Regino Oliva Lopez

Cyclist, EM ANP, Feliz husband and father and plenty of more things.
Views my own.

[Regino Oliva Lopez @Quinoteol]

@ManagingBarca @jaumemarcet Q q q q q q

[Regino Oliva Lopez @Quinoteol]

@musk_news13 Yes

[Jose Elías Navarro @jose_elias_nvr]

Me preguntaron si me mudaría de Badalona para pagar menos impuestos.

Mi respuesta es “no”.

Yo creo en los impuestos.
Pienso que hay que pagarlos para garantizar que:

- Tu hijo tenga educación.
- Y el hijo del que no puede pagarla tenga educación.
- El que tenga dinero pueda a ir a un hospital a curarse.
- Y el que no lo tenga también.

Pero:

Creo también que los impuestos se tienen que gastar de una forma eficiente.
Y veo que no es así.

- Las listas de espera de la seguridad social son interminables.
- Se invierten estos impuestos en gilip*lleces.

Deberíamos ser más eficientes en esos ámbitos y aprender a destinar los impuestos a donde son necesarios.

Sin embargo, esto no hace que quiera irme a Andorra o a cualquier otro sitio.

Seguiré viviendo en Badalona.
Es una ciudad maravillosa.

Y seguiré pagando mis impuestos aquí.
Esperando que algún día se usen mejor.

[Regino Oliva Lopez @Quinoteol]

@AlvaroMorata @CervezaVictoria @SEFutbol Después de esta final se te va a recordar en la historia del fútbol pero de lo que sin duda yo y mucha gente no te vamos a olvidar es de lo buena persona que eres. Un abrazo y disfruta

[#CF11Fitness @CF11Fitness]

We are now staying open until 18.30 on Fridays

Rydyn ni nawr yn aros ar agor tan 18.30 ar ddydd Gwener

[Regino Oliva Lopez @Quinoteol]

Pretibial lacerations | British Journal of Hospital Medicine https://t.co/xud7n9yp9q

[Regino Oliva Lopez @Quinoteol]

@FoDHalf "Need some advice, Twitter friends! 💌 I registered and paid for the Spring Forest of Dean Half Marathon back in November but haven't received any confirmation email. Has anyone faced something similar or have tips on what to do next? Really appreciate any help! #RegistrationHelp

[Jack (EMNote) @jackcfchong]

Brugada syndrome is a rare but potentially life-threatening heart rhythm condition that can cause fainting, seizures and sudden cardiac arrest. It is caused by a genetic mutation that affects the electrical activity of the heart.
https://t.co/tFjDeV8BN1

[NephroPOCUS @NephroP]

Aplicaciones clínicas de la ecografía pulmonar 🔗https://t.co/TrpAgXFkWb
#POCUS #MedEd #IMPOCUS #CriticalCare

[Lea Alhilali, MD @teachplaygrub]

Even if you’re in it for the LONG haul, sometimes it’s good to come up SHORT!

If you can’t summarize, you’ll never memorize!

Here's a shortened, summary cheat sheet for my popular thread EVER��How to read a head CT

If you're looking at head CTs, this is what you NEED to know!

➡️3 main things to look for on head CTs are:
🔸Blood
🔸Mass Effect
🔸Stroke

➡️Blood
🔸CT is just a measure of density & blood is thicker than water, so blood is denser than brain on head CT
🔸Blood can be:
▪️EPIdural: looks lentiform
▪️SUBdural: looks crescentic
▪️SUBarachnoid: looks snake-like

➡️Mass effect
🔸You won’t bleed out in your head—the problem is the calvarium is an enclosed & brain gets compressed
🔸Look for:
▪️Subfalcine herniation = midline shift, ventricles to the other side
▪️Transtentorial herniation = loss of the basilar cisterns, normally look like a pentagon & smiley face

➡️Stroke
🔸Normal gray-white differentiation looks like an octopus & is crispy & well-defined
🔸In stroke, it looks like someone took a painting & smeared the white matter paint into the gray matter paint

🌟You can see the full thread here:
https://t.co/NyrzkWz0Q2

So now you know what to look for on a head CT. Hopefully this short version stays with you for the long haul!

[Oren Gottfried, MD @OGdukeneurosurg]

Eye issues to know

[Sam Ghali, M.D. @EM_RESUS]

As a new Emergency Medicine attending 10 years ago I was asked to write about my insights into what it's like to be an ER Doctor. I just randomly came across it and after all these years I'm amazed by how much this all still rings true in my heart today. So I wanted to share it with you guys. Here's what I wrote:

MAKE THINGS HAPPEN, SAVE LIVES, ALLEVIATE SUFFERING

My Emergency Department is a battlefield. Volumes are high and the pace is fast. To succeed as an Emergency Physician I must be an expert of efficiency. I also must be an expert of triage. I am constantly triaging and re-triaging as things evolve. The ED is highly unpredictable. My entire shift I am on guard and ready for any emergency to come flying through the doors at any moment. In the meantime I am either taking care of or seeking out other emergencies. My job is not to be expert in all of medicine. My job is to be jack of all trades and master of diagnosing and treating what can and will kill you. If I cannot provide the definitive care you need, my job does not end until I have gotten you there.

The more I practice Emergency Medicine, the more I realize that what I do more than anything else is - make things happen. Cliff Reid (@cliffreid) delivered an excellent SMACC talk on making things happen in the resuscitation bay. (If you haven’t yet heard it I recommend you do). I’ve come to realize that this concept extends beyond the resus bay and pervades all aspects of my job.

So what does it mean to make things happen? Making things happen means putting my visions of what needs to happen into motion and making them reality.

In order to make things happen, I must first appreciate that my ED is equipped with an army of highly skilled staff that are the heart and soul of the department – and that without them I could make very little happen.

Making things happen means identifying a sick patient and getting them quickly moved to a critical bed; it means getting my suspected head bleed patient expeditiously to the CT scanner with least possible delay; it means mobilizing help to intervene on my flash pulmonary edema patient in hypertensive crisis and getting her on CPAP & Nitro immediately to pull her out of the water and prevent intubation; it means convincing my adamant patient who is ready to walk out the door but is clearly not well enough to go home not to sign out against medical advice, but rather to stay in the hospital where he/she is safe and taken care of; making things happen means advocating for my patients and convincing my consultants to take them emergently to the cath lab or operating room at 3 AM when it otherwise would not have happened until morning. Making things happen means constantly thinking two steps ahead. Making things happen is an art. I have learned that to excel in Emergency Medicine I must master the art of making things happen.

If my goal is to save lives, I must first recognize that a life needs to be saved – that is, I must be an expert at diagnosing life-threatening processes. The 75-year-old clutching his chest with tombstones on his ECG – that’s easy. The problem is that most of my patients are not truly sick. Some are here because they are afraid that they are sick, and just need reassurance. Some are here just for pain medications. Most of my patients are undifferentiated. Sickness is a spectrum. Truly sick patients often look sick, but often they do not. I must be expert at sifting through the crowd and identifying which patients are harboring a life-threatening diagnosis. This is not always an easy task, but it’s up to me to figure it out.

It’s my job to figure out that the 45-year-old gentleman who looks comfortable sitting up in bed watching television and texting on his phone has a Type A Aortic Dissection. If I simply get two sets of cardiac enzymes, repeat an ECG and discharge him home since these are normal – there is a good chance he will die. It’s my job to figure out that the 60-year-old lady with chest pain who was transferred to me for “NSTEMI” actually has a huge saddle pulmonary embolus. It’s not enough to just admit her to the hospital floor only for her to sit up there, decompensate, and have a bad outcome. I have to do better than that. In the Emergency Department, there are landmines scattered everywhere. It’s my job to find the landmines.

I can’t talk about saving lives without talking about Resuscitation. This is an entire topic in and of itself and I could write all day about it – but I won’t do that here. I will simply say that if I want to save lives, I must be an expert at Resuscitation. I believe that as an Emergency Physician, if I am not expert at Resuscitation – my purpose is lost and my mission is in vain. Resuscitation encapsulates those moments that matter most; the moments that often determine my patients’ fates, and define Emergency Medicine as a specialty. Resuscitation is the essence of Emergency Medicine.

In the end, Emergency Medicine is all about the patients. While patients are under my care, I consider them family. When I walk into a room, I shake hands with each patient and all their friends and family members who have come to support them. I look my patients in the eyes. I listen to them. I try my best to put myself in their shoes and empathize with them. I know that communication is vital and I make sure we are on the same page, and that all of their questions have been answered. I make a point to ensure that they know to let me know if they need anything. If my patients are not comfortable, I am not comfortable.

Some humble advice I have to offer for success in Emergency Medicine:

1. Never stop learning. There’s too much out there to know, and knowledge is the foundation for the care we provide. Your eyes won’t see what your mind doesn’t know. Never get complacent in your knowledge.

2. Trust your instincts. Gestalt is at the heart of what we do. Without it we are merely computers and robots. Gestalt trumps any clinical decision rule any day. Even if you don’t know exactly what’s wrong with your patient, but you have a feeling something bad is going on – trust it and pursue it.

3. Be decisive. I’ve seen too many times patients crash while “decisions were being made”. If you choose not to intervene that’s fine, but not intervening should never be the default decision, as a result of indecision. That is unacceptable. First do no harm, does not mean do nothing. Don’t fall victim to being more comfortable with the devil you know than the devil you don’t. Understand that sometimes not taking a risk can be extremely risky.

4. Learn to control your mind in stressful situations. Adrenalinization is normal. While it’s a natural reaction and will enhance your performance, too much will impair your thought process and technical skills. Learn to recognize when you’re becoming over-adrenalized, and learn whatever it is that works for you to be able to relax, stay calm, and temper your sympathetics.

5. Be cognizant of human factors. So much of what we do is psychological. Be aware of your susceptibility to cognitive bias. The key to conquering cognitive errors is to be aware of their existence.

6. Debrief after codes or tough cases and take time to reflect back after shifts. I do this routinely and I find it to be invaluable. Some of the greatest things I have picked up on have been via this process.

7. Learn Emergency Ultrasound.Believe me when I tell you that Emergency Ultrasound will transcend your practice. If you don’t learn EM ultrasound, at least learn the critical care stuff. If you don’t learn the critical care stuff, at least learn basic Echo – it has the greatest impact.

8. Follow up on your patients. I can’t express how much of my learning is through following up on my patients. If you don’t do it already – start! You will be amazed by how much you will learn.

9. Accept and embrace that some of your patients will have bad outcomes or die no matter what you do – but never, ever let this be an excuse to provide anything less than the best care you possibly can.

10. Be kind and compassionate. When it’s all said and done our patients may not remember details of their ED stay during what might very well have been the worst day of their lives – but they will remember how we made them feel.

[𝗥𝗲𝘀𝘂𝘀𝗠𝗲𝗱 @ResusMed]

I like simple!

[Emergency Medicine Journal @EmergencyMedBMJ]

#October2023 #Commentary

Plan A’ for ultrasound-guided regional anaesthesia in the Emergency Department

https://t.co/VzEBoUzBjw

@TraumaDataDoc @casualtysrus @Oxford_Trauma

[The Innovation | Medicine @Innov_Medicine]

Types of cardiac inflammation

Credits: @DocScribbles

#MedTwitter #MedEd #CardioTwitter #CardioEd

[| MED @medflutter_]

Master the ECG.

[Dr. OMID BANDARCHI @OBandarchi]

A beautiful clip about "Bulging disc" ! 👍
Credit: Dr Wealz

[Journal of Brown Hospital Medicine @BrownJHM]

EKG basics - What is sinus rhythm? @cardiologyoncal #medEd

[Dr. OMID BANDARCHI @OBandarchi]

🔴FEMORAL NECK FRACTURE🔴
●Common Fx
●Femoral neck blood supply is retrograde
●Neck of femur has 2distinct areas: ♦️Intra-capsular:
Subcapital,Midcervical,Basicervical.Some considered basicervical as extra-capsular ♦️Extra-capsular:
-Inter-trochanteric
-Sub-tronchanteric