Alex Koyfman

EM Physician+Educator+Pt Advocate // @emdocsdotnet EIC & Co-founder // #EMRA45u45 // #GirlDad // #citizenofworld // #selfmade

[Alex Koyfman @EMHighAK]

Released today. Pls check out what makes EM unique and at the core of medicine: https://t.co/MzfZv8066K. Deep thx to remarkable authors/leaders in our field. #FOAMed #MedTwitter

[FOAM Cortex @FOAMCortex]

Question of the shift: POCUS in crashing shock

Crashing undifferentiated shock: which POCUS findings change management now?

Open the response and see how it structures the next moves:
https://t.co/rvVF7N1iic

[Josh Farkas MD 💊 @PulmCrit]

According to this JAMA article, a meta-analysis showed that POCUS has ~90% sensitivity and specificity for diagnosis of CAP.

I looked up the source of this citation, and it's exactly what I expected (figure below):

🫤 None of the studies were from the USA
🫤 Studies varied *widely* (making their combination in a meta-analysis invalid)

In the USA where patients tend to have a high BMI and multi-morbidity, the performance would probably be lower. Also, performance in studies is generally superior to real life (Hawthorne effect).

Bottom line: POCUS is good for CAP, but I'd still combine it with a chest radiograph. CXR surveys the entire thorax & highlights areas of pathology. POCUS provides fine anatomical detail about the lung periphery.

And if this doesn't work, there's always the donut of truth left to sort things out (CT). 🍩

[FOAM Cortex @FOAMCortex]

Question of the shift: Toddler vomiting after fall

3-year-old minor head injury with vomiting, normal exam: CT or observe?

Open the response—FOAM Cortex preselects PECARN and prefills age ≥2 + vomiting before the answer.
https://t.co/EBW8qPSLtA

[emDOCs Team @emdocsdotnet]

Update on LVADs in the ED: Presentations, Evaluation, and Management https://t.co/hWqop2mSkf

[FOAM Cortex @FOAMCortex]

Source spotlight: https://t.co/Zm3tvuDg94

A free bedside fracture-management app with injury-pattern illustrations, splint recommendations, management pearls, high-risk alerts, and follow-up guidance.

Source: https://t.co/3Wpp2JY2KF
FOAM Cortex: https://t.co/INDA4vjqME

[FOAM Cortex @FOAMCortex]

Institutional search should not treat every document equally.

A current local pathway should beat an old slide deck. A concise algorithm should beat a twenty-page policy.

FOAM Cortex routes the right content forward by recency, site specificity, and actionability.

[emDOCs Team @emdocsdotnet]

emDOCs Podcast - Episode 141: Acute Limb Ischemia https://t.co/gLuH09dMWJ

[FOAM Cortex @FOAMCortex]

Source spotlight: NAEMSP

NAEMSP is a national professional association founded in 1984 that connects, educates, and advocates for EMS physicians and multidisciplinary EMS professionals to advance…

Source: https://t.co/gSRulfT4Qe
FOAM Cortex: https://t.co/INDA4vjqME

[emDOCs Team @emdocsdotnet]

Journal Feed Weekly Wrap-Up https://t.co/sTsNVg0raR

[Alex Koyfman @EMHighAK]

@suekhim 3rd-5th grade math

[FOAM Cortex @FOAMCortex]

Source spotlight: St. Emelyn's Podcast

The St. Emlyn’s podcast is a UK-based emergency medicine show for anyone working in emergency care, delivering high-quality, evidence-based education centered on…

Source: https://t.co/49a8mLB129
FOAM Cortex: https://t.co/INDA4vjqME

[FOAM Cortex @FOAMCortex]

Most operational updates already move by email.

With FOAM Cortex Smart Inbox, an ED director or ops lead can add a dedicated FOAM Cortex address to the existing mailing list.

Relevant attachments and updates get captured, indexed, and searchable — without a new workflow.

[FOAM Cortex @FOAMCortex]

Every ED has local knowledge scattered across PDFs, emails, pathways, and shared drives.

FOAM Cortex for Institutions brings it into a governed, source-backed clinical assistant: site routing, source controls, user management, audit trails.

https://t.co/T5RTuvdL8W

[FOAM Cortex @FOAMCortex]

Source spotlight: St.Emlyn's

St Emlyn’s is a team of emergency medicine and critical care clinicians producing high-quality, multimedia education to improve clinician learning and patient care, grounded in…

Source: https://t.co/YUMWCc0nsq
FOAM Cortex: https://t.co/INDA4vjqME

[FOAM Cortex @FOAMCortex]

One institution. Different sites. Different workflows.

FOAM Cortex Institutions supports site-specific content, so the pediatric ED, trauma center, freestanding ED, or clinic can surface the answer that actually applies locally.

[Alex Koyfman @EMHighAK]

Agree w this study and have spent a long time teaching this. Hard to overcome Neuro and NSGY inertia. #foamed #foamtwitter #neurotwitter

[Rory Spiegel @EMNerd_]

1/A new study by Shi et al. (Ann Emerg Med 2026) questions the current AHA blood pressure recommendations for intracerebral hemorrhage.

https://t.co/9Bzhcs2KA5

[emDOCs Team @emdocsdotnet]

ECG Pointers: MVC with Spinal Injury https://t.co/4kOEuiet6J

[FOAM Cortex @FOAMCortex]

Source spotlight: EM Updates

EM Updates brings fresh curated emergency medicine evidence updates to clinicians, highlighting practice-changing studies and systematic reviews…

Source: https://t.co/oANO3TLTr0
FOAM Cortex: https://t.co/INDA4vjqME

[FOAM Cortex @FOAMCortex]

Institutional knowledge already lives in PDFs, docs, slides, spreadsheets, CSVs, and images.

FOAM Cortex Institutions lets teams add the files they already use — then makes them searchable, ranked, and clinically useful.

[Josh Farkas MD 💊 @PulmCrit]

as a general rule, IGRA (interferon gamma release assay) should NOT be used as a test for active pulmonary TB

if you're worried about active pulmonary TB --> isolate & get induced sputa

yes, this is effort-intensive, but it's the correct way to do it