Michael Perlmutter, MD

I’m beyond excited to have matched emergency medicine @hcmcEM!! This is a decade of hopes and dreams that has finally come true and I’m so glad to be joining this amazing team! #Match2022 #teamEM

the problem is that we don't "randomly cut everything by 10-35%." when it comes to austerity, the first things on the chopping block are always education, healthcare, and aid to the poor. why don't we first try "randomly" chopping corporate welfare and "see what happens?"

@MDtheDO Congrats! Well done!

I’m super excited to share that I’ll be joining Washington University in St. Louis as an Assistant Professor in Emergency Medicine and EMS faculty starting this July! Looking forward to being part of such an incredible team!

@_JaceMullen Just get the tempur pedic you’ll thank me later

WHY THE FUCK ARE MATTRESSES SO EXPENSIVE WHAT THE HELL

Hard to believe the end of residency is in sight but I’m so stoked to be joining @HEMSDocs for EMS Fellowship and staying @hcmcEM for another year!

@HansvanSchuppen HT @ResusPadawan @ChrisRootMD @amerelman @DarrenBraude

Any prehospital services/HEMS use a small bedside invasive bloodpressure monitor for arterial lines? I have seen the compass but this only shows MAP.

This Friday, September 27th, Dr. Bonnie Snyder will be discussing her recently published paper “Association of Small Adult Ventilation Bags with Return of Spontaneous Circulation in OHCA. We will be live at 11 AM EST. Zoom Registration: us06web.zoom.us/meeting/regist…

@joshmcgoo @olsonplanner I looked at this too. We ended up with one from our mortgage company but Nerd Wallet had a good overview of options. Not sure if there were any that had both in a single place

Anyone know where I can get a 0% APR credit card for the next year AND have a high yield savings account in the same place? Right now using SoFi/Chase, but I want to just have things in one place

@HandtevyMD @orlandohealth It’s been prohibitive cost wise with such a short shelf life. Even in a very high volume high acuity system how frequently is it being used? How much is wasted?

A friend from @orlandohealth just sent me this. It's Push Pressor Epi from a compounding pharmacy. Is anyone in EMS using pre-packaged PPE?

@armyemdoc @fisherad1 @AmJSurgery @fwright00 @mitchelljayc Could you dm a copy? Thanks

When resuscitating, can you dabble in whole blood, or do you need to go all in? This paper by @fisherad1 in @AmJSurgery this month sought to answer that. He looked at increasing fractions of whole blood as a proportion of total products administered in adults. After adjusting for confounders, there was no difference in survival based on increasing proportions at 6h. However, as the proportions increased, the survival also increased at 24h. This suggests 2 things: -There is less benefit to dabbling in whole and you likely gain benefit with incorporating more into your resuscitation strategy -More interesting, IMO, is that at 6h it probably doesn't matter what you give them as long as you give them volume... but giving them volume of the less desirable stuff catches up at 24h. So, just because you see their numbers get better on the monitor right away, doesn't equate to actually fixing the problem -- their tissue oxygen debt and coagulopathy. americanjournalofsurgery.com/article/S0002-… DM me for the full paper #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #trauma #blood #medx #medtwitter

@reverendofdoubt @BrooksWalsh @joshkimbre @TannerSmida @kmpanthagani It’s also very interesting that it seems like not even a quarter had prehospital airway management? Is that a CA thing? Did they get SGA but not ETI? Just BVM? Does that matter? No idea based on this

@BrooksWalsh @joshkimbre @TannerSmida @kmpanthagani I’ll have to read the paper still but…. Idk man, I actually practice somewhere with multiple, MULTIPLE overdoses per shifts, and if a person is coming in dead from an overdose 99% of the time it’s an unknown downtime here in PEA and they need an ETT anyway and epi 🤷🏻‍♂️

This is exactly what @TannerSmida said

@reverendofdoubt @BrooksWalsh @joshkimbre @TannerSmida @kmpanthagani @reverendofdoubt do you have a good grasp of the propensity matching methodologies? I don’t and just reading table 1 they don’t actually seem reasonably matched as Brooks, Tanner, Josh all point out.

@reverendofdoubt @BrooksWalsh @joshkimbre @TannerSmida @kmpanthagani I read it a couple of times bc it challenges my priors so strongly. All the limitations for study type are here. I’m at a loss how naloxone has that profound an effect. Are a significant number of these not actually in OHCA ie profound shock but not OHCA?

@BrooksWalsh @joshkimbre @TannerSmida @kmpanthagani And half the time it’s reported as an OHCA “with ROSC” and the patient is now awake, it’s probably just hypotension from the bradycardia / hypoxia and then they got narcan. This is a registration study — I don’t really trust any of these airway, EMS, etc registries tbh 🤷🏻‍♂️

@dieworkwear do you have a favorite sunglasses brand? Asking for no particular reason…

@NoobieMatt @BenZabar @mayoclinicemres Cheers to ongoing strength and recovery!

@DitchDoc14 @BenZabar @mayoclinicemres Let me find them. Not around the office much these days. 🤦

Hot take: when calling Med control, start with what you want, then tell the story. “I’m calling for termination. I have a 72 yo male unwitnessed…” Just giving the story and then waiting doesn’t help. Do you want to stop CPR? Give bicarb? Give a sedative? #EMS #FOAMed

@NoobieMatt @BenZabar @mayoclinicemres Can you share your format/instructions Dr. Sztajnkrycer?

@BenZabar We teach a very specific format to both EMS and medical control that does exactly that. And closes with questions/concerns. Ping @mayoclinicemres

Paramedics should be taught to present patients similarly to how it’s taught in medical school (abridged version). Everyone knows what to expect.

@saugarmaripuri What’s this from?

So @olsonplanner I’m enrolled in SAVE (by decree) and now sitting in forbearance while opportunity for qualifying low payments in residency drain away. Is there any alternative other than wait and see what happens? @usedgov this is trash @reverendofdoubt

@BritFltdoc @reverendofdoubt @DrewCathers @cliffreid @AMPAdocs @ATACCFaculty @DipRTM @VikingOne_ @SydneyHEMS @EMRSscotland @emcrit It may be a matter of technique, kit, or other things but IME a stitch to secure + Tegaderm is pretty fast and a lot less messy than tissue glue. It seems to drip everywhere and takes some time to really set hard. Is there a way to speed that up?

@reverendofdoubt @DitchDoc14 @DrewCathers @cliffreid @AMPAdocs @ATACCFaculty @DipRTM @VikingOne_ @SydneyHEMS @EMRSscotland @emcrit In this study, more failure of stat locks than tissue adhesive for securement of peripheral arterial catheters. pubmed.ncbi.nlm.nih.gov/25583412/

Revisiting this great post from @cliffreid 12 years later- any HEMS/CCT/Resus teams routinely using dermabond alone for securement of fresh CVC's / arterial lines? @AMPAdocs @ATACCFaculty @DipRTM @VikingOne_ @SydneyHEMS @EMRSscotland @emcrit @BritFltdoc resus.me/superglue-for-…