Carter

Emergency Medicine Physician - USC Alum 🐔

[Carter @carterdege]

@jhemming @NdeQuadros @joshmcgoo That’s a fair question. I just used that case as a very recent example for why I don’t think we should say only unstable patients should get CTA. It’s a useful risk stratification study that’s bidirectional as well - neg study is predictive of pts who can be safely obsed

[Carter @carterdege]

@jhemming @NdeQuadros @joshmcgoo Counter point, that’s survivorship bias. There’s ample data to support that patients with an active bleed on CTA have much lower rates of rebleeding when embolized. If you have a reliable way to predict which ones will stop bleeding spontaneously, that would be very useful.

[Carter @carterdege]

@NdeQuadros @joshmcgoo Completely agree with that

[Carter @carterdege]

@NdeQuadros @joshmcgoo Yes, definitely just talking LGIB. So hemodynamically stable, but hemoglobin <8, you’re fine with getting a CTA?

[Carter @carterdege]

@NdeQuadros @joshmcgoo Well, I don’t think that was very helpful. So, if they aren’t unstable, you won’t consider embolizing?

[Carter @carterdege]

@NdeQuadros @joshmcgoo Disagree. Within the past few days have had an active bleed on CTA that went for embolectomy in someone who was, at the time, still hemodynamically-stable. Sure, most are negative, but when they are positive, which is not always predictable, change care and can save a life.

[Carter @carterdege]

@danabeers Banana and mayo sandwich. Pretty common. Very weird. Very good.

[Carter @carterdege]

@SaltyRevSr @drjohnm Obviously we now know it wasn’t a PE, but you think that complaint of chest pain points away from PE? As many as 60-70% of patients with a PE report chest pain as chief complaint. PE is one of the classic emergent things that will kill a patient who complains of chest pain.

[Dr Terry Simpson @drterrysimpson]

Behold the anti-vax evangelist.

When you contradict their mythology of COVID, they do not debate — they declare.
When you say you were there, they accuse you of lying.
When you describe hallways lined with ventilators and refrigerated trucks behind hospitals, they reply with a video of an empty clinic lobby taken at 9 p.m. on a Tuesday.
Each move is deliberate. Each designed to plant doubt.
You bring data — randomized trials, excess mortality curves, ICU capacity graphs — and they inform you that the data are fabricated. You explain how ventilators are used, and they insist you never understood them. You describe surge staffing, proning teams, tracheostomies at 2 a.m., and they counter with TikTok clips of nurses dancing for 20 seconds between codes.

The performance is the point.

They operate in a closed epistemology. If hospitals were full, it was staged.
If they were not full in a viral lull, the pandemic was fake.
If vaccines reduced admissions, the decline was natural immunity.
If admissions rose before vaccines, it was hospital fraud.
No outcome falsifies the belief. Every outcome confirms it.

This is not skepticism. It is theology.

Show them excess deaths — conspiracy.
Show them ICU occupancy — manipulated.
Show them randomized vaccine trials — rigged.
Show them global replication — coordinated fraud.
Meanwhile, they will tell you they know how to run a ventilator, despite never adjusting PEEP in refractory hypoxemia. They will mock exhausted nurses for dancing as a coping mechanism and then, in the next breath, deny the very surge conditions that made coping necessary.
They deny the fire while criticizing the smoke.
And here is the final absurdity:
They insist hospitals were empty — until the vaccine arrived. Then they insist vaccines didn’t work. The contradiction does not trouble them, because coherence was never the objective. Conversion was.
Doubt is their currency. Outrage is their marketing strategy. Certainty is their costume.

Science revises.
Medicine adapts.
Data accumulates.

But conspiracism calcifies.
And so we arrive here — where those who have never held pressure on a crashing patient accuse those who did of inventing the crash.

[Howie Roseman’s Burner @HowieBurner]

The Kevin Patullo experience is 1-3 drive a game that make you think “oh he’s got it now” and then 9 straight drives of the most utter dogshit you’ve ever seen

[Jimmy Kempski @JimmyKempski]

Kevin Patullo is an easy target, IMO. He isn’t bringing anything to the offense, but…

- Ultimately, it’s Nick’s offense.
- Nick is directing big-picture in-game strategy (ie. give-up plays, etc.)
- Nick hired him.

That’s where frustration should be directed.

[Brandon Lee Gowton @BrandonGowton]

At his best, Nick Sirianni stays out of the way and doesn’t drag the Eagles down. We saw that over the last couple weeks.

At this worst, the Eagles have to win in spite of their head coach instead of him giving them an edge.

[Carter @carterdege]

@StoolMintzy What’s an SI nerve

[Carter @carterdege]

@BrandonGowton Just come on home (if it happens)

[Sam Ghali, M.D. @EM_RESUS]

Hi, ER Doc here.

I don’t know who needs to hear this but do NOT even think about it.

[Carter @carterdege]

@SeanZ5728 @ProFootballDoc Who is treating STIs with fluoroquinolones?

[Carter @carterdege]

@Keeegs2 @adamlevitan Weird https://t.co/Sg7UWxgZyG

[Dr. Rick Pescatore @Rick_Pescatore]

You ask me why I’m slow to act when the patient’s crashing, why I walk instead of run.
You say “Shouldn’t we be doing more?”
Here’s what I’ve learned, and why I don’t reach for the epinephrine first.

A thread for young docs:

[Philadelphia Eagles @Eagles]

It’s gameday.

[Carter @carterdege]

@BFW “…for simply saying you weren’t gonna make the playoff.” Is that all you said? It’s wild to have already forgotten saying this and then change the story to play the victim.