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Ryan Feldman PharmD DABAT Profile picture
@EMPoisonPharmD
Jan 4, 2023 • 14 tweets • 20 min read • Read on X
Scrolly
A few years ago I made a digital resuscitation game with a working cardiovascular system. A playground to play with pressors/resuscitation.

TODAY I REALIZED I COULD PLAY IT IN Virtual Reality

So I made a video. An 11 part 🧵for VR septic intubation!
#FOAMcc #FOAMed #MedEd
Part 2/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 3/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 4/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 5/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 6/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 7/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 8/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 9/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 10/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 11/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
More resources on shock and how to play the game:

Basics on shock/vasopressors go here:

For game walkthrough on PC:

Rapid tutorial:

SUPER RAPID Tutorial:
That's the end. I've used this game + YT video on shock to teach ABC's/ACLS and show Shock/Vasopressor effects in real time for years now.

If you find any of this useful please RT the tweet below to share this free resource!
#MedEd

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More from @EMPoisonPharmD

Ryan Feldman PharmD DABAT Profile picture
Mar 25
You're working in the ED when a 30 y.o male presents 30 minutes after envenomation to the right index finger by his pet snake (left).

He has a picture of culprit (right) , and it is definitely NOT from America.

A 🧵on U.S. exotic envenomation management.

(shared with consent)
Image
Image
This involved a Blue Indonesian pit viper (Trimereserus Insularis) but this could have been any exotic snake. There have been 50-110 exotic snake bites reported to Poison Centers annually since 2012.

P.S. limited free copies of report available here:
tandfonline.com/eprint/D6PYXIG…
Exotic venomous animals are found in several environments within the U.S. including zoos, homes of reptile enthusiasts, laboratories of venom milking industries, and in illegal venomous reptile trafficking rings. In this case, it was a pet of a reptile hobbyist.
Read 22 tweets
Ryan Feldman PharmD DABAT Profile picture
Jun 21, 2023
Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).

Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.

So what to do?

A 🍄🧵
#FOAMed #FoamCC #MedEd
If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.
Since we almost never have that we usually rely on history and symptoms
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Read 15 tweets
Ryan Feldman PharmD DABAT Profile picture
Jan 17, 2023
Had the opportunity to be part of a fascinating work. Americas Poison Center Annual report.

A comprehensive poisoning epidemiology study compiled of data from all 55 U.S. Poison Centers

Free 🔗➡️bit.ly/3wbIwWS
Pubmed🔗➡️bit.ly/3wdgeLP

A🧵on emerging trends
This year we highlighted two important trends in addition to baseline poisoning data.

Firstly, THC product exposures have been increasing since 2016, and the demographics are changing. In 2021, edible products (red line) eclipsed plant based marijuana (blue line) for products Image
The change in products also represents changing demographics. While Adults (gold) comprise the majority of exposures, pediatric<6 (green) is taking an ever increasing share of the THC exposure calls since 2016. Image
Read 12 tweets
Ryan Feldman PharmD DABAT Profile picture
Jan 16, 2023
We wrote this case of #fentanyl exposure w/ NO clinical effects (bit.ly/3k7I1dF) to help realign fentanyl exposure risk perception.

I thought it was one of the only confirmed cases...turns out there are quite a few.

A 🧵on NIOSH health hazard evaluations
#MedEd
If someone is concerned that hazards are interfering with their job function, NIOSH can get called in to do a field evaluation.

They review exposures, med records, forensics, and write public reports.

They have QUITE a few confirmed fentanyl reports.

cdc.gov/niosh/hhe/defa…
Like this one, where a law enforcement officer had CONFIRMED methamphetamine/fentanyl blown all over them, rubbed sanitizer on it (don't do that), felt dizzy, had hypertension, were alert, breathing normally. No Opioid effects. Back to normal in a few hrs.
cdc.gov/niosh/hhe/repo…
Read 15 tweets
Ryan Feldman PharmD DABAT Profile picture
Dec 31, 2022
Tomorrow is NYE, there will be partying, pills, and powders. Some leading to overdose.

I work in the ER NYE/NYD & expect a few "OD's" from said pills n powders. What exactly is in them?

A 🧵from Camden, a VERY human 28 y.o male, on the illicit drug supply

#MedED #FOAMed Image
Cam was out with his friends celebrating NYE with some beverages when one of his friends offered him a tan powder. Cam was pretty hesitant at first but.. ImageImage
Eventually peer pressure won. Cam gave it a try.

A few minutes after trying the substance... ImageImage
Read 27 tweets

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