Daniel Adams

Emergency Physician | opinions mine

[Daniel Adams @Danimal_MD]

@DocEd @mouseter_chef @K2Pharmer I'd love to learn more about this. Do you have a citation that would be a good place to start reading more into this?

[Daniel Adams @Danimal_MD]

@mouseter_chef @DocEd We do use etomidate often for emergent RSI in the US, but it really isn't so bad! It works quickly, generally has minimal hemodynamic effect, and the adrenal suppression is treatable. Ketamine is better with very experienced team, but need to be very careful with dose. @K2Pharmer

[Daniel Adams @Danimal_MD]

@EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @ercowboy @kaynani32 @MikePallaci @Chris_McStay @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO @PulmCrit @EMinMiami @theABofPharmaC Do not let a normal lactate dissuade you from evaluating for mesenteric ischemia.

[Daniel Adams @Danimal_MD]

@AlexSchwed Congratulations!

[Daniel Adams @Danimal_MD]

@EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @ercowboy @kaynani32 @MikePallaci @Chris_McStay @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO @PulmCrit @EMinMiami @theABofPharmaC If answering the EMS biophone, remember eclampsia in the ddx for seizure. It is less intuitive to think of on phone w/o visual stimuli (ie gravid patient in front of you)! If pt pregnant, can consider Mg and get the patient to L&D facility with OB and NICU present on ED arrival.

[Daniel Adams @Danimal_MD]

@Core_EM Important to note that blood is most commonly seen between the spleen and the diaphragm in LUQ +FAST views, as in this case. Look carefully above the spleen along the entire diaphragmatic surface in the LUQ. This is different from the expected location of blood in the RUQ views.

[Daniel Adams @Danimal_MD]

@DenverEMed If you have to use IV benzodiazepines for agitation in an elderly patient, use a waaayyy lower dose than you would normally think of. For IV midazolam, I start with 0.5-1 mg, and wait several minutes before even considering trying more than that.

[DenverEM @DenverEMed]

Beers Criteria recommends avoiding anticholinergics, antipsychotics, and benzodiazepines in the elderly. So what do we do when faced with an agitated elderly patient?
#EMConf

[Daniel Adams @Danimal_MD]

@nyulangoneEM @NYULangoneBK @AlexSchwed Thank you for this awesome lecture! We loved having you in conference! @AlexSchwed

[Daniel Adams @Danimal_MD]

@AlexSchwed @nyulangoneEM @NYULangoneBK @HarborTrauma @HarborUCLASurg @DenverHealthMed @ClayBurlew I ask myself the same thing whenever I see a sick surgical patient. :) The details and the urgency with which we approach surgical emergencies truly matter; the example she set as a surgeon and intensivist made me a better EM attending and educator. @ClayBurlew

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

Preparing for the ED Thoracotomy

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

Chest Trauma by our @NYULangoneBK Trauma Surgeon @AlexSchwed

-in tension physiology PTX - first focus on relieving the pressure w/ finger thoracostomy
-no benefit for larger size of chest tube
-very reasonable to use pigtail in hemothorax

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

do NOT ignore rib fractures in the elderly!

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

Incredible PGY4 Grand Rounds by Dr. Hunt on Treatment and Advocacy for Sexual Assault Survivors in the Emergency Department

[Daniel Adams @Danimal_MD]

@Jonesy_MA So the pulse oximeter may spuriously read high (and with good waveform), and the ABG shows hypoxemia.

[Daniel Adams @Danimal_MD]

@Jonesy_MA could it be a spurious pulse oximeter reading? https://t.co/HETYddD2RU

[Daniel Adams @Danimal_MD]

@Jonesy_MA The paper suggests that the pulse oximeter in its current design may be inadequate for detection of hypoxemia in our black patients. Occult hypoxemia in the paper meant an arterial oxygen saturation of <88% despite an oxygen saturation of 92 to 96% on pulse oximetry.

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

Phenomenal PGY4 Grand Rounds with Dr. Sobolev, encouraging use to embrace our creative side in emergency medicine and finding outlets to share #narrativemedicne

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

Dr. Shar Johnson on Blunt Abd Trauma in Pregnancy:
-Look out for domestic violence
-US has lower sensitivity, CT if you are concerned
-meds dose similar. If pt at risk for early deliver, start steroids!
-be prepared for perimorterm C-section
#emconf

[NYU Langone & Bellevue Emergency Medicine @nyulangoneEM]

Pelvic Trauma with Dr. Savan Patel

-BP <110 and increased base deficit are both associated w/ increased mortality in trauma
-large practice variability in REBOA use based on trauma center location
-don't forget the GU/pelvic exam!