Top Tweets for #FOAM4Cook
Shift 10: Ears.
Pt 1: ↓ hearing, ear pain -> cerumen impaction. Warm water irrigation w/ angiocath on 10cc syringe -> complete resolution!
Pt 2: Canal edema, green discharge -> otitis externa. Can give cipro eye drops if ear drops unavail, but not ear drops in eyes! #FoaM4Cook
You have someone on the ventilator? Try to reduce the oxygen supply as much as possible while keep saturation levels high. Reducing the FiO2 while keeping a high O2 saturation can reduce/prevent oxygen radical damage. #FoaM4Cook @CookCountyEM
Shift 9: Patient with large DVT, no s/s of PE, neg trop, no R heart strain on EKG or POCUS Echo.
CTA for PE? Well, does it change management? Applying @CPSolvers Toss/Test/Treat framework, anticoagulation is same for DVT & PE, no test needed here. #FoaM4Cook (meds @epocrates)
Shift 8: Syncope. I remember my first syncope patient at the VA. Anchored on aortic stenosis after a UWorld q/anki card with the association. That moment got me into clinical reasoning; now I can share my improved schema built on @GlassHealthHQ! #FoaM4Cook https://t.co/fgCJnoRb4l
Gallbladder-intestinal fistula?! Sounds like a scary possible gallstone outcome, but oftentimes patients are asymptomatic for life and no intervention is required #FoaM4Cook @CookCountyEM
Remember the mnemonic AEIOU for indications for emergent dialysis:
Acidosis
Electrolyte Abnormalities
Ingestion/Intoxication
Overload (fluid)
Uremia
Recent case: pH 6.774, bicarb 2.9, lact 19, SCr 14. Call ICU and Nephrology!
#FoaM4Cook @CookCountyEM
Shift 4: Got to share my PE clinical tools framework with an M3 on shift. It's all about pre-test probability! Pick 1: (Experienced) clinical gestalt ≈ Wells' ≈ Geneva. Wells' has red outlined subjective "PE #1" vs Geneva all objective. PERC next step, low risk only #FoaM4Cook
Adult with long, lingering cough? Post tussive, viral URI, seasonal allergies, GERD, asthma, sure; but don’t forget pertussis! Diminishing immunity and increases in unvaxxed kids make it even more likely. #FoaM4Cook @CookCountyEM
Shift 3: Anchored on "sore throat" unresponsive to 1 wk Augmentin, HR 120s, R ant neck tenderness/edema & subjectively febrile. Wanted to ultrasound looking for MRSA lymphadenitis when attending suggested thyroiditis. ↓↓ TSH, ↑ FT4 -> suspected subacute thyroiditis. #FOAM4Cook
Overuse of naloxone can lead to flash pulmonary edema due to increased pulmonary capillary permeability from a catecholamine surge. Other causes of altered mental status must be investigated if naloxone is not effective. #FoaM4Cook @CookCountyEM
Shift 2: Chest pain. "I'm less concerned because pain is reproducible with palpation." True for ACS; the finding has a LR of 0.28 (0.14-0.54). But for PE, no differences between patients with PE and without, LR 0.83 (0.6-1.14).
Read more at https://t.co/Y0G3PhZURL #FOAM4Cook
How can you tell the difference between an anterior and posterior nosebleed?
Anterior: bleeding coming from one nostril
Posterior bleeding coming from both nostrils
Learned that Thanks to Dr. Sean Bryant!
@CookCountyEM #foam4cook
Afrin & Atomized tPA for epistaxis! Was able to see (for the first time) how to set up the atomized tPA for epistaxis treatment. @CookCountyEM #foam4cook
Who gets hyperbaric O2 therapy for CO poisoning, and why? Data supporting its' use to prevent neurologic sequelae is strong but still mostly based on animal models like this one. Lots of gray area still. https://t.co/8Qgm85BTow #FoaM4Cook @CookCountyEM
In patients with complicated or recurrent UTI, make sure to obtain a urine culture before antibiotic treatment to minimize risk of false negatives! @CookCountyEM #foaM4Cook
Shift 1: Had the opportunity to put in some ultrasound-guided IVs. With this procedure, don't stop at getting blood flash, continue the "County Walk" a few centimeters into the vessel to ensure a secure IV. #FOAM4Cook (image from https://t.co/i6SEMunGUn)
This month my fellow rotators and I will be tweeting our takeaways from shifts at @CookCountyEM. Follow along this thread and #FOAM4Cook over my 13 shifts as I improve my clinical reasoning, procedures, and patient care in EM!
Non-COVID infections can still increase the risk of DVT/clotting; chest pain attributed to pneumonia alone may be masking a PE #FoaM4Cook @CookCountyEM
Sonographic Murphy's sign is elicited by finding the gallbladder on Ultrasound and then pressing in on inspiration. It is more accurate than hand palpation since it ensures that it is the gallbladder that is being pressed. #FoaM4Cook @CookCountyEM
✨NSAIDs✨
one of the fave meds in the ER, but remember the super common contraindications! 🚨💊🚨💊
• GI ulcer
• Acute hemorrhage
• Kidney disease
• Asthma
• Pregnancy (2nd/3rd trimester)
#FOAM4Cook @CookCountyEM
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