EM:CRAP

I'm not a doctor, and I don't play one on TV. Emergency Medicine Pharmacist at Queen of the Valley Medical Center in Napa CA

[EM:CRAP @EM_crap]

#protips for management of #GIBleeds 👨🏼‍⚕️👩🏿‍⚕️🩸 focus on appropriate use of #Protonix: 40mg IV BID 🔁 8 mg/hr drip, ⬇️resources & #Octreotide: reserve for esophageal varices! 👨🏽‍🎨 credit: V. Vijey, TUC P4 student #medtwitter #pharmtwitter #mededucationboard

[EM:CRAP @EM_crap]

He’s a 10 but he’s on the Supreme Court

[EM:CRAP @EM_crap]

tPA ➡️ TNKase® for Acute Ischemic Stroke 😶‍🌫️ #pharmacyeducationboard

✅ easy to mix 💿
✅ 5 second IV push 💉
✅ may be superior for LVOs 🧱

⏰ is 🧠!
#twitterx #stroke #MedTwitter #tnkase #tenecteplase #tnkase #alteplase #tpa #ais #pharmacy #thrombolysis

[EM:CRAP @EM_crap]

I think I’m in the minority of pharmacists who are more OK with giving thombolytic for AIS in setting of DOAC in last 48 hours. Even with low pt numbers there isn’t a signal toward harm, right? You do have to be extremely careful on which pts have severe enough sx to merit tx

[Natalija Farrell, PharmD, BCPS, DABAT, FAACT @NatalijaFarrell]

Only 47 patients had last NOAC dose recorded of which half were within 48 hr preceding tPA. IMO, not enough patients to change recommendations even when combined with existing NOACs + tPA or Pradaxa + Praxbind then tPA case reports or retrospective studies

[EM:CRAP @EM_crap]

@PharmERToxGuy @ALiEMteam @MikeEMPharmD Is there much evidence to start using balanced fluids like LR in pediatric DKA +/- added K?

[Evan Mulvihill @Evancomycin87]

According to Zoom transcription, Professor Evan teaches about expanding the vascular spaceballs #zoomrecording #zoomtranscription #vascularspaceballs #twitterx #medtwitter

[EM:CRAP @EM_crap]

Texting with hospitalists is so fun… Beta Carelto for PE coming soon 🥕👨🏿‍🌾🧑🏻‍🌾🫁 #carrotsforpulmonaryembolism #MedTwitter #pharmtwitter #twitterx #xarelto #carrot

[EM:CRAP @EM_crap]

🎄TIS THE SEASON for merrymaking 🥂🍾 so watch out for “Holiday Heart Syndrome” in the ER 🚑🏥:
🍻 EtOH-induced cardiomyopathy
💓 atrial fibrillation
These patients may need cardioversion ⚡️ or antiarrhythmic tx 💉
#pharmacyeducationboard by the Twitterless Brenda Luke

[EM:CRAP @EM_crap]

@DeckC_PharmD Needs some deadly nightshade

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@adamoverberg I always knew AST and ALT had a thing for each other

[EM:CRAP @EM_crap]

Hehehehe

[EM:CRAP @EM_crap]

@garyDpeksa Sci hub yoself ! On your personal computer in an incognito window lol

[EM:CRAP @EM_crap]

@DrugInfoGeek @CDCgov I honestly don’t know I think the fastest I’ve seen CT/GC results come back is 2 hours. I think the Rec is made with the idea sometimes a pt will already have the test done with definitive results for GC/CT individually or sometimes providers waits for results to treat?

[EM:CRAP @EM_crap]

DEFINITELY seeing an uptick in STI cases with reopening and summer wild oat sowing … Friendly reminder to increase that ceftriaxone dose to 500 mg IM and to add doxycycline if chlamydia not ruled out! Consider azithro 1g dose in ER if pt expected to have barriers to compliance

[EM:CRAP @EM_crap]

4/4 She continues “but he said he doesn’t like to be caught. He said it’s better to do a crime outright than threaten to because if you threaten to and get caught then you don’t get any of the benefits.” #ayyiyi

[EM:CRAP @EM_crap]

1/2: The other day I did a Med Rec on a patient who happened to be drunk and on meth (#nojudgment). I was passing by the room later and he yelled out “Doctor!” I came in and said “We met, I’m the pharmacist. what’s up?”

[EM:CRAP @EM_crap]

3/4 The part 3 you didn’t ask for but are getting… 30 min later the hospitalist sits down next to me and says “I had a bioethical discussion with that pt.” I was thinking omg does he want assisted suicide? The doc goes “He told me he likes to commit crimes.”

[EM:CRAP @EM_crap]

@Vancbromycin I thought you were pretty skinny?

[EM:CRAP @EM_crap]

@CriticalCareNow @tsquaredmd If it ain’t broken, don’t fix it... I’ve never had much trouble with 0.6 mg/kg. Less with 1.2 mg/kg. Why ratchet up the dose for marginal returns when there isn’t much data on safety?