Nick Packer

@lilninjadoc Huge fan of the laryngoscope for this.

I love when patients teach me things! Best pro tip from last night: use the bottom half of a disposable speculum (w/ top removed) as a light-up tongue depressor for peritonsillar abscess drainage. ✅️Comfy(ish) for patient ✅️Built-in light for better visualization

It is frightening that medical emergencies are now being managed in waiting rooms and hallways after wait times >6-8h. It has never been like this before, even during the early pandemic waves. A perfect storm of ⬆️ viral illness, short staffing, ED crowding, and Connect Care.

@DirkChis Isn’t all asystole just fine vfib tho?

Most shade I've ever seen thrown in a journal article: “The higher rate of inappropriate manual shocks ... with physicians as team leaders than for paramedics out-of-hospital could be due to the fact that the physicians were internal medicine residents.” Circulation, 2007

PRIVATIZATION rant: For all of you out there that think that privatization is the solution to our health care woes. My daughter just had an outpatient procedure to treat an ingrown toe nail. This took approximately 20 minutes. Cost 690$. 1/

THERE’S NO SUCH THING AS A “BETA-LACTAM ALLERGY” OR A “CEPHALOSPORIN ALLERGY.” CROSS-ALLERGIC REACTIONS ARE LIMITED TO DRUGS WITH EXTREMELY SIMILAR R-SIDE CHAINS. SO YOU CAN ALMOST ALWAYS FIND A SAFE BETA-LACTAM. IF YOU JUST HAVE A WEE BIT OF COURAGE, THAT IS.

So yes: By all means manage the present ongoing public health emergency, with every medical, social and political tool available. But don’t pretend for a minute that our system will somehow autoresuscitate when talk of spike proteins is in our rear view mirror. It won’t. 4/

Many of the same Republicans who just voted against protecting birth control and celebrated when Roe was overturned also oppose paid family leave and efforts to make childcare affordable. This is not about supporting families—it’s about dragging women back in time.

Record heatwaves worldwide. Hospitalizations, injuries, and deaths. Crops destroyed. Fires raging. Some say bold climate action is "expensive." Compared to what?

@TomJelic Interesting. I haven’t seen this before.

TCD tracing of blunt head injured patient. Can’t say I have seen this type of waveform in the past. Raised ICP for sure. Any thoughts on the waveform? #pocus

@critconcepts Agreed. Not going to impact my immediate steps for management of the failing RV. Epi + Vassopressin, Caripul and IHD/CRRT.

@npacker2015 Cool idea! But relevant to the immediate resuscitation? Maybe a good activity for the stepdown team…

An echo case. 75m dialysis patient with bowel perforation. Ex-lap, resection, and extubated. 2L fluid given. Arrives in ICU on escalating norepinephrine doses. #POCUS shows the below. 1. What are the most key abnormalities? 2. How will you manage hemodynamics? #FOAMcc #FOAMus

@socmobem @ERmentor @shawnkdowling @iwwalker @jameslhuffman @TheSGEM Hard to send someone home w/ ongoing amnesia. My decision regarding CTA early (over NCCT) is based on trying to identify those at a higher risk of stroke (new a fib, high ABCD2, CHADS2VASC, etc.). Then if significant cerebrovascular dz on CTA + ongoing TGA = neuro consult + MR.

What is your approach to transient global amnesia workup in the ED? Dry CT/basic labs? MRI? Neuro consult? Curious on your thoughts @ERmentor @shawnkdowling @iwwalker @jameslhuffman Recently did a #SGEMHOP on use of DW-MRI in TGA workup thesgem.com/2022/04/sgem36… @TheSGEM

Last night AB Premier @jkenney spoke about his concern regarding the "stigma" faced by unvaccinated. Reality: Being unvaccinated is not an immutable trait or a noble stand. It is almost always simply a decision –usually informed by misinformation & ideological spin.

Being HIV positive and treated like garbage by society and dying alone without your loved ones is different than not being able to go to Boston Pizza

🇺🇸 857,768 deaths (2,577 per million) 🇬🇧 152,996 deaths (2,243 per million) 🇪🇺 935,822 deaths (2,093 per million) 🇨🇦 31,892 deaths (840 per million) #cdnpoli

Me me me me me me me me me me me me me me me me me me me me me me me me. Honk honk. Me me me me me me me me me honk

Going to try this with my next consult.

If you know someone who's on the fence about vaccination show them this. It's not too late.