EM doc | Views my own | Medical commentary on CNN, Yahoo, MSNBC, NBC. he/him/his
NJ
Joined March 2013
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When I was a resident, Dr. Goldfrank would ask us the same question on every patient we saw:
"What is the lesion in the healthcare system that brought this patient to us today?"
It was a challenge to look deeper into the root cause of emergencies
Every doctor who actually understands clinical medicine warned that this would happen
When laws are created to restrict women's choices on reproductive health, women will die
bit.ly/3TwgCkK
Challenges to EMTALA from Idaho and Texas threaten the very core of Emergency Medicine: Anyone, Anywhere, Anytime is truly at risk
Check out discussion w/ Dr. @darakass + Dr. Monica Saxena @REBEL__EM bit.ly/3VQJWnP
See this Instagram video by @emswami instagram.com/reel/C1r2ONjLe…
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Masterclass in reading past the headline + looking for the actual data
Nice work @RealCedricDark as always
This is why I still teach #JournalClub to the residents @BCMEmergencyMed.
You’ve got to learn to read beyond the headline.
#STATSandCOFFEE 🧵
Great crit shift w/ important teaching points:
1⃣Severe asthma: IM (or IV) epi, BPAP, Mg infusion, IVF load. Tiring = ⬇️RR + ⬇️TV
2⃣ICH: BP target ~160 mm Hg (or ⬇️20%)
3⃣Myasthenia: Avoid sux, 1/2 dose roc
4⃣Don't look for pathology you're not gonna act on
Acutely poisoned patient w/ AMS
Old: GCS < 8, Must Intubate
New: Withhold intubation
Why? Lower ICU utilization, lower adverse event rate bit.ly/417ezWy w/ great editorial @resusone
Check out the December #EMRAP free content: induction meds w/ @emcrit bit.ly/49YCmfr
#Intubation #RSI #emergencymedicine #criticalcare #airway #ketamine
Great crit shift @statenislandem w/ some good learning pearls:
- BP target in traumatic SAH
- SCAPE management (coreem.net/core/ape/)
- Meningitis treatment
#FOAMed #emergencymedicine
November #EMRAP Free Content: Caring for kids w/ Autism in the ED bit.ly/3MNvoQL
Great practical tips from the experts on making the visit less painful for the child #FOAMed #Autism
Crit Shift Teaching Pearls:
SVT: CCB >>>Adenosine Link: bit.ly/3rZbyLa
Stroke Workups
Wernicke’s Encephalopathy Link: bit.ly/3QzR3Oo
#emergencymedicine #cardiology #stroke #neurology
EMRAP Breaking News: CDC Draft on Masking Policy bit.ly/46IHv9t
The CDC has a draft updating hospital masking policy but does it make sense? We dive in with @celinegounder. Take a listen to her bottom line
#covid #covid_19 #emrap #foamed #n95 #masking
COVID hospitalizations continue to climb + are an indicator of climbing cases (despite low testing/reporting)
😷In public spaces
💉Get a booster if eligible (particularly if immunocompromised + > 6 mo since last vax)
🧪If symptomatic + isolate
UNOS monopoly on organ transplantation has been an unmitigated disaster w/ clear evidence of neglect, kickbacks + perpetuating racial inequity
Senate/Congress vote to overhaul the system was desperately needed bit.ly/43KKCLF
I hope this leads to better care
Worrisome giving both low overall testing + prevalence of home testing (w/o reporting)
Additionally, @CDCgov showing significant rise in hospitalizations
What can you do?
- Update booster if eligible/indicated
- Mask in indoor public places
- Test + stay home if you're sick
Glad to hear @KingJames kid is in stable condition.
This event gives us the opportunity to educate + dispel some frank lies
Short 🧵 1/
Dual antiplt therapy non-inferior to alteplase in minor stroke: The ARAMIS Trial: bit.ly/44ivdDo @JAMA_current
Echos findings from PRISMS bit.ly/2DFwev4
Based on costs + risks, this should be enough to move away from lytics in minor strokes
NEAR database shows no assoc between weight-based dose of etomidate/ketamine + post-intubation hypotension bit.ly/3XH4dLv
Take Homes:
1⃣Etom/keta don't have intrinsic, dose-related BP effects: standard dose is fine
2⃣Reduced dose propofol for induction still recommended
Same handle on threads. Come over and join the MedEd community! threads.net/@emswami
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