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reuben strayer
Emergency medicine updates of interest to emergency clinicians. Discussion requires more than 140 characters; post comments/Qs to
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reuben strayer May 16
Replying to @emcrit @kovacsgj
Key takehome: breathing techniques require MORE skill than paralyzed/RSI–learn RSI first and don't attempt DAI without capability to paralyze. Also, when you complain to about not being able to do a full awake technique because you don't have concentrated lidocaine:
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reuben strayer May 16
Replying to @emcrit
Full awake/topical safer than KOBI/DAI, but cognitive bandwidth/cooperation/speed concerns put full topical out of reach for many providers. DAI/KOBI gets non-paralyzed, breathing intubation techniques into everyone's hands, with appropriate safeguards discussed here.
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reuben strayer May 16
Selecting a twitter moderator for a conference talk/panel can be challenging. Must strike the right balance between being really good at twitter (i.e. young) and being able to distinguish good and bad questions (i.e. old).
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reuben strayer May 10
I suspect if we had a live K monitor, ala the pulse ox, sux would be verboten. No question many of these arrests in the ED are attributed to "sick patient." Oh wait, we do have a continuous potassiumeter: the ECG. Case report today.
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reuben strayer Apr 26
Using ketamine without paralysis to improve airway safety: Ketamine-Only Breathing Intubation. and lay out a roadmap today in . 9 minute video illustrates the benefits and risks of KOBI.
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reuben strayer Apr 22
Tucked into this remarkable reporting on the most progressive approaches to opioid addiction is the stunning finding that heroin users randomized to prescription heroin vs. prescription hydromorphone cannot distinguish between the two.
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reuben strayer Apr 6
Replying to @ACEPNow
3.5 visits to this sobering center per patient. For the first 10 years of my career, I would have said, great, take them to a sobering center, we're not doing anything for them. Now my reaction is: why aren't we doing anything for them?
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reuben strayer Apr 6
Placing the post-intubation OG tube is often harder than placing the endotracheal tube. Do it under repeat laryngoscopy: quicker, atraumatic, and a chance to use the laryngoscope calmly, slowly. You used video for the ETT, now's the time to go for DL. Build muscle memory.
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reuben strayer Mar 17
"Avoid nitro in inferior MI" is in my view one of many rules whose value is mostly to show that the speaker knows the rule. all patients under my care with active ischemic chest pain and a decent pressure get a nitro drip. if I don't like its effect on BP, I titrate down or off.
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reuben strayer Mar 8
In this volunteer airway obstruction study, as the airway diameter decreased, the RR also decreased. Saturation never fell below normal. If this is true IRL, another reason RR is the most vital VS. Consider capnography to monitor RR in at risk patients.
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reuben strayer Mar 7
The next version of pubmed, in "pubmed labs," is already more functional than the prod version, with big buttons right where you need them that do things you often need to do. has got to be the highest functioning part of the US government.
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reuben strayer Mar 6
Essential strategy if pt not withdrawing. I was reluctant at first, too. It's a paradigm shift for emerg docs, but the stakes for continued street opioid use in 2019 are so high, we must stretch our scope. And you will, ! Because right now it's what our patients need.
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reuben strayer Mar 3
?advantage vs usual nasal airway anything that promotes nasal pathway over oral wins–nasal ventilation beats oronasal (i.e. conventional bag mask) ventilation hands down. I wonder if you could pop the top off that thing and attach a bag.
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reuben strayer Feb 24
Replying to @EDPharmDRoy
fuck yes.
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reuben strayer Feb 22
Postoperative neck hematoma is not often discussed in emergency medicine but behaves a lot like neck trauma, because it is neck trauma. These patients should be managed with a high-resource approach and discharged reluctantly, after careful deliberation.
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reuben strayer Feb 12
Sending an ED patient home on bup, or sending someone home who's *thinking about* bup? Buprenorphine patient information/discharge instructions, courtesy of . .pdf and customizable .rtf at
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reuben strayer Jan 29
Good to know that some airlines keep **6000** mcg buprenorphine in their medical kits. If you respond to an in-flight emergency and want to aggressively treat pain (for Press Ganey?), analgesia dose for opioid-naive is much lower than the addiction dose.
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reuben strayer Jan 13
The emergency department chest pain evaluation pathway. Developing clinical pathways endorsed by your organization may reduce practice variability and offer protection when a patient has a bad outcome despite good care, which is common.
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reuben strayer Jan 5
Sustained comprehensive addiction care is the goal for all OUD patients, but every hour they are therapeutic on bup is an hour they are safe from overdose, withdrawal, cravings, and an hour they can contemplate recovery. Do not wait for a perfect outpatient link to get started.
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reuben strayer Jan 5
We are converging on best practices for ED-initiated buprenorphine. X-waivered docs and strong connections to outpatient addiction care are not required to turn lives around with the most effective treatment for opioid addiction. Contact any of us for help starting a program.
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