Emergency Medicine News
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Our July issue is out!
Make your month more enjoyable with articles from
@Rick_Pescatore
@blakebriggsMD
@matt_bivens
@edwin_leap
@ERGoddessMD
@3rdRockUS
@writergina
@brandtwriting
Ruth SoRelle, MPH; & Robyn Hitchcock, MD, at
#FOAMed
0
0
2
2/2 Dr Laughrey’s reaction to a child’s death was a reminder of the work EPs do every day and the humanity they bring to the world’s toughest job. Unfortunately, Dr Laughrey died Feb 27. We honor his commitment to emergency medicine and his patients with this photo one more time.
9
144
286
.
@edwinleap
: Much of what patients need in discharge instructions is a little less technical education and a little of the God’s honest truth that will actually help them (Don’t run these past legal!)
96
53
167
.
@Rick_Pescatore
spoke up the NRA & Ann Coulter. If you liked his tweet (691,000+ RTs!), you’ll love his column and podcast with
@AliRaja_MD
:
#ShamelessSelfPromotion
#ThisIsOurLane
2
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99
A damaging clot caused by
#arterialbloodgas
drawn from the
#radial
#artery
left
@matt_bivens
with a wariness of the
#ABG
.
He says
#EPs
should think twice about ABG. Instead, opt for a
#VBG
; it adds no pain or risk & reliably tracks
#pH
in
#DKA
.
#FOAMed
9
38
106
Do you have a patient with a worse-than-mild case of
#alcoholwithdrawal
? Consider
#phenobarbital
#IV
in place of a
#benzodiazepine
, writes
@M_Lin
with a shoutout to
@PulmCrit
.
#FOAMed
3
21
106
A 23yo woman at an electronic dance music festival had sudden onset of dyspnea, anxiety, & cyanosis.
@tayburkholder
says she ingested a small bottle of liquid that others were inhaling.
#whatsthediagnosis
#FOAMed
10
10
99
Potentially diagnosing a
#hypertensive
emergency? There’s an algorithm for that, developed by
@thame
.
#FOAMed
2
22
82
An EP spending an hour in critical care bay shouldn't get reprimanded by administration for decreased throughput. He should be thanked for saving a life.
#physicianburnout
1
18
73
If your patient’s vitals start to crash with
#bradycardia
and
#hypotension
, think of
#BRASHsyndrome
.
@M_lin
says BRASH can worsen
#hyperkalemia
and cause renal failure. Here’s how to treat it.
#FOAMed
2
19
70
When a pilot delays a flight for safety, the airline CEO doesn't tell him to depart immediately because of growing number of passengers at gate. The same should be true for patients in the
#ED
waiting room.
#physicianburnout
1
36
68
With
#hospitals
crowded and understaffed and many
#patients
spending hours lying on stretchers in
#ED
hallways,
@CMO_doc
says it’s time
#EPs
consider a new specialty:
#hallwaymedicine
.
1
28
69
When considering pharmacologic options for stable
#Vtach
, the wrong choice could end in a “clean kill,” as
@amalmattu
says.
@L_swish
says a regular really wide complex
#tachycardia
is a good clue about how to proceed.
#FOAMed
4
17
60
When considering pharmacologic options for stable
#Vtach
, the wrong choice could end in a “clean kill,” as
@amalmattu
says.
@L_swish
says a regular really wide complex
#tachycardia
is a good clue about how to proceed.
#FOAMed
6
21
60
Join us in congratulating
@ERGoddessMD
for receiving a Grand Award for Writing in the APEX 2018 Awards for her Emergency Medicine News article, “Enough!” about how administration and employers tried to censor her and other EPs:
#womeninmedicine
#womeninEM
11
13
56
Dr. James Roberts and
@proceduralpause
spell out the A to Z in managing
#ankledislocations
, a common ED presentation that can be dastardly if not treated properly
#FOAMed
#blog
#video
2
25
57
PARAMEDIC2 trial randomized 8014 pts to
#epinephrine
or placebo and found increase in
#ROSC
and survival, but survivors had increased neurological devastation. Use epi judiciously. says
@coreyslovis
A thread from
#AAEM23
13
9
57
The name
#STEMI
cognitively inspires EPs to fail at the reperfusion decision because it makes clinicians believe that the ST segment is the only ECG finding predictive of occlusion
#myocardialinfarction
#FOAMed
@smithECGBlog
@PendellM
@EM1MinuteGuru
2
30
53
The
#EMmatch
was a disaster bc
#EM
leaders failed
#EPs
and
#residents
, says
@3rdRockUS
. He says EM must not open new residencies, corral NPs & PAs, & pressure ACEP
@EmergencyDocs
to divest itself of corporate medicine. And that
@RobertMcNamar12
was right.
4
22
55
EPs like
@ApparentLiMD
and
@DrLISAMORENO1
, president of
@aaeminfo
, push back against
#ACEP
lecturer who said EDs should use the least expensive resource to staff the department, even GPs, NPs, and PAs.
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34
52
It is with a heavy heart that we report that EMN’s longtime board chair and human extraordinaire James R. Roberts, MD, died yesterday. Our condolences to his family, friends, and colleagues. Read our editor’s tribute here:
3
13
54
Ankle dislocations can occur from all kinds of blunt/traumatic incidents. Watch this preview of the next blog from Dr. James Roberts &
@proceduralpause
for tips on reducing them. Find more in their next blog, going live March 1 at
#FOAMed
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Physicians can use public health methods to identify the causes of
#gunviolence
, those who are at risk, and what can prevent or mitigate injuries with the help of groups like
@ResearchAffirm
#ThisIsOurLane
1
22
44
Recent studies have suggested no benefit of a
#bolusprimer
of
#insulin
, which has a theoretical risk of iatrogenic
#hypoglycemia
. This is why
@M_Lin
says to go straight to the insulin drip for
#DKA
.
#FOAMed
1
19
50
An
#epistaxis
management analysis found
#TXA
superior to nasal packing. Merocel sponges and
@SmithNephewPLC
's Rapid Rhino were also top options for
#nosebleeds
, says
@matt_bivens
#FOAMed
2
11
47
#Appendicitis
is a sneaky, difficult
#diagnosis
.
@blakebriggsMD
says don’t trust clinical decision rules (even
#Alvarado
), make
#ultrasound
a first-line test, and follow
@EmergencyDocs
’ new clinical policy.
#FOAMed
#FOAMus
0
13
47
Have you seen our latest issue? It covers EM
#residents
losing procedures to
#NPPs
, more analysis of the 2023
#EMmatch
, diagnosing
#aorticdissection
, whether
#NSAIDs
hinder fracture healing, and much more. Read it now at
#FOAMed
0
10
47
June 2016: Still using C-collars? Read this to find out why you should stop.
#FOAMed
#bestof2016
0
44
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0
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#Bestof2020
for Oct: A new paradigm for AMI mgt challenges ST segment as only finding predictive of occlusion
#FOAMed
@smithECGBlog
@PendellM
Oct runner-up: Exorcising the CMG Demons of Emergency Medicine by Saba Rizvi, MD
0
19
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Bad news for
#emergencymedicine
: 555
#residency
slots were unmatched.
@3rdRockUS
@RobertMcNamar12
@Rick_Pescatore
6
10
42
.
@blakebriggsMD
wants to dispel the
#myth
that using
#lidocaine
with
#epinephrine
can cause skin
#necrosis
.
#FOAMed
1
6
41
Inhaled isopropyl alcohol has shown promise as an antiemetic, and may be superior to oral
#ondansetron
via
@EMedHome
#FOAMed
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26
42
What do
#EPs
do if a critically ill patient needs more rapid
#potassium
repletion for
#hypokalemia
but does not have a central line?
@M_Lin
says with a trick of the trade.
#FOAMed
2
12
40
.
@M_Lin
says not all cases of
#vomiting
in
#pregnancy
should be treated with
#ondansetron
as a first-line approach—start with safer, proven medications first to avoid unclear risks to the fetus
#FOAMed
1
15
40
.
@Rick_Pescatore
says regional
#anesthesia
for
#headache
like the
#sphenopalatine
ganglion block,
#bupivacaine
&
#occipitalnerveblock
should be part of every EP’s armamentarium
#FOAMed
0
20
38
#Appendicitis
is a sneaky, difficult
#diagnosis
.
@blakebriggsMD
says don’t trust clinical decision rules (even
#Alvarado
), make
#ultrasound
a first-line test, and follow
@EmergencyDocs
’ new clinical policy.
#FOAMed
#FOAMus
0
12
38
.
@M_Lin
says evidence shows checking the coagulation profile of patients, including INR levels and platelet counts, before
#paracentesis
may not be necessary to prevent severe bleeding from the procedure
#FOAMed
0
18
38
Fight, flight, or freeze: stress training helps EPs pick the right move
@michaelmallin
@HumanFact0rz
@ResusPadawan
1
42
36
How to avoid falling for
#stroke
mimics and chameleons?
@EvieMarcolini
says go back to the basics—a thorough physical exam and complete neurological exam
#FOAMed
#FOAMneuro
0
6
21
A new study asserts
#ED
#intubations
are harming
#trauma
patients. But
@matt_bivens
says researchers missed the point:
#EPs
deal with more severely injured pts, ED
#intubation
may signal
#OR
dysfunction, & hospitals must resource trauma services better.
0
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34
Blade size matters when it comes to intubation.
The Mac 3 has been the standard for adult endotracheal intubation, but many in EM now say the Mac 4’s longer length is better. But is it?
@blakebriggsmd
looks at the data to find out.
#FOAMed
3
7
34
July 2017: Docs need to act fast when treating suspension syndrome, which can kill within 30 mins
#FOAMed
@hawk_sc
@Pearcebeis
#BestOf2017
1
31
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How long should EPs observe patients with
#anaphylaxis
for another episode?
@M_Lin
has some suggestions for this condition that occurs in 5% of patients.
#FOAMed
2
10
33
Potentially diagnosing a
#hypertensive
emergency? There’s an algorithm for that, developed by
@thame
.
#FOAMed
1
14
32
Equating acute
#abdominal
pain & older age w/ needing an
#abdominopelvis
#CT
should be system 1 thinking. Learn why from
@M_Lin
.
#postitpearls
#FOAMed
4
7
31
.
@M_Lin
says not all cases of
#vomiting
in
#pregnancy
should be treated with
#ondansetron
as a first-line approach—start with safer, proven medications first to avoid unclear risks to the fetus
#FOAMed
2
12
31
A 22yo man w/ no significant medical history presents w/ bilateral leg weakness so severe that he cannot walk. What does his
#ECG
show?
#whatsthediagnosis
#blog
#FOAMed
@EM1MinuteGuru
9
18
29
.
@nyphospital
&
@WeillCornell
now offer telemedicine consults to disaster response in Puerto Rico
#HurricaneMaria
1
11
30
.
@edwinleap
says the latest hospital policy banning food and water from ED staff’s workspaces is yet another way of exerting control over those actually engaged in the hard work of saving lives
2
17
30
Here’s a firsthand account of what’s working for evaluating and treating
#COVID19
patients, straight from two EPs in the epicenter
@steven_jejunum
@dgottmd
1
19
29
@amalmattu
: If you're not repeating ECGs, you're missing STEMIs. Study found 85% of STEMIs diagnosed with first ECG; 15% with second ECG. Repeat the ECG if first is normal but patient has ongoing symptoms.
#AAEM18
1
22
28
.
@Rick_Pescatore
is the new chairman of our edit board! And in some heartwarming continuity, he will write InFocus, which Jim Roberts took on when he became bd chair.
Announcement , his vision , his 1st column
4
2
29
Lactated Ringer’s does not cause
#hyperkalemia
, according to
@blakebriggsMD
; NS is the dangerous one, causing
#metabolicacidosis
.
#FOAMed
6
6
27
#VExUS
protocol authors theorized they could get a better idea of a patient’s true volume status by thinking beyond just an evaluation of the
#inferiorvenacava
.
@EMNSpeedofSound
shows how.
#FOAMus
#FOAMed
1
14
28
.
@grahamwalker
says he feels the best he has in years, lost 10 pounds, and his body is in the best shape it’s ever been. His secret?
#Intermittentfasting
2
8
26
Forget IV vs IO in
#OHCA
,
@blakebriggsMD
says. Instead,
#EM
should work on decreasing delays to
#CPR
and shortening the time to
#defibrillation
.
#FOAMed
#FOAMcc
0
8
28
.
@Rick_Pescatore
says regional
#anesthesia
for
#headache
like the
#sphenopalatine
ganglion block,
#bupivacaine
&
#occipitalnerveblock
should be part of every EP’s armamentarium
#FOAMed
1
11
28
Recent studies have suggested no benefit of a
#bolusprimer
of
#insulin
, which has a theoretical risk of iatrogenic
#hypoglycemia
. This is why
@M_Lin
says to go straight to the insulin drip for
#DKA
.
#FOAMed
0
10
28
We're going to figure out a way to put these on our website to print out so everyone can have one. :) Stay tuned!
1
4
27
We all know ED crowding is a huge problem. But how do we fix it?
Kruti Shukla, MD, found 34% of patients referred to her ED were sent by a medical provider, often w/ poor or no communication. To fix crowding, she says, EM needs to fix referrals.
4
11
26
#Ketamine
is adaptable and safe for
#pain
control in the
#ED
and allows
#EPs
to avoid
#opioids
or use a multimodal
#analgesic
approach, writes
@Rick_Pescatore
.
#FOAMed
0
16
26
#Acetaminophen
overdoses are so commonly seen in the
#ED
that it’s easy for
#EPs
to think they know everything about these
#poisonings
.
But
@poisonreview
says
#APAP
#poisoning
has nuances that still haven’t been completely parsed.
#FOAMed
#FOAMtox
0
14
26
.
@Rick_Pescatore
says
#doxepin
and
#mirtazapine
are safe and efficacious options to combat chronic or refractory
#urticaria
when standard
#antihistamines
have failed
#FOAMed
2
6
25
Inhaled isopropyl alcohol has shown promise as an antiemetic, and may be superior to oral
#ondansetron
via
@EMedHome
#FOAMed
1
19
26
Happy
#MatchDay2019
! Tweet us your photo and tell us which
#emergencymedicine
program you matched, and we'll retweet you. Congratulations!
0
2
26
Is a patient’s
#ASTelevation
higher than his
#ALTelevation
? EPs should consider acute
#rhabdomyolysis
, says
@M_Lin
.
#FOAMed
1
6
26
Docs need to act fast when treating suspension syndrome, which can kill within 30 mins
#FOAMed
@hawk_sc
@Pearcebeis
1
24
25
Buy an
#AppleWatch
, marry an emergency physician, survive a
#heartattack
. That’s exactly what happened to Dr. Jill Eippert’s husband, who sent this
#ECG
taken on his
@apple
smartwatch to her
0
6
24
A 32yo man with a history of Wolff-Parkinson-White syndrome presents with palpitations after running. What does his
#ECG
show?
@EM1MinuteGuru
#whatsthediagnosis
#FOAMed
2
11
24
.
@emswami
debunking myths about kayexalate for hyperkalemia.
#FOAMed
http://t.co/abwcEEEv2v
http://t.co/rJxeS8Zijh
0
23
24
#EPs
are used to seeing the impact of
#gunviolence
at work, but
@ERGoddessMD
now knows firsthand after her son’s 16yo friend died in a shooting. She says no one should accept gun violence as normal.
@meganranney
@ResearchAFFIRM
#ThisIsOurLane
1
6
24
.
@M_Lin
says corner
#sutures
have multiple benefits compared with using simple intercepted sutures to close lacerations, such as lowering the risk for tissue necrosis and minimizing wound gaps
#PostItPearls
#FOAMed
0
18
23
Many
#ED
pts say their dr told them “go to the ER.”
@ERGoddessMD
thought they must be wrong … until it happened to her son.
She says this advice often comes from a nurse or office staff, & it’s one way
#EPs
bear the brunt of a broken
#healthcare
system.
1
11
24
.
@poisonreview
says the
#osmolalgap
, often used in a misguided attempt to rule in or out toxic alcohol exposure, is a stupid test and never changes management in a good way
#FOAMed
#FOAMtox
1
14
23
Like pilots can't control the weather,
#EPs
can’t control how busy the ED is or how long wait times are. So why do EPs stand for performance metrics like those?
#physicianburnout
1
12
23
That's the modern version of my dog ate my homework. We approve, and give your puppy 11/10. 🐶😍
Dear
@EMNews
-
I’m TRYING to finish my overdue column, but someone has other ideas.
#CorgiLove
8
2
99
0
2
22
1/2 The emergency physician in this photo, featured on the web myriad times & in EMN twice by Rob Lam
@AAEMinfo
&
@ERGoddessMD
, has finally been identified as Thomas Laughrey, MD, of Riverside, CA. (See next tweet.)
0
18
21