John Cook

Learner of all things EM, Ultrasound, and Critical Care. Cook county alum. Just a guy.

[Al Jazeera English @AJEnglish]

‘We can’t confuse Hamas with all Palestinians’: Spain says amid aid review https://t.co/W6Nm16Ew6f

[Josh Farkas MD 💊 @PulmCrit]

again for the people in the back:

“increasing the proportion of registered nurses is associated with improved outcomes and, potentially, reduced net cost.”

[John Cook @J_County]

@toxiholic @CookCountyEM @poisonreview But then the ol’ “but doctor, what about this…”

[John Cook @J_County]

Unresolved tasks (cognitive or otherwise) generate MORE tasks. Don’t put off the cognitive work, or as Dr. Moskoff at .@CookCountyEM always told me, “don’t turn one pt into two pts.”
#RMWC23

[John Cook @J_County]

Quality Metrics: how to move the needle? 1. Focus on the right metrics. Should benefit pts, society, system. 2. Metric should be able to have figurative needle moved by the ones actually providing care. 3. Something you actually need improvement on. 4. Measurable
#RMWC23

[John Cook @J_County]

Power Up by: working out before shift, bolus healthy meal before shift and healthy snacks during, timely caffeine, avoid high sugar intake (neg effect on mood & vigor). nights: sleep schedule, nap b4 shift, no caffeine last 3-4 hrs of shift, & cold, dark room for sleep.
#RMWC23

[RockyMtnEM @RockyMtnEM]

In addition to the systemic toxicity, it’s peripheral vasoconstricting effect may worsen wounds

[RockyMtnEM @RockyMtnEM]

Xylazine is an increasingly common co-ingestion with opioids. So what is it and why do we care?

It functions as an alpha 2 agonist (like clonidine) and can cause increased sedation, hypotension and peripheral vasoconstriction.

[John Cook @J_County]

Most studies show about 40-45 sec to deliver some extra words for compassionate care. Well worth the time, especially in the ER!
#RMWC23

[John Cook @J_County]

Compassionate care, does it matter? The data that exists does show better pt outcomes. Makes sense. Better therapeutic relationship will translate to better outcomes.
#RMWC23

[Very General Orthopaedist @generalorthomd]

I looked up my “peer” who denied an indicated surgery.

My “peer” hasn’t been allowed to do surgery for 10 years because he put a hip replacement in backwards, but he gets to overrule my decisions.

This is insane.

[John Cook @J_County]

The Death Cap, give cyclosporine? What?! .@toxiholic bringing it per usual #RMWC23

[John Cook @J_County]

Amlodipine OD, severe vasoplegia, pressors to treat but what else?! Methylene blue counteracts mechanisms by which amlodipine causes profound shock…case reports have some success. Your tox center may recommend…whaddyagunnado?
.@toxiholic #RMWC23

[John Cook @J_County]

.@toxiholic covering Focused therapies in Tox in an upside-down world.
Is there an adjunct to NAC for APAP OD? Fomepizole…Maybe! Talk to poison control & they may suggest in certain cases…
#RMWC23

[RockyMtnEM @RockyMtnEM]

Which is best AED to use in status epilepticcus? Keppra, phenobarbital and phenytoin all equal so take your pick! #RMWC23

[RockyMtnEM @RockyMtnEM]

Dr. Adam Rousssas shares tips for improving care for the migrant patient:

1) establish a safe environment
2) ask why they left
3) consider human trafficking
4) ask about mental health

#RMWC23

[RockyMtnEM @RockyMtnEM]

Some trauma airway pearls from Dr: Windsor @UMEmergencyMed #RMWC23
1️⃣ Airway is not always first priority 2️⃣ Turn your NRB to flush flow rate 3️⃣ Ketamine induction agent of choice 4️⃣ HypoT? Double paralytic and half induction agent

[John Cook @J_County]

At the end of every difficult airway algorithm is cold hard steel. Prep your mind & team that this is part of the plan. Best photo ever btw
#RMWC23

[John Cook @J_County]

OrthoPearls
Consider carpal tunnel view if swinging injury mechanism and persistent pain on the ulnar side. What might you find? A hook of hamate fracture! Standard 3-view can miss it!
#RMWC23

[John Cook @J_County]

#RMWC23
Anyone ever reach for IV midaz over IV lorazepam/diazepam for status epilepticus?