Barrie Stevenson

@EmergMedDr @mark_tehan @DrLindaDykes @Medic_Russell @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @EMTAcommittee @richardbody @LWestafer @docib @dnepo @srrezaie @First10EM Doing bloods on this cohort is hardly ever useful. I often find myself wondering which patients need as CT head, though

Can anyone share their hospital guideline for the ED management of hypertension? Looking to simplify ours @EmergMedDr @Medic_Russell @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @srrezaie @First10EM

@srrezaie @EmergMedDr @Medic_Russell @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @First10EM Thank you. I didn't know the US policy so that's really interesting

@TheBreachEM @EmergMedDr @Medic_Russell @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @First10EM If purely asymptomatic HTN (i.e. "My Blood Pressure is High)...ACEP has a clinical policy on this --> acep.org/patient-care/c…

@DrJlo29 @EmergMedDr @Medic_Russell @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @srrezaie @First10EM I'd love to have a policy like this, but I fear there would be an extreme reluctance from many patients to accept it. Many of my colleagues are also very nervous about sending patients with BP >200 systolic home. I think a pretty huge cultural change is needed in many hospitals

@TheBreachEM @EmergMedDr @Medic_Russell @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @srrezaie @First10EM I could share it, but I dislike it because I think it entirely unnecessary to keep patients in the ED whilst we treat their asymptomatic hypertension with Nifedipine. Could you simplify to: Hypertensive emergency - resus for IVs. Otherwise - home with GP ?

@Medic_Russell @EmergMedDr @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @srrezaie @First10EM Would love that, but don't think management would 😂

@TheBreachEM @EmergMedDr @AndyNeill @precordialthump @EMManchester @RCEMPolicyVP @DrLindaDykes @EMTAcommittee @richardbody @LWestafer @docib @dnepo @srrezaie @First10EM My personal one would be “end organ damage? Yes - GTN/labetalol, No - send them home” but that’s not official with a trust logo or anything.

Dizziness is a notoriously tricky chief complaint to work up in the ED. Let’s review one of the most up to date guidelines on how to approach it. 🧵 1/8 #MedEd

What angle would you cast this fracture in? 90° or 45°? Genuinely curious... #ortho #emergencymed @InvictaOrtho @traumaticum @FractureDoc @generalorthomd @StressHoop @NaanDerthaal @RCEMdean @DrLindaDykes @EmergMedDr @First10EM @srrezaie @EMSwami

@gfaronica I don't think so, sorry. How did you discover it?

@TheBreachEM Hi, just come across your podcast. Only two years late but there you go! It's very good, are show notes still accessible?

Hi friends. Just wanted to let everyone know that we're shutting down The BREACH blog and podcast. 😢 Please download any episodes you'd like to keep in the next few days before they're all taken down. Thanks everyone for your support and encouragement. It's been a blast!

@DrDavidWarriner A patient of mine claimed to be a retired gynaechiatrist

What's the most interesting combination of specialties you've encountered? Respiratory medicine and ITU quite common, ditto GP and palliative care. Anything more niche or unusual?

@lexiehats @DrLindaDykes Lovely, thank you

@TheBreachEM @DrLindaDykes Not an info graphic as such but useful I think england.nhs.uk/coronavirus/wp…

Does anyone know of a good infographic advising patients with covid when to contact a healthcare professional? @DrLindaDykes

@DrNads77 @DrLindaDykes Wow, this sounds great

@TheBreachEM @DrLindaDykes Havent got an infographic, but we’ve started a community monitoring service where we discharge patients with a sats probe and advice when to seek further attention. They also get phone calls checking on them. Only just started, referred my first pt this weekend 🤞🏼

@First10EM @chrischirp @srrezaie @drphiliplee1 @EmergMedDr Ah, yes. To clarify, I'm thinking of health care workers who probably have some immunity (already had covid) but who have ongoing exposure at work. Is there minimal risk of transmission to their families because of this immunity?

@TheBreachEM @chrischirp @srrezaie @drphiliplee1 @EmergMedDr Not sure I understand the question They shouldn’t be infectious at all. Almost all transmission occurs within first 10 days with a few rare exceptions. Do you mean do they have immunity?

Are there any studies looking at how infectious someone is if they are several months post-covid (and have antibodies)? @chrischirp @First10EM @srrezaie @drphiliplee1 @EmergMedDr

this is an incredibly important paper from LSHTM @AdamJKucharski on the new variant. @IndependentSage just met as well to discuss the new situation we find ourselves in. Stay tuned. cmmid.github.io/topics/covid19…

@mforlin Workload was getting extreme on top of other commitments. My life was becoming medicine, medicine, medicine. Something had to go, and I need my day job!

@bobbykansara I thought above knee slab was only necessary for proximal or middle third fractures... Am I wrong?

How Not to Splint: Episode 3 (Distal Tibia Fracture Edition): 1. Tibia fractures should be admitted to monitor for compartment syndrome. 2. Stirrup not enough. Needs posterior slab. Get that foot out of equinas! 3. Must be long leg to control rotation #orthotwitter #MedTwitter

@apsmunro Can you recommend a good summary of the evidence for the general public? I loved the post and podcast, but think the language is too 'medical' for the concerned parents at my daughter's school...

Conclusions -Children about half as susceptible -Have roughly same amount of virus -May be less infectious, ?due to less symptoms -Lots to learn once schools open END Check out the podcast too🎙️ open.spotify.com/show/46C01zzm2… dontforgetthebubbles.com/podcast/covid-… dontforgetthebubbles.com/the-missing-li… 13/13

There has never been more confusion about the role of children in transmission of #SARSCoV2 , and tensions are running high over implications for #schoolsreopening Time for some clarity @Damian_Roland and I review ALL the evidence on @DFTBubbles dontforgetthebubbles.com/the-missing-li… 1/13