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reuben strayer
emergency physician maimonides medical center rocuronium, ketamine, droperidol, buprenorphine, chocolate
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reuben strayer Nov 21
As if one epidemic weren't enough: The creatine kinase misspelling epidemic.
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reuben strayer Nov 2
Docs immediately steal some tetracaine when they suffer a corneal abrasion because it is 1000x better for pain than alternatives and safe when used for a day, which is all you need. How many studies required to extend this courtesy to our patients?
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reuben strayer Oct 23
Is anyone surprised that ketamine is synthesized and excreted by the fungus pochonia chlamydosporia and has nematicidal activity against the parasite caenorhabditis elegans?
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reuben strayer Oct 22
First case series describing severely agitated patients treated with ketamine that includes patients who became agitated after taking recreational ketamine. Data courtesy of event medicine superstars and
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reuben strayer Oct 20
Replying to @emupdates
PLUS, "abuse" of bup mono is drastically safer than full agonists–patient is still protected by bup against respiratory depression/overdose! AND bup mono is cheaper Do benefits of bup/nalox combo outweigh harms?
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reuben strayer Oct 20
Replying to @emupdates
Turns out: Minimal reduction in abuse with bup/nalox Naloxone IS absorbed SL and causes significant adverse effects in some, potentially causing pt to d/c bup (very dangerous) Naloxone may accelerate loss of opioid tolerance (very dangerous if return to full agonist use)(2/3)
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reuben strayer Oct 20
Buprenorphine/Naloxone Combo vs. Bup Monoproduct Conventional teaching: The naloxone in bup/nalox combo product (Suboxone) is not absorbed when bup is taken SL as intended, and it prevents abuse of bup by crushing/injecting, so favor bup/nalox over bup mono. (1/3)
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reuben strayer Oct 10
Perfusion index is measured via pulse oximetry and displayed on many monitors. This study found remarkable LRs in predicting need for blood in trauma. Worthy of more study, and: Suspect hypoperfusion when a patient has a poor SpO2 waveform or loses it.
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reuben strayer Oct 10
Benefit:Harm clearly favors treatment in hypoxic confirmed covid+ patients, and likely favors treatment in hypoxic suspected covid+ patients, so I have a low threshold, especially if the patient is the president of the country.
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reuben strayer Sep 24
Simulation Package for ED Management of Opioid Use Disorder All the materials you need to run a 3-case sim session for emergency clinicians. Prevent OUD (judicious prescribing) Protect people with OUD (harm reduction) Treat OUD (with buprenorphine)
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reuben strayer Sep 19
Replying to @emupdates
Bonus 15 second video demonstrating 10 feet of suction tubing to attach needed 3rd suction. Double-bonus: meconium aspirator setup (on the ground) used to turn endotracheal tube into esophageal suction device. That was the second suction.
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reuben strayer Sep 19
Securing a Blakemore tube is tricky. You can remove the clamp from one AnchorFast ETT securing device and add it to the one already on the patient, apply the appropriate amount of tension, and fasten. h/t
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reuben strayer Sep 16
Replying to @choo_ek
Having a large, unmuted audience usually isn't worth the inevitable unwanted audio. But figuring out how to present *while being able to see the chat and audience windows* makes a huge difference. How to do this: Present slideshow in window. This can be done in ppt and Keynote.
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reuben strayer Sep 2
Replying to @emupdates
How is the patient handling secretions? How carefully can the patient be monitored? What are the patient's other problems? What is the expected clinical trajectory? “GCS of 8, intubate” is not an appropriate maxim for airway experts.
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reuben strayer Sep 2
76% of alcohol-intoxicated patients with GCS ≤8 in this series did well without intubation. Most with etoh+coma will fly with proper head/neck positioning and a close eye on them. If the concern is airway protection, GCS is not how that is assessed. Nor is blood alcohol level.
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reuben strayer Aug 25
Review of excited delirium literature cannot establish causation but suggests death more likely from physical restraint than underlying process. When you see restraints on an ED patient, ask, what do I need to do to get this patient out of restraints.
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reuben strayer Aug 24
Take-homes from 2020 ACEP Opioids Clinical Policy 1. Treat opioid withdrawal with buprenorphine 2. Preferentially prescribe non-opioids for acute pain 3. Avoid prescribing opioids for chronic pain 4. Do not prescribe sedatives to patients taking opioids
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reuben strayer Aug 18
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reuben strayer Aug 18
1 in 6 "sudden cardiac deaths" was an occult overdose on post-mortem analysis during a 3 year period in San Francisco. The burden of drug overdose deaths is likely even larger than we think. Drug class most likely to cause single-agent OD: stimulants.
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reuben strayer Aug 16
These pharmacokinetics ninjas effect a 3-day withdrawal-free transition from methadone to buprenorphine by replacing methadone with a fentanyl patch while accelerating methadone metabolism using carbamazepine and urine acidification. High level.
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