow along for a short #medtweetorial review on the highlights. #EM #EMPeds #EmergencyMedicine #MedTwitter
What is a BRUE? It reflects a general “catch-all” CC

The old term was ALTE (apparent life-threatening event), but this term was too broad and incorrectly assoc symptoms and SIDS.

It peaks in incidence at <2 months of age but can occur anytime within the first year
Clinical features that define BRUE (includes any of the following): typically <1 minute

- cyanosis or pallor

- absent, decreased, or irregular breathing

- change in tone

- altered mental status
Read 17 tweets
👋👋 A quick poll to start off this week's TIL
[❔]: Does your institution have droperidol on formulary?

1/
#TwitteRx #MedTwitter #FOAMed #emergencymedicine #NurseTwitter
Droperidol ➡️ butyrophenone, D2 receptor antagonist, similar to haloperidol with
✅ faster onset (3-10m IV/IM)
✅ shorter-acting
✅ more sedating

Dosing = 0.625 - 10 mg
Indications: Agitation, N/V, HA/migraine, vertigo, adjunct analgesic

ADEs = EPS, hypoTN, QTp
Preg = C

2/
[1961]: Developed
[1960s - 2000]: Frequently used in ED

[2001]: FDA ⬛️ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of 💉 products ⏩ ultimately withdrawn from market 🪦

[2019]: American Regent™️ announces droperidol is back 👀... so is it worth the risk?

3/
Read 9 tweets
#crazy Useless #patient

1/n
Middle-aged man, loves his #family, #farming, drives a cab, #happy. Son & wife at #home. Father-son relationship strong as rock. One #morning, son finds father mumbling to self. Mother says he hardly slept
Mumbling becomes angry ramblings. #Clinical LAENNEC WAS TAUGHT THE IMPO...
2/n
Has very little #breakfast. Walks excessively. Goes and lies down, only to get up and walk again. Family interactions little. Sleeps well for 2 hours from 12 to 2PM. Lunchtime. Groggy #father gets on the lunch table and defecates near plates and food. Son and mother aghast.
3/n
Father has gone mad. Calls the friendly neighbor, brings his car, rushes to #Medical specialty #clinic nearby. Father disoriented. Son gets the Fword from his own father multiple times, he is shocked! Then comes hurling of abuses after which they restrain him in the car.
Read 15 tweets
The @AmerMedicalAssn's stance on Taking care of our students: Preparing for the 2021 residency application cycle.

So far.. lots of #medstudents attending this sesh
Most programs are considering #virtualinterviews

#MedStudentTwitter #MedED #classof2021
Lots of important stakeholders represented in the Coalition for Physician Accountability.

Next month: watch out for the report on pathways for graduating medical students (#class2020) and their journey to residency.

#MedStudentTwitter
"We anticipate stakeholders will commit to policies that prioritize these guiding principles yet recognize the necessity for innovation and flexibility in this new #COVID19 environment"
Read 22 tweets
Umbereen S Nehal MD MPH: who is this person? Several people have been asking

A thread

Where am I from? Hooboy.
Let’s say, citizen of the world, human ping pong ball. Third culture kid. Genetic mutt

Born: 🇺🇸
🇵🇰 parents - when my parents born colonial rule, pre-Pakistan
To thoroughly annoy my Twitter bestie, @DrvanTilburg

Am an ENFP - a cross between Snoopy, Robin Willians, Ellen Degeneres, Dr. Seuss, Charles Dickens, Upton Sinclair

I border on ENTP - love new info and love to challenge in order to break through barriers or limitations
My great-grandfather was given title "Khan Bahadur" (brave). As a judge, a brown man under Colonial rule, he threw the book at a British attorney. "Learn the law" if in his courtroom. Hence my stiff moral backbone

My mom & me:

(She loves this song)
Read 52 tweets
I've had too many patients die in these past weeks. As a physician, you would think it gets easier to tell families that their loved one died the more times you have to do it.

It doesn't.

#COVID19 #EmergencyMedicine @HarborUCLAEM @californiaacep
1/x
I've been running code after code, but most patients don't make it. After coming out of the room, I finally start humanizing the situation and gathering the strength to speak to family members to deliver the bad news. It is then when I realize that a human life was lost
2/x
What hurts the most is having to deliver the news outside of the hospital or by phone. Most of my patients aren't allowed to have their loved ones at their side when they are nearing death or even after because of the pandemic
3/x
Read 8 tweets
1/ Hey #medtwitter #proudtobeGIM

cc @mmteacherdoc @templeratcliffe @tony_breu @meggerber @laurelfick @adamcifu @DrSinhaEsq @SusanHingle

Received a text this AM from division’s admin coordinator

‘What a beautiful day it would have been for opening day - Let’s Go Mets ..’
->
2/ 2which my Chief of DGIM responded:

The one constant through all the years, Ray, has been baseball.

America has rolled by like an army of steamrollers. It's been erased like a blackboard, rebuilt, and erased again. But baseball has marked the time.

This field, this game->
3/ it’s part of our past, Ray. It reminds us of all that was once good, and what could be again.

Ohhh, people will come Ray. They most definitely come

To which I responded ->
Read 5 tweets
Anyone that took the #EmergencyMedicine ITE last week knows that we got approximately 220 out of 225 questions on LVADs, and I’m pretty sure I got 85% of those questions wrong. So here’s a #tweetorial on LVADs

#FOAMed #CardioTwitter

1/
LVAD Basics

🔺They dont have pulses‼️due to linear flow device
🔺How to assess perfusion? Mental status, cap refill, warm extremities
🔺Auscultate (more on that later)
🔺Pulse Ox can be unreliable due to lack of pulsatility➡️get ABG if poor waveform
🔺Do bedside echo early

2/
Blood pressure with LVADs

✅MAP goal: 65-80mmHg
🔺Measure BP using manual cuff and doppler (95% accurate) as opposed to standard automated BP cuff (~50% accurate)
🔺Put in A-line if critically ill for continuous BP monitoring

#FOAMed #FOAMcc

3/
Read 13 tweets
Last week, we posted about the opening of our new trauma bay @UnityHealthTO, a space that we “purposely designed, extensively tested, revised with end-user feedback.” – @HumanFact0rz #design #trauma #emergencymedicine

Here's a thread with more details 1/
We received considerable positive feedback and questions about the details of the process. This was a team effort from architects, operational readiness, clinicians, sim team to name a few. Here goes... 2/
Once upon a time…(all good stories start like this) 4 yrs ago we ran a study, called TRUST (Trauma Resus Using in situ Simulation for Team training). Using debriefing feedback & human factors expert video review we identified latent safety threats within our old trauma bay. 3/
Read 11 tweets
Reading more about venous air embolism after putting in/removing ~10 CVCs in last 2 weeks is kind of freaking me out so I decided to do a deeper dive

#FOAMed #FOAMcc #EmergencyMedicine
🔺Symptoms: acute onset dyspnea, cough, syncope, AMS, “mill wheel murmur" (specific but not sensitive)

🔺Clinical manifestation: acute R-heart failure, cardiogenic shock (hypotension, oliguria, JVD), acute embolic stroke (air bubbles pass thru patent foramen ovale)
🔺Clinical Dx but can use:
🔹EtCO2: decreased due to increase physio dead space & worsening V/Q mismatch
🔹EKG: signs of R-heart strain (R axis deviation, RBBB, peaked P waves), non-specific ST changes
🔹TTE/TEE: Air in cardiac chambers, RV dilation
🔹CXR: pulmonary edema
Read 7 tweets
A quick thread on why I make and use algorithms for the evaluation and management of patients in the ED:
#FOAMed #EmergencyMedicine #Metacognition
1/8
There are two systems for the processing of illness presentations:
1) Intuitive: rapid, high-capacity, low-effort
2) Analytical: slow, cognitively taxing
2/8
In the emergency department, system 1 and system 2 processes are often initiated in parallel and may recur during the ED course.
3/8
Read 8 tweets
"Our experience of waiting and how we feel about it varies radically depending on the context.

It turns out that #design can completely change whether our five-minute wait goes reasonable or completely unbearable."

- Angus Chen on @99piorg
For anyone in #healthcare & #EmergencyMedicine involved in the #design of how patients wait, please listen to this. bit.ly/2lFVHis

The psychology of waiting should be integrated into how we #design the waiting experience in healthcare.
Things like "radical transparency". Empowering people so that they feel they're making progress.

We can certainly improve the patient waiting experience. Its time we apply what tech design has learned long ago cc: @DrCarolynSnider @HumanFact0rz
Read 3 tweets
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,

- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
Read 88 tweets
Cetoacidosis Diabética #DKA #CAD #AMTIP

Bases de la Enfermedad y análisis del Diagráma de Flujo @NICEcomms Diciembre 2018

Abro hilo, iniciamos👨‍💻y abierto comentadios

@MarianaPediatra @FOAMexico @CantillMauricio @Javier_Prego @erikablasco @pediatraweb10 @RobustosMD @carsolbal
Para ti #urgenciologos, #pediatras e #intensivistas

Daremos un repaso discreto de CAD y analizaremos el texto de la NICE Pathway

Comentaremos con relación a las guías @ispad_org, una de las más utilizadas a nivel mundial

En pocas palabras, el diagrama con relevante información
#CAD puede presentarse en #T1D y #T2Diabetes. Debido a obesidad, han aumentado los casos en esta última, presentándose también como debút.

#T1D es resultado de destrucción autoinmune progresiva de células beta. Ocurre a una tasa de 6-8%/año en aquellos con Dx establecido.
Read 39 tweets

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