Pietro

He could have gone for general but he went for himself instead

#POCUS review 🖊️"POCUS can be seen as an evolution of the stethoscope, perhaps bringing clinicians back to the bedside and providing time to build a therapeutic relationship while harnessing the advantages of technology" 🔗 onlinelibrary.wiley.com/doi/full/10.11… #MedEd #IMPOCUS #Nephrology

Acute variceal bleed + unstable vital signs = give blood products & get an emergency endoscopy However, if the patient is stable & Hgb is >7, don’t transfuse Quick reference on upper GIB in the ED: buff.ly/3cles56

@EMBoardBombs STE in aVR & v1 could be left main or triple vessel disease. I think I would also ask for right and posterior leads

Dyspnea. 150s/90s. Next best step?

If you’re presented with a patient who is bradycardic and hypotensive after a calcium channel blocker overdose, you are going to be expected to initiate high dose insulin therapy as this is the standard of care in CCB OD

A secondary spontaneous PTX is considered stable if: 😮‍💨 RR <24 ❤️HR > 60 and <120 beats per minute 💪 Normotensive 🌬️ SpO2 >90% on room air 🗨️ Able to speak in full sentences

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex @PendellM hqmeded-ecg.blogspot.com/2022/11/an-eld…

Clinical features that define a BRUE include any of the following: - cyanosis or pallor - absent, decreased, or irregular breathing - change in tone - AMS These occur for <1min & pt must be asymptomatic at the time of presentation Free quick reference: buff.ly/3A4JNl9

@JudkinsSimon @TheSGEM @ACEPNow @CAEP_Docs @acemonline @stemlyns Add Italy to the list

@TheSGEM @ACEPNow @CAEP_Docs @acemonline @stemlyns Add in Australia and New Zealand, Britain, Ireland, South America, Hong Kong… the list is long…

American ERs having similar problems as seen in Canada. healthcaredive.com/news/emergency… @ACEPNow @CAEP_Docs @acemonline @stemlyns

Fluoxetine overdose pearls -Toxic dose: >1500mg -Toxidrome: Sedation, respiratory depression, serotonin syndrome -Treatment: Supportive care, cyproheptadine (5-HT receptor antagonist) Listen to podcast Ep53 for more details!

I can’t figure out why we give tPA so liberally for stroke but everyone is afraid to give it for massive PE.

Boulderisti scatenati sui massi delle Alpi🇦🇹🇨🇭 e degli States🇺🇸❗️ Ecco le ultime realizzazioni fino all’8️⃣©️nel boulder‼️ up-climbing.com/boulder/news-b…

@cliffreid As one of my mentor used to say, I've never seen ph or lactate with my #POCUS, so probably they don't exist. Clinical picture needed

pH 6.85 Lactate 26.2 Bicarb 6.0 Base Excess -17.3 What are the chances of surviving 24 hours after these blood gas levels without mechanical ventilation, vasoactive support, hemodialysis or ECMO?

☑️This device has saved millions of lives. Retweet if you know how to use it.

@FrancoMaycol @smithECGBlog @amalmattu @EM_RESUS Yes

69 yo male, ex-smoker, htn, Barret’s E. Come to ED for sharp chest pain radiating to the left shoulder and back from >6hrs never experienced before. The yellow one is a previous ekg. Your thoughts? Cath lab y/n? @smithECGBlog @amalmattu @EM_RESUS #Cardiology #EDtwt

@First10EM For reference, see Italy last national election and the relation between results and voters abstinence

As our province declines into chaos through utter mismanagement, I have seen many people angry about voter apathy or complacency These takes completely miss the fact that voter suppression is goal of some major parties, and designed into the system

Bottom line: Giving supplemental O2 to someone w/ severe COPD really *can* cause oxygen induced hypercapnea. It occurs for three reasons: 1. Loss of hypoxic vasoconstriction --> worse V/Q matching (major reason) 2. Haldane effect 3. Decreased respiratory drive 15/15

This - the loss of hypoxic vasoconstriction to poorly ventilated lung areas - turns out to be the primary reason for oxygen induced hypercapnea. ncbi.nlm.nih.gov/pmc/articles/P… 14/

@nickmmark Ping @FedeRebustello

This is a hard question! You probably learned that "its bad to give someone with COPD ‘too much’ O2 because they might stop breathing” Turns out hypoxic respiratory drive causing apnea is a MYTH..but there is an important truth here: A🧵on Oxygen induced hypercapnia! 2/

Here’s another pulmonary physiology question that *everyone* who gives O2 to patients ought to know: What is the primary mechanism by which supplemental oxygen can increase PaCO2 in someone with severe COPD? 1/

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab? @ECGcases hqmeded-ecg.blogspot.com/2022/11/90-yea…

L'8️⃣©️➕ di #Gakido 💎💎💎 a #Chigobutai 🇯🇵 vede la prima ripetizione ad opera del fortissimo Ryuichi Murai 🔝‼️ up-climbing.com/boulder/hot-ne…