Justin Cook

ED physician with a penchant for sono, airway, medEd, & 80s drumming. Critical Points & ULA faculty.

[Justin Cook @ER_Dr_ummer]

Yes!

[Justin Cook @ER_Dr_ummer]

Anyone using a COVID “protected code blue” model that incorporates a P100 respirator for the immediate first responder to start CPR/apply O2 by mask? Versus N95, for which many don’t pass fit testing, and PAPR donning which takes obviously longer . . .

[Justin Cook @ER_Dr_ummer]

@critcareguys Winters: Predictors of peri-intubation cardiac arrest (DeJong 2019)
✓ Hypotension prior to intubation ✓ Hypoxemia prior to intubation
✓ Absence of preoxygenation
✓ Obesity
✓ Age over 75 years

Hypoxemia: the most significant factor.

#CritPoints19

[Justin Cook @ER_Dr_ummer]

@ER_Dr_ummer: Deliberate practice for vascular access and nerve blocks: extra-firm tofu is your friend.
Take a tofu time-out.
https://t.co/3Ra59SSbp3

[Brian Lin, MD, FACEP @bwlin720]

“We are playing a team game, and they are still testing us as solo athletes.” Dr Jeff Drazen, editor of NEJM, on continuing certification & assessment in medicine. Thought provoking! @KLIC_SF @KPMedSchool @KPShare #MedEd @theMedEdGuru @ZivTali @ucsfklic

[Justin Cook @ER_Dr_ummer]

@GoodCPR @emcrit N.B. Other loveliness about original SPEEDBOMB is it also has POST-intubation checklist of same mnemonic. Check it out.

[Justin Cook @ER_Dr_ummer]

@GoodCPR @emcrit Thanks for sharing! To clarify, this is a team-focused modification of previously-published SPEEDBOMB checklist here: https://t.co/vCsISUcj8p

[Justin Cook @ER_Dr_ummer]

(2/2) When doing nerve blocks, also avoid LAST (local anesthetic systemic toxicity) by:

-incremental injections of 3-5 mL at a time
-use nomogram to dose your local anesthetic safely:

https://t.co/Hct7VlXbLO

#PRFest19

[Justin Cook @ER_Dr_ummer]

Superficial cervical plexus block uses:
-laceration to the helix or lobule of ear
-laceration in submandibular region, adjacent to angle of mandible
-placement of IJ vein central line
. . . and may have some benefit for clavicle fractures

#PRFest19

[Justin Cook @ER_Dr_ummer]

(1/2) When doing nerve blocks, avoid LAST (local anesthetic systemic toxicity) by:
-using the smallest volume of the least-toxic local anesthetic
-using ultrasound!
-avoiding multiple injections
-aspirating before you inject . . .
#PRFest19

[Justin Cook @ER_Dr_ummer]

@emlitofnote "In the bougie group, the operator attempted to pass the bougie into the trachea. If successful, an assistant loaded the endotracheal tube..." So ETT not preloaded or Kiwi/D-grip. Speaks to need for role assignments + team training 4 community ED practice.

[Justin Cook @ER_Dr_ummer]

2wk old has glucose of 30. Draw these labs (=orderset) BEFORE dextrose (unless seizing or coding); 11 cc required. #NateMick #CritPointsIES

[Critical Points @CritPoints]

Why Nate uses only cuffed tubes in peds intubations. #NateMick #CritPointsIES

[Justin Cook @ER_Dr_ummer]

@bedsidesono @HGHED @JoeLex5 So true! Otis has the Ken of a poet.

[Justin Cook @ER_Dr_ummer]

First Stranger Things, now 24k Magic. We have just reached peak 80s nostalgia, folks. Sell your Jovi concert T now

[Justin Cook @ER_Dr_ummer]

I just heard the raddest Gap Band/Grandmaster Flash mashup! Oh wait, it's the new Bruno Mars song

[Bret Nelson @bretpnelson]

Breaking news!
2016 @ACEP_EUS ACEP ultrasound guidelines just published
https://t.co/QoKfEGeDAg
#FOAMed

[Justin Cook @ER_Dr_ummer]

Our course is only two months away! Register now at https://t.co/vaJsqonAbg to learn, refresh, and play at the Rancho Bernardo Inn.

[Justin Cook @ER_Dr_ummer]

@britfltdoc @critpoints Funny you should ask—was going to drop this ~Thursday from Critical Points account. In- and out-of-plane . . .

[Justin Cook @ER_Dr_ummer]

@britfltdoc My pleasure! Hope you have success with whatever strategy you choose.