Pietro

EM specialist, after all... reader, undiagnosticated ADHD, not-so-young-but-still-here free climber, coffee and protein bars (italian by birth, not my fault)

[Pietro @ppett87]

He could have gone for general

but he went for himself instead

[NephroPOCUS @NephroP]

#POCUS review
🖊️"POCUS can be seen as an evolution of the stethoscope, perhaps bringing clinicians back to the bedside and providing time to build a therapeutic relationship while harnessing the advantages of technology"
🔗 https://t.co/TQfumvKW69
#MedEd #IMPOCUS #Nephrology

[EM Board bombs @EMBoardBombs]

Acute variceal bleed + unstable vital signs = give blood products & get an emergency endoscopy
However, if the patient is stable & Hgb is >7, don’t transfuse
Quick reference on upper GIB in the ED: https://t.co/DQZerwURry

[Pietro @ppett87]

@EMBoardBombs STE in aVR & v1 could be left main or triple vessel disease. I think I would also ask for right and posterior leads

[EM Board bombs @EMBoardBombs]

If you’re presented with a patient who is bradycardic and hypotensive after a calcium channel blocker overdose, you are going to be expected to initiate high dose insulin therapy as this is the standard of care in CCB OD

[EM Board bombs @EMBoardBombs]

A secondary spontaneous PTX is considered stable if:
😮‍💨 RR <24
❤️HR > 60 and <120 beats per minute
💪 Normotensive
🌬️ SpO2 >90% on room air
🗨️ Able to speak in full sentences

[Stephen W. Smith @smithECGBlog]

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex @PendellM

https://t.co/Bw0UPumkyI

[EM Board bombs @EMBoardBombs]

Clinical features that define a BRUE include any of the following:
- cyanosis or pallor
- absent, decreased, or irregular breathing
- change in tone
- AMS
These occur for <1min & pt must be asymptomatic at the time of presentation
Free quick reference: https://t.co/OcTJWPaBrK

[Pietro @ppett87]

@JudkinsSimon @TheSGEM @ACEPNow @CAEP_Docs @acemonline @stemlyns Add Italy to the list

[EM Board bombs @EMBoardBombs]

Fluoxetine overdose pearls
-Toxic dose: >1500mg
-Toxidrome: Sedation, respiratory depression, serotonin syndrome
-Treatment: Supportive care, cyproheptadine (5-HT receptor antagonist)
Listen to podcast Ep53 for more details!

[Emily Fridenmaker @emily_fri]

I can’t figure out why we give tPA so liberally for stroke but everyone is afraid to give it for massive PE.

[UP Climbing.com @upclimbing]

Boulderisti scatenati sui massi delle Alpi🇦🇹🇨🇭 e degli States🇺🇸❗️
Ecco le ultime realizzazioni fino all’8️⃣©️nel boulder‼️
https://t.co/kcYuqYM4Km

[Pietro @ppett87]

@cliffreid As one of my mentor used to say, I've never seen ph or lactate with my #POCUS, so probably they don't exist. Clinical picture needed

[Hans Huitink @AirwayMxAcademy]

☑️This device has saved millions of lives. Retweet if you know how to use it.

[Pietro @ppett87]

@FrancoMaycol @smithECGBlog @amalmattu @EM_RESUS Yes

[Pietro @ppett87]

@First10EM For reference, see Italy last national election and the relation between results and voters abstinence

[Nick Mark MD @nickmmark]

Bottom line:
Giving supplemental O2 to someone w/ severe COPD really *can* cause oxygen induced hypercapnea.

It occurs for three reasons:
1. Loss of hypoxic vasoconstriction --> worse V/Q matching (major reason)
2. Haldane effect
3. Decreased respiratory drive

15/15

[Nick Mark MD @nickmmark]

This - the loss of hypoxic vasoconstriction to poorly ventilated lung areas - turns out to be the primary reason for oxygen induced hypercapnea.

https://t.co/f9XgY9gnn2

14/

[Pietro @ppett87]

@nickmmark Ping @FedeRebustello

[Stephen W. Smith @smithECGBlog]

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab? @ECGcases

https://t.co/81CFXialMO

[UP Climbing.com @upclimbing]

L'8️⃣©️➕ di #Gakido 💎💎💎 a #Chigobutai 🇯🇵 vede la prima ripetizione ad opera del fortissimo Ryuichi Murai 🔝‼️
https://t.co/icKUupHTgZ