.D. Brady Pregerson, MD takes a different approach to finding the cause of metabolic acidosis or alkalosis, delving into the anion gap and discussing mnemonics that can help you make the diagnosis, only in the #EM Logic #podcast .

tinyurl.com/EMN-EMLogic #FOAMed

The days of the fixed 100 mg tPA bolus for massive PE are likely numbered.

Less is more when it comes to thrombolysis for massive pulmonary embolism, says Chris Mondie, DO, & it increases risk of bleeding with no benefit for underlying pathology. tinyurl.com/y5z8d422 #FOAMed

Patients with simple problems like colds & sinus infections seem as rare as PCPs today.

The pandemic created anxiety, fear, & a new focus on physical & emotional afflictions, & it has Edwin Leap longing for the days of a regular ankle sprain. tinyurl.com/mje9razj

More than 10 million people misused opioids in 2019, and 1.6 million had opioid use disorder.

But EPs can’t help these pts if they don’t come to the ED, and they won’t come if they feel judged. Gina Shaw looks at how to improve OUD care in the ED. tinyurl.com/4sepwudx

A 78yo woman w/ a history of diabetes mellitus and dementia presented with confusion and a fever.

Bonnie Kaplan says she had an indwelling Foley catheter with discolored urine in her catheter bag. #Whatsthediagnosis tinyurl.com/ywtahd2u #FOAMed

A patient w/ trouble swallowing or swelling in the throat might not prompt a detailed neurological exam, but that dysphagia could be a sign of Wallenberg syndrome.

EMedHome says posterior circulation strokes are often misdiagnosed. tinyurl.com/yc6sz92r #FOAMed

Miss lithium toxicity & you’ll end up in court.

Lithium has a narrow therapeutic index, & a “therapeutic” serum level doesn’t rule out toxicity. Leon Gussow says EPs should always consider it when a pt on the drug has clinical deterioration. tinyurl.com/y2ztfzxt #FOAMtox

Is calcium chloride part of your “kitchen sink” medications for patients in undifferentiated cardiac arrest?

Maybe it shouldn’t be.

Michelle Lin, MD looks at how evidence suggests calcium not only isn’t beneficial but might also be harmful. tinyurl.com/3jhddvkp #FOAMed

.Amal Mattu delves into afib controversies with Lloyd Tannenbaum, MD; infected urolithiasis with Ryan Spangler, MD; and managing cardiogenic shock with Zachary Wynne, MD, only in this month’s EMedHome podcast.

tinyurl.com/EMN-Mattu #FOAMed

Close enough is good enough in many things medical, but when it comes to getting correct vital signs, EPs need to be meticulous.

Unfortunately, Matt Bivens, MD says EM can be bad at getting blood pressure, heart & resp rates, pulse ox, & temp. tinyurl.com/37axxfzr #FOAMed

Usually, the more experience you have, the more certain you are about your job.

Not in EM.

Bill Kreider, MD, says the longer he practices, the more patients he meets who make him to question what he knows. tinyurl.com/5ft47wjm

Patients go to the ED looking for answers. They want to know what’s going on and when it will be over.

But Ryan Richman, MD, FACEP says “I don’t know” is usually the best answer of all, and that can be a hard concept for EPs to accept. tinyurl.com/bdemy4jy

Flexible bronchoscope-guided endotracheal intubation is an advanced technique that you need in your difficult airway toolbox, say Munish Goyal & Alex Koo, MD, only in their latest video blog Procedural Lifelines.

#FOAMed tinyurl.com/ProceduralLife…

Controlling hip fracture pain can be a real, well, pain.

EPs have used ultrasound to perform femoral nerve blocks and fascia iliaca blocks for some time, but Christine Butts says pts receiving PENG blocks have significantly lower pain. tinyurl.com/3v698t56 #FOAMed #FOAMus

Residents have been forming unions since the 1930s. But the number of residents unionizing has now skyrocketed.

3rd Rock Ultrasound, LLC says maybe it’s because physicians are increasingly treated as commodities. tinyurl.com/4jzhbtsh

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. tinyurl.com/4ar7zp3s

EPs & NPs are not interchangeable, no matter what the health care system suggests.

An NPP’s training of 2800 hrs or less is a far cry from a physician’s 14,000+ hrs, & Sandy Simons MD says EPs must speak up against nonphysicians taking over pt care. tinyurl.com/599bhm8k

A staggering 97 percent of EPs misapply the HINTS exam when assessing vertigo.

The gap between the exam’s theoretical effectiveness and its practical application might be discouraging, but Rick Pescatore, D.O. says there is hope. tinyurl.com/3ut8ztfs #FOAMed

What are the top 3 causes of shock in trauma? Hemorrhage, hemorrhage, and hemorrhage. That’s not a typo! Blake Briggs, MD and iltifatMD discuss how to treat traumatic bleeding, only in this month’s EM Board bombs.

tinyurl.com/BoardBombs-EMN #FOAMed

Treating SVT is quite different from treating VT, and their mortality outcomes are also much different.

@blakebriggsmd says the safest way to treat wide complex tachycardia is to assume VT until proven otherwise. tinyurl.com/22dxuyxb #FOAMed