Alec Weir

EM/EMS/TEMS MD. Faculty at @ToughEnoughEM. Former academic chief resident at @DallasEMed #FOAMed #FOAMems. Opinions my own.

[Therese Mead @theresemead]

“Excited Delirium: Care at the Point of Contact” with @Weir_Alec: treat quickly, Ketamine 400-500mg IM and be prepared to manage sequelae #MEMA18

[Therese Mead @theresemead]

@Weir_Alec fields great questions during his Excited Delirium lecture as opener for #MEMA18. @MCEP_NEWS

[Medical Axioms @medicalaxioms]

“What time does your shift end today?”
“7pm”
“When will you be home?”
“I don’t know.”
“Can we make plans for 8?”
“You can make them. No guarantee I’ll be there.”
“How come you don’t know when you’ll be done with work?”
“Because I’m a doctor I guess.”

[Alec Weir @Weir_Alec]

@thatERguy Where you headed?

[Alec Weir @Weir_Alec]

Shift over. Time to Murph. #MemorialDay2018

[Medical Axioms @medicalaxioms]

@ERDoc4Kids Or accept that the answers you are getting are the best you’re going to get and start doctoring.

[Australian Tactical Medical Association @ATMA_Tactical]

“To operate at 100 miles per hour, you have to train at 200 miles per hour”

Maj Jon Christensen, NATO SOF education #SOMSA18 #NATOSOF #MilitaryMedicine

[Alec Weir @Weir_Alec]

@medicalaxioms Unless it only contains one diagnosis. Then it’s not a differential and is just an anchor.

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy Completely agree with that. I do the same but it’s usually after I’ve done some other things. Either diagnostic tests or physical/history and decision making. Rarely first order in patient without wheezing and without history. That was meant by the first tweet.

[Alec Weir @Weir_Alec]

When did albuterol become a panacea for undifferentiated shortness of breath?

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy Ballsy. What about HR >100? What if recent surgery? What if hx of clot? What if big swollen leg? Still giving albuterol first order out of the room?

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy Totally agree with parallel work but I think you may not be giving yourself the credit of your experience on which patients you DONT give it to upfront and await diagnostics. My concern is when it’s the first order on a non-wheezer with no hx of RAD.

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy While risk is low if any drug has zero benefit then only effects will be negative. That be sympthatic worsening of HTN in APE or moving someone from compensated R heart failure of PE to decompensated. Or the fact the don’t get their damn CXR done in time cause strapped to O2.

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy No but in those patients when it was a PE or CHF probably not the best idea.

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy Then you’re doing some differentiating prior to giving it. Doesn’t have to be wheezing. But OP is stating don’t like seeing it given prior to these things happening by EMS or EM. And it seems to be happening

[Alec Weir @Weir_Alec]

@ercowboy @IdiotTracker @thatERguy Are you giving this before doing some decision making that this pleuritic CP isn’t a PE?

[Alec Weir @Weir_Alec]

@thatERguy @IdiotTracker Agree. Doing something at dc different than doing something at the front end prior to evaluation/thought process of differentiating the complaint.

[Alec Weir @Weir_Alec]

@IdiotTracker @thatERguy Right but I’m guessing you’re assuming some things. But I’m the truly undifferentiated (no wheezing on exam which would make it differentiated, no hx of RAD which would increase prob of albuterol working). And not with zero downside. It’s ok to do nothing until differentiated.

[Alec Weir @Weir_Alec]

I feel true growth occurs at the edge of comfort. But I’m still working on pushing learners to the breaking point aka the learning point without losing them to apathy.

[Steve Carroll DO MEd @embasic]

We could take the money spent on TPA ambulances to give blood pressure medications to an entire city and it will have a much better health impact than these ambulances ever will

But they look cool...so let’s do it! https://t.co/D0mOm9JuVm

[Alec Weir @Weir_Alec]

@gateshil @tbouthillet Lots of patients with both CHF and COPD/asthma history. And in extremis should reach for PPV first. And if not in extremis Should be careful albuterol being sprinkled on everyone.