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Salim R. Rezaie, MD Profile picture
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25 Oct, 6 tweets, 4 min read
Cruising the Literature: Updates in GI Emergencies at #ACEP21

-CODA: Abx 1st vs Surgery 1st for Appendicitis
-HALT-IT: TXA for GIBs
-Timing of Endoscopy in GIBs
-Topical Capsaicin Cream for Cannaboid Hyperemesis
-Inhaled Isopropyl Alcohol for N/V
CODA: Abx 1st vs Surgery 1st for Appendicitis

rebelem.com/rebel-cast-ep-…

-Abx non-inferior to surgery BUT...
-Appendectomy in 30% by 90d
-3x more ED visits
-2x more complications
-Appendicoliths higher risk for complications
HALT-IT: TXA for GIBs

rebelem.com/rebel-cast-ep8…

-No Benefit
-Increased Harms
-Timing of GIB Difficult
Timing of Endoscopy in GIB

rebelem.com/rebel-cast-ep8…

-HD Stable = Optimize Medical Conditions 1st
-HD Unstable = Resuscitate+Medical Tx+Endoscopy ASAP
-GI: HD Unstable Pts Get Earlier Endoscopy BUT do Worse
-ED: Do worse because they are just sicker not from endoscopy itself
Topical Capsaicin Cream in Cannaboid Hyperemesis

rebelem.com/topical-capsai…

-Worth a shot
-Low cost
-Widely available
-Low adverse event profile
BOTTOM LINES: Cruising the Literature: Updates in GI Emergencies at #ACEP21

-Appendicoliths = Complicated Appendicitis
-TXA for GIB = NO Benefit
-HD Stable GIB = Optimize Medical Conditions 1st
-Cannabis Hyperemesis = Try Capsaicin
-N/V + No IV = Try Inhaled Isopropyl Swabs

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More from @srrezaie

Salim R. Rezaie, MD Profile picture
26 Oct
Bloody Hell: GI Bleed Management in the ED at #ACEP21 Image
Upper vs Lower GIB at #ACEP21

Low BP = Assume UGIB
BRBPR w/Clots = LGIB
BUN/Cr >30 = UGIB
NGL = NOT Helpful Image
EVEN GI guidelines don't support NGL #ACEP21

The American College of Gastroenterology 2012 guidelines state NGL is not required in pts with UGIB for diagnosis, prognosis, visualization, or therapeutic effect Image
Read 5 tweets
Salim R. Rezaie, MD Profile picture
25 Oct
ECG Indications for Emergent Reperfusion via @amalmattu at #ACEP21

Concerning Symptoms PLUS...
-STE in Contiguous Leads
-Posterior STEMI
-Non STE-ACS WITH...
-Refractory Ischemia
-Developing Acute Heart Failure
-Electrical Instability
-HD Instability
Additionally, Increasing Lit BUT NOT YET in the US Guidelines...

-LBBB w/Sgarbossa Criteria(& Modified)
-Pacers w/Sgarbossa Criteria(& Modified)
-de Winter T-Waves
-STE aVR w/Diffuse STD

Serial ECGs if you see...
-Hyperacute Ts in Symptomatic Pts
-STD in aVL in Symptomatic Pts
Sgarbossa & Modified Criteria

A = Concordant STE ≥1mm in any lead
B = Concordant STD ≥ 1mm in V1, V2, or V3
C = Discordant STE ≥5mm (Less Specific)
Modified = ST Deviation > 25% of size of S Wave
Read 4 tweets
Salim R. Rezaie, MD Profile picture
9 Mar
Great time chatting with @TessaRDavis @VenkBellamkonda @marco_propersi @M_Lin on productivity...here are some thoughts from me...

#MedEd #productivity
Email

-Focus on Task Zero NOT Inbox Zero
-Email for me falls into 4 categories:
1 Actionable item (>5min to accomplish)->Task manager
2 Junk->Delete
3 Reference->Evernote
4 Quick action (<5min to accomplish)->Answer right then

Goal isn't zero emails but zero tasks in ur email
Time Management

-Schedule things into your calendar
-Review your calendar the night before for next day
-Review your calendar Sunday night for upcoming week
-Make sure you schedule downtime for yourself
Read 8 tweets
Salim R. Rezaie, MD Profile picture
8 Mar
CDC Releases Interim Guidance for Those Who Are Fully Vaccinated

cdc.gov/.../fully-vacc…

#COVID19 Image
Fully Vaccinated is ≥2weeks after 2nd dose of Moderna/Pfizer

Fully Vaccinated is ≥2weeks after 1 dose of J&J
Fully vaccinated ppl can:
-Visit w/other fully vaccinated ppl w/o wearing masks/physical distancing
-Visit w/unvaccinated ppl from single household who are low risk for severe COVID19 dz w/o wearing masks/physical distancing
-No need for quarantine & testing if asymptomatic
Read 4 tweets
Salim R. Rezaie, MD Profile picture
12 Oct 20
COVID-19: An EBM Take Part 2 at #ACOEP20

-Anticoagulation
-Awake Proning
-Invasive Mechanical Ventilation
-ECMO
-Hydroxychloroquine

#FOAMed #FOAMcc @ACOEP
Anticoagulation in #COVID19

-Admitted pts = weight based prophylaxis (unless contraindications)
-IMV = therapeutic anticoagulation
-Intermediate dosing has ZERO evidence base
-Thrombolysis --> Only if other indication (i.e. MI, PE, CVA)

#FOAMed #FOAMcc @ACOEP
Awake Proning in #COVID19

-Will not work on everyone
-Longer duration is better than shorter duration
-Pts require frequent assessments as they can become prone and O2 dependent (DO NOT ADMIT to Regular Floor)

#FOAMed #FOAMcc @ACOEP
Read 6 tweets
Salim R. Rezaie, MD Profile picture
12 Oct 20
COVID-19: An EBM Take Part 1 at #ACOEP20

-When to Change Practice
-N95 Reuse
-Corticosteroids
-Remdesivir
-Convalescent Plasma

#FOAMed #FOAMcc
When to Change Practice

Expedited thirst for info & rapidity of pandemic lead to abbreviated peer review, publication of unvalidated data, retraction, and dissemination through press release

When to change = multidisciplinary discussion to set standard care at each institution
N95 Decontamination and Reuse

Make sure technique kills virus BUT doesn't affect filtration or fit
Best options: Vaporized H202, UV Light 260 - 285nm, or Time based strategy
2nd Best options: Autoclave 121C or Dry Heat 70C
Not an Option: 70% Ethanol
Read 7 tweets

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