Jeff Anderson

@raghu_venugopal At least they aren’t coming in on back boards any more.

Typical c-collar workflow: -Elderly ground-level fall -No neck pain, lucid awake patient -Immobilized with c-collar by EMS -Miserable patient who might rip it off anyway -Zero or trivial neck pain on exam -Normal CT brain and cervical spine -Very rare c-spine fracture with neurosurgery or spine ultimately deciding soft collar and outpatient follow-up @TheSGEM

@pagingdrsank @chaossapphicc Paramedic here. I was thinking the same thing. Most ED’s push us right through the door to L and D as long as the baby isn’t crowning. Not realistic but made for intense TV.

@chaossapphicc The ER doesn’t manage pre-e patients either. They send them to L&D the second they learn the baby is viable actually. And she was an L&D nurse, not a resident.

The Pitt is disrespectful to OBGYNs. Lmao. First season, they acted like they’d deliver a shoulder dystocia by themselves & NOW, an eclamptic patient + bedside csection in the ER with NO OBGYN present in a major hospital?! Someone get me the writers number bc I have words to say!

@AlexTran677026 I’m gonna save you Momma! That’s why you had me Momma!

Best comedy every made; one of the best films ever made😍

@liseybooboo @BarbellFi Most of the time you are not allowed to have a job in medical school.

@BarbellFi how do you NOT get a job during med school??

Neighbor’s son graduated med school Just got his first real job at 32 $0 saved for retirement $400k in student loans They threw a party to celebrate 😬

Imagine winning this hard. Impossible

Sodium Bicarb in DKA Don't treat the number, treat the physiology. 3 Indications for Bicarb: 1. Refractory Hyperkalemia 2. Cardiac Arrest 3. Sepsis-induced Cardiomyopathy (to improve EF) Use an infusion, not pushes. It’s a bridge, not the cure. Comment to discuss.

@HandtevyMD It would be nice to know what flavor of SVT this ended up being. Hopefully they are getting follow up with an electriphysiologist.

With the long QT and WCT we avoided adenosine and Amio. Gave Magnesium over 20 minutes and the QRS narrowed and her symptoms resolved, but still tachy >200. In the ED they hemmed and hawed for 20 min and finally decided to give adenosine. Final dx SVT with aberrancy.

Great case yesterday. Pediatric patient with 9/10 chest pain/pressure and palpitations. BP wnl. Sats normal. No syncope. Otherwise healthy. No PMH or FHx relevant. Will post outcome in a bit. I want to hear your thoughts.

@James98445697 @HandtevyMD @ecgrhythms I meant antidromic. Hasty error. Thanks.

@jeffmedic @HandtevyMD @ecgrhythms This looks more likeAntidromic, AVRT (wide complex)

It's not just phonics: Schools have failed to teach reading because they ignore 50+ years of findings in cognitive psychology that reading depends on general knowledge. ED Hirsch has been banging this drum for a long time but Ed Schools shut their ears because the whole idea was unromantic & had a vaguely right-wing aroma. Now he joins with Dan Willingham to make a strong case that kids can't read if they don't have the background knowledge that makes sense of the rarer vocabulary, allusions, and understandings that allow us to read between the lines - which all reading requires. educationnext.org/rediscovering-…

@jdimick1 Would the antibiotic route be a good choice for patient’s taking a NOAC?

The framing for this has always seemed strange to me. Surgery has a 0% failure rate at preventing recurrent appendicitis (yes if done well) and antibiotics a 44% failure rate. Unless surgery is strongly contraindicated, appendectomy seems like the right choice.

@DrDiGiorgio @HeartOTXHeartMD I have seen that happen. It is maddening. Another facet of this problem is the amount of imaging and testing the sending facility has to do just to get the transfer accepted.

I once had a brain trauma patient transferred into our ER from an outside facility. It was a small brain bleed, but even a small bleed can be life threatening if it grows. Repeat CTs are essential to ensure it’s not growing. The patient didn’t arrive with imaging from the transferring hospital. They simply neglected to send them. We called and asked them to upload the images to an online portal (HIPAA compliant, widely used). They refused. We asked them if they could put the images on to a CD or flash drive and send it over. They refused. The only way they would release the images is if our hospital sent a courier with a records release form to their hospital to pick up a CD. The amount of time that would take made the images meaningless. So we just repeated the CT to get a new baseline. Stuff like this happens every day.

@rastokke I just learned about Integrated Math. What do you think about this approach to high school math?

@dperkinsed Memorization, like alot of other things in education, is necessary to get our student where we want them to be but is not sufficient.

I agree, we definitely shouldn't dismiss knowledge acquisition and think AI or tech can be a meaningful proxy for that, but we should also recognize that things like memorization can also be an illusion of mastery. wegrowteachers.com/overcoming-the…

@CoffeeBlackMD The Jeffery Fuller books by Joe Buff. Great military action books similar to Tom Clancy.

Looking for good stories. Books. Suggestions from the group. No romance. No horror. No first person stories unless you think it’s really so very good or maybe noir (or adjacent). If you think it’s better in audio let me know. Also. If you don’t mind tell me why you like it.

You know the term 'skinny fat?' I think we should also say 'stupid smart.' For example you could say, 'Look out for Larry, he's stupid smart. He may be great at quadratic equations but he gave all his bitcoin to a Nigerian man pretending to be Sydney Sweeney.' Stupid smart, you heard it here first! (Yes I know it sounds like it could mean extremely smart since stupid can mean 'very.' But 'dumb clever' and 'dumb smart' sounded wrong.)

@HeartOTXHeartMD Would you feel the same if the patient was taking a NOAC?

POLL: You have acute appendicitis. Which initial treatment plan do you want? x.com/jama_current/s…

Fresh paper. Adenosine is metabolized by red blood cells. Do people with higher hematocrit need higher Adenosine doses? Nope, but now we know. Negative studies matter 😂 Amazing work by our past resident Dr. Seth Carroll (@SethCPharmD) pubmed.ncbi.nlm.nih.gov/41547655/

@TheMonologist This is a family favorite. Very fun movie.

@HeartOTXHeartMD @DrMarthaGulati @hvanspall @DrDave01 @GDandamudiMD @HeartBobH @ClintHurdle13 @mcuban @IUBloomington @simonsinek @garyvee Sorry I did not complete the assignment. These summaries look good except The Resilience Shield is an actual book by 3 retired Australian SAS officer, one of whom is an EM doc.

Sound great. I’ve not read these. Thank you. The three books you mentioned—Leadership and Self-Deception, How to Think Like a Roman Emperor, and The Resilience Shield (likely a general concept or related title)—focus on internal mindset shifts for better leadership and life: Leadership & Self-Deception by the Arbinger Institute reveals how we create problems by being "in the box," hindering relationships and results; Donald Robertson's How to Think Like a Roman Emperor teaches Stoic principles (control what you can, virtue, resilience) through Marcus Aurelius's life for modern challenges; and concepts like "Resilience Shield" (often linked to Stoicism) teach managing reactions to adversity, making these powerful tools for self-mastery and effective leadership.  1. Leadership and Self-Deception: The Secret to Call in the Workplace (Arbinger Institute) •Core Idea: Explains how people get "in the box" (self-deception), blaming others and creating problems they then struggle to solve, sabotaging relationships and results. •Key Takeaway: Move "out of the box" by seeing people as people, not objects, to foster better collaboration and leadership. •Relevance: Practical, story-driven guide for organizational dysfunction and personal blind spots.  2. How to Think Like a Roman Emperor: The Stoic Philosophy of Marcus Aurelius(Donald Robertson) •Core Idea: A modern guide to Stoicism, using the life of Emperor Marcus Aurelius to teach emotional resilience, virtue (wisdom, courage, justice, temperance), and handling adversity. •Key Takeaway: Apply Stoic practices (like negative visualization, mindfulness, focusing on what you control) to manage emotions, build inner strength, and live a fulfilling, virtuous life. •Relevance: Blends ancient philosophy with modern psychology for practical self-improvement.  3. The Resilience Shield (Concept/Related Works) •Core Idea: While not a single definitive book title, "Resilience Shield" points to the Stoic concept of building inner fortitude (like Marcus Aurelius did) to deflect life's inevitable hardships. •Key Takeaway: Develop mental toughness by accepting reality, managing perceptions, and transforming obstacles into opportunities for growth, rather than being crushed by them. •Relevance: Offers strategies to cope with pain, stress, and uncertainty by strengthening your internal self.  How They Connect •Self-Awareness: Leadership & Self-Deceptiontackles self-deception; Roman Emperor uses self-reflection (meditation) for self-mastery; a "Resilience Shield" requires knowing your triggers. •Control & Acceptance: Roman Emperor teaches focusing on controllable reactions (Stoicism); Self-Deception shows how uncontrolled reactions create issues; the "Shield" idea is about accepting what you can't change. •Actionable Wisdom: All three move beyond theory to provide practical frameworks for better thinking, leading, and living.

I’m going to be starting a leadership bookclub for my leadership team in the new calendar year. I know which ones are my go to’s, but tell me your most precious one and tell me why. Thanks!😊