Alex Zozula

nytimes.com/2025/12/14/us/… Not the best PR @ESO_Solutions

@DrJeffJarvis @EmsLighthouse Not sure if you've seen @First10EM's discussion on WOMAN first10em.com/3-misunderstan… but I share his concern when overall mortality shows no difference. ACOG's position statement is "consider" -- these guidelines seem to strengthen that rec without new data.

@azozula @EmsLighthouse Fair point about primary composite being negative and about challenges with composite outcomes. Death due to bleeding, however, showed improved survival with TXA. It isn't magic, but there is some benefit.

Thanks to Drs Jenna White and Chris Zahn for talking with us about the ACOG EMS guidelines for treatment of women wtih preeclampsia, eclampsia, and postpartum hemorrhage! youtu.be/tRmN6VDLzXk

@EmsLighthouse @DrJeffJarvis Could be wrong but I don't think IV TXA is FDA approved for PPH though PO is for menstrual bleeding.

@EmsLighthouse @DrJeffJarvis Appreciate the nuanced discussion of TXA here but still think the EMS guidelines are overstated. WOMAN was negative for the 1⁰ outcome and disease-specific mortality is a fraught 2⁰ outcome. That there's little else to offer in many EMS systems isn't a compelling argument IMO.

@ABEMCert Your new portal isn't exactly mobile friendly. The submit buttons are hidden on pretty much every page...

Was any methodologist involved in the grading of evidence/drafting of this guideline? This goes further than the original ACOG position statement.

@NAEMSP @acog Just reviewed your new model prehospital PPH guidelines and disappointed to see the overstated evidence for TXA. WOMAN was a negative trial. "Evidence-based recommendations for this patient population..." is a nonsensical statement given the best available evidence.

What does it mean to be a doctor in a war zone? Stanford faculty member, Dr. Ayesha Khan, shares a gripping personal account of treating patients in Gaza. 🔗 Read more - ow.ly/j5Ef50Vp3iG

@DOGE_FAA It's 2025. These should be required in medical kits.

@FlyFrontier The FAA may not require pulse oximeters, but you certainly are allowed to stock more than the bare minimum. Lmk if you need help picking some out.

@BMorshediMD @NAEMSP @NicholeBosson @benabo @JLyngEMSMD Really liked this but the discussion of fluids neglected the fairly abundant data on balanced fluids vs. NS in medical hyperK (summarized by @PulmCrit a decade ago at this point tinyurl.com/yc4nnm8d). Also if the *trivial* K in LR is a concern, blood products would be 💀.

Management of the entrapped, entangled, and crushed patient. @NicholeBosson @benabo @JLyngEMSMD tandfonline.com/doi/full/10.10… #NAEMSP2025

.@JLyngEMSMD & @ColwellMD are presenting an update on the Trauma Compendium now! #NAEMSP2025

@swil_ems Certainly reasonable to try though lifesaving for epistaxis may be overstating the evidence just a tad.

🩸 Unstoppable nosebleeds meet their match in EMS! Tranexamic Acid (TXA) shines as a lifesaver, controlling bleeding by promoting clotting. When seconds count, TXA stops the flow. Ready to halt nosebleeds in their tracks! 🚑💉 #EMS #Nosebleed #TranexamicAcid

@AlanPlotzker But if you don't get daily labs, how can you completely ignore expected variation and comment on meaningless trends from one day to the next? That sodium went from 135 to 134. Someone had better take notice!

(If you even need daily labs at all)

My medical hot take of the day is that the default time for daily labs on non-ICU patients in the hospital should be be like 8 PM instead of 2-4 AM You rarely need hot-off-the-press labs for day-to-day medical management, and there’s no need to add extra delirium risk

@TheResusRoom @laing_simon @robfenwick @heli_med_james @TRRevents @SJTREM Loved the episode and I recognize that many guidelines haven't caught up, but I'm not sure I agree with avoiding LR or other potassium containing fluids. I'm reminded of an excellent post by @PulmCrit from almost 10y ago on fluid choices for hyperkalemia.

Crush Injury; Roadside to Resus Podcast out now! itunes.apple.com/gb/podcast/the… open.spotify.com/show/4pGoo1XFn… TheResusRoom.co.uk #FOAMed

@AlanPlotzker What's the lit on (non-febrile) seizures and otherwise asymptomatic bacteruria? I've never seen anything particularly compelling and the problem I have is that people often reflexively get started on beta lactams which are known to increase the chance of having another seizure...

My rule is that it’s not asymptomatic if it’s causing delirium (or worsening symptoms of MS, or breakthrough seizures, etc. etc.). Those are all symptoms!

@AlanPlotzker @dfreedman7 @phil_bilodeau I'm not sure that's necessarily true. I think many just tire of the same discussion time after time and just order it, especially in places where neuro is either seeing the patient right away or admitting primarily.

@dfreedman7 @phil_bilodeau Same! It wasn’t controversial at all where I trained, then I get on Twitter and all the EM people here think it’s like injecting someone with cyanide

Can ED Twitter stop being so condescending to neurologists?

@alvarezzzy @EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO Seems ripe for a larger, more definitive trial to really settle the issue one way or the other. It's not a particularly rare condition that's difficult to study...

@alvarezzzy @EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO Never got to play with ibutilide in residency ☹️. pubmed.ncbi.nlm.nih.gov/9581743/ would suggest it's better/faster than procainamide but then you have studies like pubmed.ncbi.nlm.nih.gov/12682468/ that suggest it's no better/faster than amio. Too many different seemingly random dosing regimens...

Procainamide use in ED setting - pearls? #FOAMed #foamcc #MedTwitter @elewMD @TheShenger @drjgutt @SkylerLentz @rbyyny @sreeja_natesan @MprizzleER @alvarezzzy @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO

@alvarezzzy @EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO Compared to electricity, sure. Compared to amio though... pubmed.ncbi.nlm.nih.gov/17560882/

@EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @rbyyny @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO takes a while. takes a while. takes a while. good to use so residents learn in case their future shop runs out of certain medications... otherwise... takes a while.

@alvarezzzy Miss you guys too! Interestingly they're both $250 at Kaiser...and at VMC, a BMP is $651 but a CMP is $390. Gotta love American "healthcare"!

@azozula As always, a person of evidence. Miss you at the Farm, Alex!

CMP in every abdo pain pt or not? #FOAMed #foamcc #MedTwitter @elewMD @TheShenger @drjgutt @SkylerLentz @rbyyny @sreeja_natesan @MprizzleER @alvarezzzy @PulmCrit @kaynani32 @MikePallaci @Chris_McStay @moyinscrubs @MRamzyDO @NotSoLilMD @ShehniNadeem @EdelsMD @HeyDrNik @ResusOne