Briefly, @walterlekh and others in the #OSINT community. Question about usage of #nerve agents (more likely than blister or irritant) and how to protect oneself. Carbon filters are essentially the best barriers available on the ground (car air filters for example).

🧵
#Organophosphate poisoning is punctuated by “excessive parasympathetic” nerve tone - think the “rest and digest” but in overdrive. This causes excessive salivation, bronchoconstriction (wheezing), lacrimation (tearful), airway secretions, flushing, diarrhea, vomiting, …
…muscle tremors, constricted pupils, sweating, and confusion. The first symptoms are usually salivation (makes sense; quickest to react). Treatment is atropine and 2-PAM Chloride (see Mark I Kit).
How can you protect yourself? Honestly, we don’t know how effective these are in this day and age with ubiquitous mask usage (it’s AT LEAST a barrier). My homemade masks have a pocket to put in a carbon filter if needed. I had this made since I was one of our first COVID docs.
Carbon filters, if not available, can be cut from car air filters, maybe some central air units, or frankly purchased in bulk. It’s more effective than nothing.

amazon.com/Resinta-Activa…
Here are some more carbon filters
Some enterprising individuals might consider crushing up some charcoal and pancaking non-carbon filters in these to at least provide some absorption (like, maybe a shirt, mask, whatever). You can even purify water with charcoal 🤷🏻‍♂️!
If you want to purify water with charcoal, here we go.

medium.com/final-prepper/…
Most nerve agents are heavier than air and will layer towards the ground, possibly going into bomb shelters, basements, etc. Good ventilation is always necessary (also for general hygiene and prevention of respiratory pathogens).

osha.gov/emergency-prep…
In a post-COVID world, we don’t know how effective these agents are, but it’s best to provide adequate protection when and if necessary.
Lastly, I received this letter when I was deployed once. Don’t send letters like this. I’ve saved it for years 🤣.

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More from @BrighamSK

Mar 28, 2020
Well, @TheCurbsiders, it’s been over a week since I’ve posted here… but it seems like it’s been mere days. #COVID19 has not necessarily overwhelmed our hospital system, but has absorbed our lives.

Resources will be included in this "Tweetorial"

covid19toolbox.com
Our colleages at @SCCM has put out some excellent resources for treating #COVID19 patients. I've asked all our staff to review the modules at:

sccm.org/Disaster/COVID…
Furthermore, @SCCM released some guidelines that can be helpful; however, as this information is ridiculously fast moving, these guidelines may be approaching obsolescence as time goes on.

sccm.org/getattachment/…
Read 25 tweets
Jul 6, 2019
Well @TheCurbsiders, thought I forgot about following up on this tweet?! Well, I did. I'm on the inpatient Hospitalist Service. Nevertheless, let's go down this rabid hole together...
So the question remains - what is the best pharmacologic intervention to reduce post-operative VTE after orthopedic surgery. A prior EBM presentation that I routinely give compares Apixaban vs Enoxaparin which finds that the NNT to prevent one major VTE of 166.
Great, so Apixaban may be better than Enoxaparin (with questionable cost benefit). Apparently, oral anticoagulants, in general, are likely more efficacious than Enoxaparin.
Read 8 tweets
Apr 7, 2019
Effective teamwork, like relationships, isn’t defined by the absence of conflict; if fact, without conflict, there can be no authentic growth. No, these are defined by the ability to resolve conflict, allowing divergent positions to mature into something greater. @thecurbsiders
Similarly, you will constantly find yourself in conflict, both internal and external, when dealing with, among other things, your patients and colleagues.
For your patients, seek first to understand before being understood. A “difficult” patient presents an opportunity to grow, build rapport, and develop an authentic patient-caregiver relationship that is more meaningful than just “refilling meds.”
Read 11 tweets
Mar 28, 2019
Standing up a Hospitalist Group:

(a) Disposition is key; need dedicated case managers

(b) Need to alter APP/MD schedule to prevent burnout after just one week.

(c) Need better transition tools than historical sign outs.

(d) Relationship with consultants is pivotal.
You make friends by just taking over as primary and learn from colleagues.

(e) Admit when you’re wrong.

(f) Round with the nurses, maybe at the nurse station, and include them. Teach them.

(g) Don’t be afraid to hug a patient, especially when you are their only family…
…and they are about to die.

(h) The APPs look up to you as a resident would their attending; teach them and mentor them in the same way.

(i) Ensure team members know their limitations and how to step outside of that box.

(j) If a resident asks you to take a patient, say yes…
Read 15 tweets
Mar 14, 2019
What is the most effective way to treat nocturnal cough, post-URI cough, or related to post-nasal drip? @thecurbsiders @ShreyaTrivediMD @cjchiu @medrants @InduPartha @aoglasser @ETSshow @meggerber @HannahRAbrams @cacace_frank
Answer will be given in 8-hours in a new tweetorial! Yay!
I didn’t include Benzonatate, Codeine, Steroids (that’s also in the literature from Iran), Albuterol, Nasal Atrovent, or many others, mostly because of poll limitations.
Read 12 tweets

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