Discover and read the best of Twitter Threads about #EmergencyMedicine
Most recents (24)
Drug of choice for ANAPHYLAXIS in a patient with no response to Epinephrine?
Patient is on Propranolol 60 mg BD for essential tremors.
#MedTwitter #emergencymedicine #CriticalCare
Patient is on Propranolol 60 mg BD for essential tremors.
#MedTwitter #emergencymedicine #CriticalCare
Which drug should be given?
#MedTwitter #MedEd #MedicalStudentTwitter #IMGs #IMG #medicaleducation #medicalinternship #medicineresidency #internalmedicine #doctors #madaktari #Medicos #medicina #médecins #Medizin #Likitoci #medicine #medical #FOAMed #FOAMim #FOAM4GP
#MedTwitter #MedEd #MedicalStudentTwitter #IMGs #IMG #medicaleducation #medicalinternship #medicineresidency #internalmedicine #doctors #madaktari #Medicos #medicina #médecins #Medizin #Likitoci #medicine #medical #FOAMed #FOAMim #FOAM4GP
Anaphylaxis is a severe, life threatening systemic hypersensitivity reaction characterized by being rapid in onset with potentially life threatening airway, breathing, or circulatory problems and is usually, although not always, associated with skin and mucosal changes.( ICD-11)
A summary thread from the great Emergency Medicine Australasia issue I finally read on the plane; @EMAJournal #foamed
Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%).
Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%).
@EMAJournal #emergencymedicine
surf injuries were mostly lower c-spine
NEXUS underperformed compared to Canadian C-spine.
#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns
surf injuries were mostly lower c-spine
NEXUS underperformed compared to Canadian C-spine.
#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns
@EMAJournal [my $0.02 on immobilising (virtually) anyone prehospitally: cervical immobilisation is a myth: collars don't actually immobilise, and 'immobilisation' doesn't actually prevent neurological injury...it *does* however harm (eg aspiration and other harms)]
What can we learn from buprenorphine precipitated withdrawal in the ED/hospital? A 🧵 @AustinKilaru @JMPerroneMD @kit_delgadoMD @m_lowenstein @especially_APT @JACEPOpen @NIDAnews @PennMedicine #emergencymedicine #toxtwitter
#1 Check those COWS Scores. 4 out of 13 cases of PW, got bupe for COWS scores of less than 8 (see below). Also important to check COWS scores shortly after getting bupe to make sure they are actually getting better. Great place for ordersets to improve care
#2 PW from traditional bupe inductions is real! Definitely a concern in the fentanyl era. We had patients develop PW after greater than 12 hours (sometimes even longer) since last opioid use. people who use fentanyl might be at higher risk
“Ten tips to optimize #vasopressors use in the critically ill patient with #hypotension.” #IntensiveCare #MedTwitter #CardioTwitter #sepsis #FOAMed #FOAMcc #CriticalCare #EmergencyMedicine #PedsICU #ICU #EMCCM
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
1. Set goals of mean or diastolic blood pressures.
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
5. Consider agents with a different mechanism of action as a second line agent.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
Having received a number of texts and calls tonight....
as a emergency doc who studies cardiac arrest for a living: a mini thread on CPR and #cardiacarrest
#hamlin #CPR #BuffaloBills #emergencymedicine
as a emergency doc who studies cardiac arrest for a living: a mini thread on CPR and #cardiacarrest
#hamlin #CPR #BuffaloBills #emergencymedicine
2/5
cardiac arrest is when the heart stops - abruptly and with little warning
this is different than a "heart attack" when there is a blockage to a coronary artery, and USUALLY the heart doesn't stop
cardiac arrest is when the heart stops - abruptly and with little warning
this is different than a "heart attack" when there is a blockage to a coronary artery, and USUALLY the heart doesn't stop
3/5
cardiac arrest is 100% fatal UNLESS actions are taken immediately - those actions include CPR and the use of a defibrillator
cardiac arrest is 100% fatal UNLESS actions are taken immediately - those actions include CPR and the use of a defibrillator
🚨🚨🚨The latest competition ratio for #EmergencyMedicine is huge and increased from previous years. As it’s application season again and I’m invested in seeing so excellent people join my specialty here’s a thread in my tips for applying ☺️
1️⃣ Here’s your recruitment timeline for this year -
Be aware of the dates - you’ll have to have evidence for any points you’ve assigned yourself in the application phase by the time of the interviews, so realistically by January. You’ve also only got 4 weeks to apply!
Be aware of the dates - you’ll have to have evidence for any points you’ve assigned yourself in the application phase by the time of the interviews, so realistically by January. You’ve also only got 4 weeks to apply!
2️⃣ Person specifications -
Here’s the list of essential and desirable criteria. I picked 10-15 of them and wrote a few sentences about how I fitted them to - I found this useful for interview later on.
ACCS EM ST1 Person Spec: specialtytraining.hee.nhs.uk/portals/1/Cont…
Here’s the list of essential and desirable criteria. I picked 10-15 of them and wrote a few sentences about how I fitted them to - I found this useful for interview later on.
ACCS EM ST1 Person Spec: specialtytraining.hee.nhs.uk/portals/1/Cont…
ACC & @American_Heart released a 🆕report outlining key data elements & definitions for #ChestPain & acute myocardial infarction (#MI) based on the 2021 ACC/AHA Chest Pain Guideline. Take🏠Points in🧵Below ⬇️ #cvAMI #ClinicalGuidelines #JACC @JACCJournals
@American_Heart @JACCJournals 1⃣ The #ACCClinicalDoc presents a clinical lexicon of data elements related to #ChestPain & #cvAMI, in context of how the terms are used in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR #ClinicalGuideline for the Evaluation and Diagnosis of Chest Pain: bit.ly/3CIBldf
2⃣ This lexicon follows the plans contained in the new #chestpain guideline and NOT all conceivable types and causes of chest pain are considered here. #ClinicalGuidelines @JACCJournals
‼️ #CriticalCare #Tweetorial ‼️
🫁 Tracheostomy Basics & Trach Emergencies 🫁
Join me on a review tracheostomy tube basics and can't miss emergency situations!
#EmoryNCCTweetorials
#FOAMcc for #CritCare #EmergencyMedicine #HospitalMedicine #MedEd #Neurocrit #PulmCrit
1/🧵
🫁 Tracheostomy Basics & Trach Emergencies 🫁
Join me on a review tracheostomy tube basics and can't miss emergency situations!
#EmoryNCCTweetorials
#FOAMcc for #CritCare #EmergencyMedicine #HospitalMedicine #MedEd #Neurocrit #PulmCrit
1/🧵
Goals for this #Tweetorial
1-Review basics of the tracheostomy tube
2- Review anatomy relevant to tracheostomy placement
3- Safety tips for your inpatients with trachs
4- Review emergency situations relevant to trachs
2/🧵
1-Review basics of the tracheostomy tube
2- Review anatomy relevant to tracheostomy placement
3- Safety tips for your inpatients with trachs
4- Review emergency situations relevant to trachs
2/🧵
Lets start with a case...
60s y/o male with a left basal ganglia ICH 🧠 who is now s/p bedside percutaneous tracheostomy placement 4 days ago. You are called into the room for a high pressure alarm 🚨
What is your first step?
3/🧵
60s y/o male with a left basal ganglia ICH 🧠 who is now s/p bedside percutaneous tracheostomy placement 4 days ago. You are called into the room for a high pressure alarm 🚨
What is your first step?
3/🧵
Today's pearl is about Salicylate☠️!
Toxicity is most often seen with acetylsalicylic acid (Aspirin), but also methyl salicylate (Oil of Wintergreen- 5 mL = 22 aspirin), bismuth subsalicylate (Pepto-Bismol), teething gels, & headache preparations (BC Powder) ingestion
🧵1/11
Toxicity is most often seen with acetylsalicylic acid (Aspirin), but also methyl salicylate (Oil of Wintergreen- 5 mL = 22 aspirin), bismuth subsalicylate (Pepto-Bismol), teething gels, & headache preparations (BC Powder) ingestion
🧵1/11
- Mechanism of Action:
Uncouples oxidative phosphorylation & ↑Renal NaHCO3 excretion➡️AG Metabolic Acidosis
Stimulates medullary 🫁 drive ➡️ 1° respiratory alkalosis
- Clinical: Tinnitus, N/V, Tachypnea/Hyperpnea, AMS & Hyperthermia (late)➡️⚠️RAPID DECOMPENSATION
🧵2/11
Uncouples oxidative phosphorylation & ↑Renal NaHCO3 excretion➡️AG Metabolic Acidosis
Stimulates medullary 🫁 drive ➡️ 1° respiratory alkalosis
- Clinical: Tinnitus, N/V, Tachypnea/Hyperpnea, AMS & Hyperthermia (late)➡️⚠️RAPID DECOMPENSATION
🧵2/11
- Labs: Order at minimum BMP, HFP, VBG, Salicylate /APAP lvl, EOTH, UA,EKG
Salicylate Lvls:
Acute Tox:
15 - 30 mg/dl = therapeutic range
>30 mg/dl = symptoms begin
> 90-100 mg/dl = severe toxicity
Chronic Tox:
40-60 mg/dl = severe toxicity
🧵3/11
Salicylate Lvls:
Acute Tox:
15 - 30 mg/dl = therapeutic range
>30 mg/dl = symptoms begin
> 90-100 mg/dl = severe toxicity
Chronic Tox:
40-60 mg/dl = severe toxicity
🧵3/11
Happy Monday to all my new/existing follows! So excited many people are willing to share their experiences with racism and are READY to dismantle it! I’m a nurse, speaker @NSB_Speakers, writer @ByBlacks, medical contributor @CBCNews @globalnews @CP24 and podcaster @GrittyNurse!
I discuss & advocate for #mentalhealth #healthequity #poverty.
I am mom of neurodivergent twins and a little girl. I am a #autism & #disability advocate and anti-racism educator who specializes in anti-racism in healthcare. I’m also an intersectional feminist! #Speaker
I am mom of neurodivergent twins and a little girl. I am a #autism & #disability advocate and anti-racism educator who specializes in anti-racism in healthcare. I’m also an intersectional feminist! #Speaker
I have also advocated for #nursing as a profession, discussed the intersection of policy and healthcare and openly advocate for healthy and safe work environments free from bullying and harassment (got no time for bullies!) #NurseTwitter
1) Welcome to a new #accredited #tweetorial about an important complication of #pulmonaryembolism (#PE): chronic thromboembolic pulmonary hypertension #CTEPH. Follow this thread to earn 0.75h CE/#CME #physicians #physicianassociates #NPs #nurses #pharmacists.
2) I am Jason Weatherald @AlbertaPHdoc of @UAlberta and you may recall my previous tweetorial in this feed. It's still available for credit at cardiometabolic-ce.com/pah2/. @cardiomet_CE is your ONLY home for earning CE/#CME entirely on Twitter! Howdy to @vic_tapson @lauralynndonah1
3) This program is intended for #healthcare providers and is supported by educational grants from Actelion, Bayer, Chiesi, & AstraZeneca. Faculty disclosures are listed at cardiometabolic-ce.com/disclosures/. Prior programs, still available for credit, are at cardiometabolic-ce.com
1) Welcome to a new #accredited #tweetorial on parenteral #antiplatelet therapy in #neurovascular interventions. Our expert author is Fawaz Al-Mufti MD @almuftifawaz, interventional #neurologist Interventional Neurologist @NYMedcollege @WestchesterMed @neurocritical @svinsociety
2) This program is intended for #healthcare providers & is accredited for 0.5h CE/#CME for #physicians #PhysicianAssociate #nursepractitioner #nurse #pharmacists and is supported by educational grants from AstraZeneca, Bayer, and Chiesi.
3) Be sure to see prior tweetorials on #antiplatelet management, still available for credit, at cardiometabolic-ce.com/category/plate…. Faculty disclosures are listed at cardiometabolic-ce.com/disclosures/.
Another #CriticalCare #Tweetorial!
🫀Left Ventricular Assist Device for the non-cardiologist🫀
Join me on a journey through LVADs with some #FOAMcc highlights useful for #CritCare #EmergencyMedicine #HospitalMedicine #Meded
#EmoryNCCTweetorials
@CardioNerds @emoryheart
1/🧵
🫀Left Ventricular Assist Device for the non-cardiologist🫀
Join me on a journey through LVADs with some #FOAMcc highlights useful for #CritCare #EmergencyMedicine #HospitalMedicine #Meded
#EmoryNCCTweetorials
@CardioNerds @emoryheart
1/🧵
Goals for this #Tweetorial
1-Review the basics of what an LVAD is and does
2-Discuss indications for an LVAD
3-Review some common complications of the device itself
4-Review systemic complications of an LVAD
2/🧵
1-Review the basics of what an LVAD is and does
2-Discuss indications for an LVAD
3-Review some common complications of the device itself
4-Review systemic complications of an LVAD
2/🧵
Lets start with some basics of the LVAD. Historically the two most commonly encountered are the Heartmate 3 and the Heartware.
We will focus on the Heartmate 3 (Shown below)
3/🧵
We will focus on the Heartmate 3 (Shown below)
3/🧵
1/7: POCUS Pearl!: Calculating EF Using Simpson's Biplane Method (without math!!) - A Tweetorial: @PennUltrasound @3jeffkramer @Novaleda @cruhlmoore @runawaycar09 @williamhui @Rpourmir @nilan_schnure
2/x: Start with obtaining 2 views above: Apical 4 chamber and Apical 2 chamber. To obtain Apical 2 chamber rotate your probe 90 degrees from A4C view while keeping LV in center (probe marker away from patient or toward ceiling in this case) *Note: My view is too cephalad for A4C
3/x: Try to make sure you are getting a true apical view in each case to most accurately depict chamber size. Apex wall will be thinnest compared to rest of LV and most elongated (base to apex) if you are truly apical.
Today's #POCUS lecture by @mtabbut about the FAST exam in Hemodynamically Pediatric Blunt Abdominal Trauma. #MetroEUS
Aggregate sensitivity of FAST for all intra-abdominal injuries is low. Specificity is high. Remember though, the FAST was designed to look for FF, not all injuries. So if the injury is not associated with FF, the FAST will likely not see it.
So what can we do to increase the sensitivity of the FAST? Serial exams and adjunctive labs.
Thank you to everyone who responded to our call below.
All signposts to resources/networks/committees will appear in the following Wiley texts (if proposals accepted), see thread 🧵👇🏻
#AdvancedPractice #ACP #ACCP #SCP #CNS #FCP #ANP @HonoraryGeordi_
All signposts to resources/networks/committees will appear in the following Wiley texts (if proposals accepted), see thread 🧵👇🏻
#AdvancedPractice #ACP #ACCP #SCP #CNS #FCP #ANP @HonoraryGeordi_
📕#ACP at a glance - approved, due in print Autumn/Winter 2022
📙#AdvancedPractice Framework (APF) for UK practice - approved, due in print Autumn/Winter 2022
📘 APF for Acute, Emergency & Crit Care - proposal under peer review
#CriticalCare #emergencymedicine #ACCP #ECACP
📙#AdvancedPractice Framework (APF) for UK practice - approved, due in print Autumn/Winter 2022
📘 APF for Acute, Emergency & Crit Care - proposal under peer review
#CriticalCare #emergencymedicine #ACCP #ECACP
📗 APF for #Paediatric & Child Health - proposal in development
📙 APF for MH, LD & Autism - initial expressions of interest (EOIs)
📕 APF for #PrimaryCare - initial EOIs
📘 APF for #Frailty , Rehabilitation & community-based care - (initial EOIs!)
#AdvancedPractice #ACP #AP
📙 APF for MH, LD & Autism - initial expressions of interest (EOIs)
📕 APF for #PrimaryCare - initial EOIs
📘 APF for #Frailty , Rehabilitation & community-based care - (initial EOIs!)
#AdvancedPractice #ACP #AP
Why is there so much talk about ambulance offload delays? A look into the process, challenges, and solutions (a 🧵).
While not a new problem, there has been increased conversation on ambulance offload delays as we weather this latest COVID surge. Systems all over the world are struggling to get ambulances back in service in a timely manner after transporting pts to the hospital.
@NEMSISTAC nationwide data shows offload times (elapsed time from the arrival of an ambulance with a pt to the ED until the ambulance is back in service) have increased and spiked at various times in 2020 & 2021 (red + purple lines) compared to 2018 & 2019 (blue + green lines).
I am trying to understand this response. Yes, #mentalhealth access is very limited & victims of abuse or domestic violence are at risk: ~3 women are killed daily by domestic violence.
Generational trauma can create perpetrators in subsequent generations. #GhislaineMaxwell
Generational trauma can create perpetrators in subsequent generations. #GhislaineMaxwell
As a #pediatrician I have one signed papers & worked with authorities to evaluate a family situation, even remove children from a home.
Working in #emergencymedicine we also had children boarding for days due to lack of access.
Access *is* limited.
wbur.org/news/2021/02/0…
Working in #emergencymedicine we also had children boarding for days due to lack of access.
Access *is* limited.
wbur.org/news/2021/02/0…
As I learned more about disparities & social justice & bias, I began to understand that *the system* is the source of “broken” Black & brown families, criminalizing certain parenting while much worse is *not* identified in privileged families.
time.com/5946929/child-…
time.com/5946929/child-…
This makes me so 🤢
The idea that women are automatically “safe” is exactly what creates this “opportunity” for some women to exploit children & monetize their “optics” of “trustworthy” on behalf of predators.
Gender does not predict ethics, integrity, safety.
The idea that women are automatically “safe” is exactly what creates this “opportunity” for some women to exploit children & monetize their “optics” of “trustworthy” on behalf of predators.
Gender does not predict ethics, integrity, safety.
Why does #GhislaineMaxwellTrial matter to #womeninSTEM?
⬇️federal funding
➡️private donors (Epstein)
“Socialites” open doors to elite spaces, including #academia #science #STEM
Women=“optics” & “reputation management” for these wealthy predator men
theverge.com/2019/9/19/2087…
⬇️federal funding
➡️private donors (Epstein)
“Socialites” open doors to elite spaces, including #academia #science #STEM
Women=“optics” & “reputation management” for these wealthy predator men
theverge.com/2019/9/19/2087…
These same connected women, often daughters of powerful businessmen
are on boards of #WomeninSTEM “empowerment” organizations or on #MeToo (TimesUp scandal)
the very women who are predators of young women are given access to women’s “safe spaces”? (!!!)
bustle.com/entertainment/…
are on boards of #WomeninSTEM “empowerment” organizations or on #MeToo (TimesUp scandal)
the very women who are predators of young women are given access to women’s “safe spaces”? (!!!)
bustle.com/entertainment/…
Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_CE. #Emergencymedicine #thrombosis researcher @md_pollack will be discussing safe, effective management of selected patients with venous thromboembolism (#VTE) from the #emergencydepartment.
It used to be SOOO much more complicated, but since we entered the era of the #DOACs, #lifeisgood! #Physicians #nurses #pharamcists all work together to make it happen, and all can earn CE/#CME here! @AlexSpyropoul @ScottKaatz @RenatoDLopes1 @GenoMerli @aakonc @vic_tapson
1) Welcome to a #tweetorial on the safe and effective management of acute venous #thromboembolism (#VTE) directly from the #emergencydepartment. This program is accredited for 0.50 credits for #physicians #nurses #pharmacists by @academiccme! I am @md_pollack.
This 🧵 resonated. Trained in Houston, #asthma central, I was in this scenario SO many times.
I had the best #pediatric training at @TexasChildrens & @bcmhouston - you see it all.
Amazing that mere tweets can transmit humane, quality #MedEd teaching across the globe.
I had the best #pediatric training at @TexasChildrens & @bcmhouston - you see it all.
Amazing that mere tweets can transmit humane, quality #MedEd teaching across the globe.
After moving to Boston I found myself surrounded by highly anxious doctors. We have an over abundance of resources and a healthier population. I saw people quick to overreact and manage (poorly) their own anxiety & need for control, with harmful aggressive overintervention.
I also do get being “Harvard” makes one a target. Juries are not going to understand “at the brink of death” and not intubating or the equivalent action in another scenario. “Jury of peers” is not present in a malpractice case. Good care can seem negligent, paradoxically.
Doing a 🧵 of @EM_RESUS’s thread with screenshots.
We see a lot of screenshots of what is wrong in #SciComm.
What went right here? How can one doc transmit knowledge & confidence to another so well via a series of tweets?
We see a lot of screenshots of what is wrong in #SciComm.
What went right here? How can one doc transmit knowledge & confidence to another so well via a series of tweets?
First: what was the outcome of the #SciComm? Intention matters little as communitarian happens on the terms of the listener/reader. How was your #communication received/understood?
A doc:
recognized similar scenario
calmed team
avoided overaggression
achieved a similar result
A doc:
recognized similar scenario
calmed team
avoided overaggression
achieved a similar result
The fact that the #MedEd teaching allowed an EQ & #leadership outcome (staying course despite others’ anxiety), not merely medical knowledge/journal club, is striking. How was this achieved? Let’s look at the thread. How do you transmit courage AND knowledge via tweets in a 🧵?
Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_ce. #Emergencymedicine researcher and devotee of deep understanding of drug mechanism of action @md_pollack will be considering why being #nonsteroidal means better #MRA. Don't miss it! @GoggleDocs
@drkevinfernando @kidney_boy @KateIsabelle24 @SantosGallegoMD @aayshacader @VietHeartPA @Lross246 @SeguraCardio @ValleAlfonso @edgarvlermamd @nephondemand @DrRaniKhatib @HanCardiomd @SABOURETCardio @ChristosArgyrop @JavedButler1 @Steph_Achenbach @mvaduganathan #cardiotwitter
1) Welcome to a #tweetorial where we’ll explore the mechanism of action of mineralocorticoid receptor antagonists (#MRA) & consider why it's so #vogue to be #nonsteroidal. This program is accredited for 0.50 credits for #physicians #nurses #pharmacists. I am @md_pollack. #FOAMed
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?
