Discover and read the best of Twitter Threads about #EmergencyMedicine

Most recents (18)

👋👋 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[2001]: FDA ⬛️ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of 💉 products ⏩ ultimately withdrawn from market 🪦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
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/ Forward of one US doctor's Covid experience. Self-proning, discharging multilobar pneumonia home, 20-30% survival rate for pts requiring intubation, it's necessary education for the rest of us that may face similar situations in a week or two.
2/ Hope UK and Europe will soon be coming out the other side of the covid case spike. #covid #covid19 #emergencymedicine

"Clinical course is predictable.

2-11 days after exposure (day 5 on average) flu like symptoms start.
3/
Common are fever, headache, dry cough, myalgias (back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Read 33 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
1/ My husband gets up before the ass crack of dawn (he’s quarantined to a separate floor and we haven’t slept together in maybe 2 weeks). His first alarm woke me at 3:30, so I got up off the couch to get his coffee mug ready. I text him his coffee is ready.
2/ He thanks me via text, then grabs a few more minutes of sleep. Half an hour later, he leaves the house. No more kisses or hugs. An “I love you, have a good day” has to be enough. He’s not an #emergencymedicine MD, but an #MDMPH in his 2nd year of Gen Surg residency. This means
3/ he and his coworkers spend a solid amount of time taking consults in the #emergencydepartment . He comes home at the end of the day and tells me things like; we have 100 ventilators. They’re all being used by our regular patients. If we get a surge of #COVID19 patients, it
Read 4 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
I need to talk about some shit that just went down.

Thread/13
Ambulance toned out for an infant in cardiopulmonary arrest.

Not known when they were last seen normal.

A fucking infant.
There’s snow on the roads. No helicopters are flying. I don’t have an ICU.

Right now it’s on us.

We got ready:

ET tube
Pads
Defibrillator
IO
Pharmacy
Respiratory
Broselow Tape
BVM
Suction
All the trimmings
Read 15 tweets
Happy Friday! This is @TarakTrivedi. I'm an Emergency Physician and research fellow at @NCSP_UCLA. For #NCSPScholarFriday, I want to share research and perspectives on systems of care for psychiatric emergencies.
2/ While training @HGHED in @AlamedaCounty, I cared for hundreds of patients in psychiatric crisis, and I learned about the roles of #EMS , #Police , and #EmergencyMedicine. For Psych Emergencies, many cities have 911 systems that look something like this:
3/ Most places, Police are the de-facto response to 911 calls for psych-emergencies. As a result, Crisis-Intervention-Training (CIT) programs for police have proliferated, and even led to reduced arrests @NAMICommunicate #NCSPScholarFriday
Read 12 tweets
**Arterial Blood Gas Interpretation for Paramedics**

You asked for it so here it is!
Started off last week with a request from my #Paramedic mates wanting to know more..

#CPD
#EmergencyMedicine
#TeamNHS
2.
3.
Read 48 tweets
2 new papers on drivers of unscheduled admission w/ @NHSBartsHealth @QMULBartsTheLon colleagues #emergencymedicine: bmjopen.bmj.com/content/7/6/e0…
Key messages from this #mixedmethods project: (1) working with routine #emergencymedicine data difficult - gaps, interpretation, caveats
Read 7 tweets

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