Shweta Mishra

imperfect 😀#FOAMed

[Cliff Reid @cliffreid]

“One day we will…stop making patients lie flat”

- @HumanFact0rz

[Matt Reed @mattreed73]

What is the evidence around diagnosing Acute Aortic Dissection in the ED? At @EuropSocEM #eusem2024 I summarised the results of DAShED, ASES & PROFUNDUS. Here is a copy of my presentation; https://t.co/Ats8tole5K

[Shweta Mishra @SKarrtik]

Some tough cases bring life into perspective.

https://t.co/DbluWeHUhb

[Shweta Mishra @SKarrtik]

@doc_khuram 🤣🤣

[Cliff Reid @cliffreid]

Surviving as a team leader in emergency medicine. Here are 10 learning objectives & strategies I recommend:

1. Develop a resuscitation mindset, taking responsibility for the critically ill patients under your care

- ownership is key

[Benjamin Smith @benjamin0594]

Please could I ask you spare a few moments to vote for me, for Inspiring Leadership award at the Kent and Medway Pharmacy Professionals Conference being held tomorrow. Voting closes on Sunday 🤞Link in comments

[Shweta Mishra @SKarrtik]

Kolkata your resilience will shine through …

We stand together!

❤️❤️❤️❤️
#BengalHorror
#KolkataDeathCase

[Shweta Mishra @SKarrtik]

Kolkata💔💔💔💔

[Shweta Mishra @SKarrtik]

Today my parents say good you did not stay back
Today her parents say - we wish you weren’t a doctor.

💔💔💔💔💔

#KolkataDoctor

[Shweta Mishra @SKarrtik]

For someone who did her internship in Kolkata, and has such beautiful memories of Kolkata, everything happening there right now is way too personal.

As an intern we have walked around empty hallways , dealt with abusive patients, did long tedious hours, no rest, no sleep.

[Shweta Mishra @SKarrtik]

Spent many a nights searching for a moment, a place to catch our breath.

All of us are her! All of us were her!

We have all lived that fear, 10 years since I worked in Kolkata and things have gone worse.

[Aortic Dissection Charitable Trust @AorticDissectCT]

More needs to be done to save the lives lost to #aorticdissection in #emergencymedicine.

Please watch and share this 3 minute masterclass created by experts, and together we can make a difference.

#AortaEd

https://t.co/subkUj6EdE

[Ross Prager @ross_prager]

Communication as code leader during a cardiac arrest is hard.

Here are 5 things you can do to improve your code communication right now. 👇

A 🧵

#medtwitter #foamed #meded

[Hassan BencheqrounMD @DrBCalifornia]

Your list is excellent!!

I added some of my methods that I teach to residents in a lecture “I’m leading a code blue. Overcoming the fear to lead with confidence”.
Feel free to disregard if not along your direction.

1. Everyone in my team knows ACLS. I’m here to guide not to tell what to do in ACLS

2. I Coincide the pulse checks with the switch of the chest compression person with their relief. Saves a few seconds repeatedly of interrupted chest compressions

3. I Organize the swap of the Chest Compression person with their relief by timing it.
Ex:
- Person A notifies me when CLOSE to tired.
- Relief person B is positioned behind.
- Person A told to step down on the right.
- Person B step UP from the left. - Person C (pre-designated) takes the pulse.

I’m the code leader counting 5 seconds for everyone.

- PersonC: No pulse
- Person A: I’m off
- Person B: in position.
- Code leader me: Resume chest compressions.
To the Documenter: No pulse.

4. Call family and keep them on the phone. Put the phone to the ear of the patient after telling family he/she won’t respond but we’re still fighting for them. Say 1. I love you 2. Thank you 3. I’m sorry 4. Good bye. (Coaching an emotionally traumatized person what to say during a traumatic moment, will have reverberations years down the road).

5. ROSC: If pulse is retrieved, I say immediately to my team:
“code not over. Please stay in position”.
I keep the team for at least 5 min to recheck pulse and see that it’s sustained response before I can end the code.

6. Pronouncement: As a code leader, I summarize the case towards the end before stopping the code, to my team and explicitly ask for feedback if I forgot something.
—
Ex: 71 yo presented with cited complaint of weakness found to have renal failure and hyper K. HR was given hyper K protocol twice and started on pressors and CRRT. He “didn’t respond to the treatment” and went into cardiac arrest. During our code we did 5 Epi, no shock was indicated, intubation with good O2sat, uninterrupted CPR for 17 min so far, pupils are unresponsive, patient is comatose, echo shows the patient has EF 20%, and renal failure worsened. Lactic is 12. At this point, we treated what is to be treatable. Anything else I missed?
—
My team agrees or someone says for ex “what about fingerstick?”i proceed to make that happen thanking the person.
In the end, whenever all feel at peace with the decision to pronounce it, I call for a
- final pulse check.
- Stop chest compressions
- Stop ventilating
- Examine the exam for death: pupils, neuro stimulus, auscultation for spontaneous heart beat or spontaneous breath, pulse check in at least two areas.
- Then I call it.

6. I give condolences to the family.

7. The post pronouncement moment of silence (The mercy moment). If family is present, involve them. I found it is healing to the CPR team and has long lasting positive effect on the loss of a patient everyone fight hard for. We have the speech in a laminated card so people have guidance as to what to say (see below).

8. I swing by later to check on my team members individually for any that are struggling with sadness or complex feelings post pronouncement (RT, RN. phlebotomist, security, nursing student, resident, medical student, Xray tech..).

9. Later at night after the end of the day, I take a moment to check in internally. I start by finding the words from the chart of emotions that describe what I feel. Then take it from there to try to make my own voice and feelings feel heard (see below).

[Cliff Reid @cliffreid]

NEW Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!
https://t.co/Io2Xgy8gOy

[Shweta Mishra @SKarrtik]

Starting work after 2 weeks of vacation.. and the biggest fear is whether I will remember how to drive!!
#IYKYK

[Shweta Mishra @SKarrtik]

7 years with this gorgeous man!
He makes living worth it❤️❤️❤️
@DrRahulRSingh

[Shweta Mishra @SKarrtik]

It was a fun day
#NYC

[Shweta Mishra @SKarrtik]

I can get used to this!! ❤️❤️❤️❤️ it’s snowing, it’s cold, it’s just amazing! No crowds, life is at the perfect pace…
#NYC