I fell in love with learning after I left school.

We need additional ways to risk stratify (who is true high risk PE) and more data on say…lysis versus catheter based treatments in high risk PE patients #PERT2024

When it comes to obesity everyone is talking about weight loss drugs. Not enough are talking about fixing the broken food and pharma system that got us here.

Lots of love for LMWH by experts at #PERT2024 even from interventionists for potential for mechanical thrombectomy. Yet….we found disturbing trend in ⬆️ use of UFH in patients hospitalized with acute PE annemergmed.com/article/S0196-… 😬

All the reasons I like to sit my patients up in respiratory distress who require #intubation -Pts in Resp Distress Want to Sit Up -Remove Weight Off Chest/Diaphragm -Recruit Posterior Alveoli -Use Gravity to Prevent N/V -Better View of Cords #FOAMed #FOAMcc #Resuscitation

If you are giving 3% HTS… -GIVE IT AS A BOLUS (Not a continuous infusion) -YOU DON’T NEED A CVC (Use a PIV to limit delays) #FOAMed #FOAMcc #Resuscitation #CriticalCare

Also an EM fact. Do a cardiac and lung and possibly a full RUSH. Whether the #POCUS has normal findings or pathology, whatever you find will help you one way or another and you will not regret doing it. I promise.

It’s been an unaddressed item in house of medicine for quite some time. EM has been somewhat of a crutch as a result. #FOAMed #MedTwitter Andrew Petrosoniak

📕Hyponatremia in textbooks Elegant algorithm and diagnostic testing leads to definitive diagnosis 🤷HypoNa in real life Diagnostic tests/history are conflicting & cause is uncertain Tx: Not sick: do nothing and see what happens Sick: do something and see what happens to Na

Do you have a hard time remembering how to treat a patient with Hemophilia? What products you should use? I certainly do. This paper by Brit Long Roy Khalife might be helpful with your next hemophilia patient: rdcu.be/dVIOo #hemophilia #emergencymedicine

To celebrate Hispanic Heritage Month, we are excited to highlight some of our incredible residents. We recognize the important work and advocacy that our colleagues do daily to help serve our patients! ❤️🎉

Acute limb ischemia pearls? #FOAMed #MedTwitter Alex Sheng Josh Guttman Skyler Lentz Sree Natesan, MD (she/her) Mike Pallaci🇺🇸🇮🇹🇮🇱🇺🇦 Zaf #EndGunViolence Qasim 🇵🇰🇬🇧🇺🇸 David Carr 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Tim Montrief Dane O'Donnell Roberto Cosentini Andrew Petrosoniak Scott Kobner Aaron Lacy Mark Ramzy, DO, EMT-P Alex Janke 🦋doctor doubt🦋

Alex Koyfman Alex Sheng Josh Guttman Skyler Lentz Sree Natesan, MD (she/her) Mike Pallaci🇺🇸🇮🇹🇮🇱🇺🇦 Zaf #EndGunViolence Qasim 🇵🇰🇬🇧🇺🇸 David Carr 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Tim Montrief Dane O'Donnell Roberto Cosentini Andrew Petrosoniak Aaron Lacy Mark Ramzy, DO, EMT-P Alex Janke 🦋doctor doubt🦋 Basic, but actually finding a pulse in patients complaining of lower ext pain. So often folks miss this step and just shoot off some X-rays from the waiting room. Doppler if you have it, ultrasound if not. Also remember to check proximal pulses as the problem can be higher.

Alex Koyfman Alex Sheng Josh Guttman Skyler Lentz Sree Natesan, MD (she/her) Mike Pallaci🇺🇸🇮🇹🇮🇱🇺🇦 Zaf #EndGunViolence Qasim 🇵🇰🇬🇧🇺🇸 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Tim Montrief Dane O'Donnell Roberto Cosentini Andrew Petrosoniak Scott Kobner Aaron Lacy Mark Ramzy, DO, EMT-P Alex Janke 🦋doctor doubt🦋 Not every red leg is cellulitis. Respect sudden atraumatic leg pain. If the contralateral exam is Normal. Be afraid

Alex Koyfman Alex Sheng Josh Guttman Skyler Lentz Sree Natesan, MD (she/her) Mike Pallaci🇺🇸🇮🇹🇮🇱🇺🇦 Zaf #EndGunViolence Qasim 🇵🇰🇬🇧🇺🇸 David Carr 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Tim Montrief Dane O'Donnell Roberto Cosentini Andrew Petrosoniak Scott Kobner Aaron Lacy Mark Ramzy, DO, EMT-P Alex Janke 🦋doctor doubt🦋 Expand what triggers the suspicion: pain #1 but also paresthesia and erythema

Alex Koyfman Alex Sheng Josh Guttman Skyler Lentz Sree Natesan, MD (she/her) Mike Pallaci🇺🇸🇮🇹🇮🇱🇺🇦 Zaf #EndGunViolence Qasim 🇵🇰🇬🇧🇺🇸 David Carr 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Tim Montrief Dane O'Donnell Roberto Cosentini Andrew Petrosoniak Scott Kobner Aaron Lacy Mark Ramzy, DO, EMT-P Alex Janke It sounds silly and super basic but for PIT shifts if someone is complaining of leg pain in triage, you really just have to look at the leg quickly and take off shoes / socks. It’s a really bad look if you put foot ischemia back in the waiting room because you did zero exam

Alex Koyfman Alex Sheng Josh Guttman Skyler Lentz Sree Natesan, MD (she/her) Mike Pallaci🇺🇸🇮🇹🇮🇱🇺🇦 Zaf #EndGunViolence Qasim 🇵🇰🇬🇧🇺🇸 David Carr 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Tim Montrief Dane O'Donnell Roberto Cosentini Andrew Petrosoniak Scott Kobner Aaron Lacy Mark Ramzy, DO, EMT-P Alex Janke EMRAP really great episode pearls recently: 1. Fast or slow onset 2. Motor or sensory changes (very concerning if so) 3. Doppler: no sound? Monophasic or multi-phasic 4. Likely will need CTA run off 5. If you have a limb salvage team- call them asap when they arrive!

refractory EtOH withdrawal dissapears. intubation solely for EtOH withdrawal stops. EtOH withdrawl seizures are easily treated. prevention of withdrawal is easy. the insanity of benzo gtts is a distant fever dream. ICU RNs and staff can feel the diference (#2/4)

perhaps the single best thing about PB is that it helps distinghish EtOH withdrawal from general ICU delirium with benzos, delirium tremens often transitions into ICU delirium continuing to bang away with benzos makes them worse, pushing the pt into a bzd-delirium vortex (#3/4

with PB once you’ve given 20-30 mg/kg you’re *done* treating EtOH withdrawal- so stop messing around with GABA receptors any residual delirium/agitation can be treated with antipsychotics or clonidine switching to a different receptor is effective & avoids bzd-delirium vortex