Laura Sofia Nasiff

Emergency Medicine Physician❤️‍🔥- World Traveler

[Laura Sofia Nasiff @LSNasiff]

We kindly invite you to visit our poster in ISICEM. Stand 04. Presented by Dr Sandra Bernal. @NNavarreteMD @Jimenitacx

[IMCrit @IM_Crit_]

Shock is not about hypotension but about hypoperfusion

[Critical Care Reviews @CritCareReviews]

Advances and Challenges in Sepsis Management: Modern Tools and Future Directions

CCR Journal Watch
https://t.co/Sp06oA6IDG

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://t.co/nitMzacLrj

[Critical Care Reviews @CritCareReviews]

Today's paper of the day is on the vasopressor-sparing action of methylene blue in severe sepsis and shock

https://t.co/JKgcYjlUQ5

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2024

[Julia Malott @AlottaMalotta]

Please share this widely! I couldn't be more terrified of our country's healthcare crisis and @ONThealth can do better!

Ontario healthcare is broken and we've long known it. It's been like this my entire lifetime, and I'm not exactly young.

This is my daughter's IV line, which she's been connected to since 2:00am this morning. She's been awake for well over 24 hours, as have I, as we await care at @StMarysGenHosp in Kitchener, Ontario.

We arrived shortly after 10:00pm yesterday evening after my daughter complained of excruciating abdominal pain. As usual, care took hours to arrive. She was given a bed where she squirmed and sobbed until finally, shortly after 2:00am, the doctor paid her a visit and ordered pain meds to make things bearable.

It was evident by 4:00am that we were almost certainly looking at appendicitis, as the pain was centralizing in the lower right quadrant. We all suspected this, but we couldn't confirm until 8:00am because... apparently we don't have ultrasound technicians during the evening. No one has medical emergencies in the middle of the night, I suppose?

For those who haven't had the pleasure of an inflamed appendix, appendicitis often leads to a ruptured appendix after a period of increasing pain, and that rupture can be fatal. Fortunately for us that hasn't happened yet, but time matters. There's nothing this hospital can do for us as 'we need to confirm it's appendicitis'. We wait until 8:00am

By 5:00am we are told that my daughter needs to give up her emergency room bed. Someone else needs it. She is still in pain, but will now make due sitting in the waiting room, putting pressure on her abdomen in the process. There's no negotiation—there are no beds available.

We wait until 8:00am. We wait until 9:00am. Some guy walks in with a Tim Horton's cup during our tenure and gets the first ultrasound slot. I'm sure his condition was just as severe.

By 10:00am the doctor confirmed what had been evident for hours—we've got a case of appendicitis on our hands and we need to move forward with emergency surgery.

...Except... they can't do that in this particular hospital and @grhospitalkw doesn't have any beds available either. No one knows when they will have a bed for my daughter who is both sleep deprived and in critical medical condition.

I inquire. An hour? A bed by noon? Will we even get one today?

No one has an answer. No one wants to have the conversation. I can tell I am a burden to the overworked staff.

We return to the waiting room and my daughter keeps sitting. She's been awake now since yesterday morning. Her pain flares up every few hours and—after being brought almost to tears the edge is subdued with another dose of pain suppressants.

She's refused a bed because there are no beds available, and I can't take her home to her bed because she needs surgery—though there's none of that available either.

She hasn't eaten in more than 18 hours and she's been told that she's not allowed one bite because she might have surgery any moment... Or perhaps never... so we sit and wait—watching her IV machine go into upstream occlusion every 5 minutes. The nurses don't have time to do anything about it.

This is a simple problem to fix. Fund our healthcare system! @SylviaJonesMPP, @fordnation, our citizens deserve better.

Fix it!

[Informal Economy @EconomyInformal]

Energy Price Inflation (%)

Colombia🇨🇴: 21.8
Czechia🇨🇿: 12.5
France🇫🇷: 11.7
Ireland🇮🇪: 9.3
Australia🇦🇺: 9.1
Canada🇨🇦: 5.4
Korea🇰🇷: 5.2
Italy🇮🇹: 1.7
Germany🇩🇪: 1.4
US🇺🇸: -0.5
UK🇬🇧: -0.7
EU🇪🇺: -3.6
Mexico🇲🇽: -4.5
Japan🇯🇵: -11.7
Spain🇪🇸: -14.0
Sweden🇸🇪: -26.4
Belgium🇧🇪: -28.7

@OECD

[Emergency Medicine News @EMNews]

Not all #EDs are created equal. It’s upsetting for patients who are told to “go to the #ER” to find the #ED can’t provide services or doesn’t accept their insurance.

.@ERGoddessMD says #PCPs & #EPs should be more transparent about which EDs can do what. https://t.co/kCgQXLMVQl

[Dr. AK 🇮🇳 @docakx]

💥AMIODARONE is a class III antiarrhythmic drug which is widely used in ER for treating arrhythmias.

A 🧵 on situations where blind use of amiodarone in emergency can be counterproductive ⚠️⚠️⚠️

With alternate therapeutic options

Read on...👇
#MedTwitter #MedEd #MedX

[Emergency Medicine News @EMNews]

Beware the painless #PE, says @EM1MinuteGuru because they’re usually larger and more severe than painful #pulmonary #emboli.

Read why: https://t.co/Ld6B0q5lTE. #FOAMed

[Tommaso Scquizzato, MD @tscquizzato]

TOP 10 EMERGENCY MEDICINE JOURNALS BY 2022 IMPACT FACTOR

1️⃣ World J Emerg Surg IF 8.0
2️⃣ Resuscitation IF 6.5
3️⃣ Ann Emerg Med IF 6.2
4️⃣ Emergencias IF 5.5
5️⃣ Burns & Trauma IF 5.3
6️⃣ Acad Emerg Med IF 4.4
7️⃣ Eur J Emerg Med IF 4.4
8️⃣ Am J Emerg Med IF 3.6
…

[Dr. Kylie Booth @KylieBoothDr]

Attention all Ontario EM docs, and welcome (on July 1st!) to our new grads - you aren't alone! Peer-to-peer is available 24/7 - CTAS I-V, anytime, anywhere... We are here to help! @NourKhatibMD @SRPCanada @snewbery1 @ROMPonline

[NephroPOCUS @NephroP]

Framework/thought process for optimized fluid management.
🔗 https://t.co/4x8TvV4HGb
#POCUS #FOAMed #FOAMcc #Nephpearls

CRT capillary refill time, CO cardiac output, CVP central venous pressure, EVLW extravascular lung water, VS venous stasis

[Laura Sofia Nasiff @LSNasiff]

May the 4th be with you #EM💪🏻

[Royal College of Emergency Medicine @RCollEM]

🚨Publication of true 12-hour length of stay data a welcome & significant step for Emergency Medicine @RCEMpresident

In February 2023, 125,505 patients waited 12+ hours from their time of arrival, equal to 10.59% of Type 1 attendances.

Full statement: https://t.co/ahihG46H8k

[Shunichi Nakagawa @snakagawa_md]

You don't have to know everything.

But if you don't know what you don't know, that is a problem.

You just have to know what you don't know, and ask for help appropriately.

[Roberto Cosentini @rob_cosentini]

My 20 years in ER with @davidcarr333 at #CEU2023

Teach to increase your skills

Listen to nurses

Prepare to navigate the bad to reach the good

Listen to patients

Stay curious

Share thoughts and feelings. Find a “Failure Friend”

Find a mentor and mentees

[Avraham Z. Cooper, MD 🩺 @AvrahamCooperMD]

Easily one of the coolest and craziest medical images I’ve seen - an aortic arch that extended way up into the person’s neck 🤯

#MedTwitter

[Hubble @NASAHubble]

To close out Hubble's 2023 #MessierMarathon, here's a new image of M19!

M19 is a star cluster with a slightly elongated shape. It's relatively close to the heart of our Milky Way, so the gravity from the galactic center could be stretching it: https://t.co/9PeZFuz5Hd

[Scott Isaacs @scottisaacsmd]

Physical activity is 1.5 times more effective at improving symptoms of depression, anxiety and distress compared to antidepressants. https://t.co/MBGCVar221

[Critical Care Reviews @CritCareReviews]

Fluid management in septic patients with pulmonary hypertension

CCR Journal Watch
https://t.co/Sp06oA6IDG