everyone learns about TCA overdose in med school, but not bupropion XR overdose time to level up bupropion XR overdose is increasingly common & VERY dangerous ongoing drug absorption creates a "toxin bomb" wherein patients look OK initially, but deteriorate later on... (#1/2) #EMIMCC

Should you be scared of the dark? If you think lower odds of survival from out-of-hospital cardiac arrest (OHCA) is terrifying, then yes. jamanetwork.com/journals/jam... 🧵 #medsky #emimccm #foamed

Even with an initially shockable rhythm and witnessed by family or EMS, the odds of surviving a cardiac arrest are much worse at night. FWIW Petter doesn't much like this time of day either. @joshkimbre.bsky.social jamanetwork.com/journals/jam...

Phenomenal write up for anyone working in EMS/Code Team/RRT quality and safety. I will be referencing this. TCP is always thrown out as "what they should have done"-- but lit is showing this is a low success maneuver. I'll still do it-- but good to escalate chronotropes and prep for TVP.

Transcutaneous pacing (TCP) is an intervention for unstable bradycardia. Electrical stimulus is provided ~1/s to increase heart rate. With transvenous pacers and chronotropic meds, TCP is mostly limited to the prehospital setting and low-resource centers. We suck at TCP. #emimcc #medsky #cardiosky

If you're going to use transcutaneous pacing, dial up the milliamps! That dial goes up above 100 for a reason. Study headed up by Tanner Smida and @joshkimbre.bsky.social (COI: I'm co-author 8/13) www.resuscitationjournal.com/article/S030...

When intubating with VL, the cords should be as far away as possible, while still visible. Large cords=close camera=blocked tube delivery. #EMsky #EMS @mdaware.org @joshkimbre.bsky.social

Been away for awhile having the time of my life. I usually stick to medicine here but figured y'all could take a peek at my personal life today.

you couldn't waterboard this out of me

New RCT: Avoiding A-line in shock didn't affect mortality (trend towards *reduction*) & decreased line complications They avoided A-lines despite patients requiring pretty substantial doses of vasopressors Very #zentensivist Don't need to rush to an A-line www.nejm.org/doi/full/10.... #EMIMCC

MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP Mortality benefit easier to demonstrate w/ less resources available to salvage pts Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered) www.nejm.org/doi/pdf/10.1... #EMIMCC

Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.

New ACLS guidelines highlight the perils of failed capture during pacing. @joshkimbre.bsky.social Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...

I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...

The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine. This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become. Available: paramedicinejournal.org

📢 Check out our study in Academic Emergency Medicine:Systematic review of +32K patients in US EDs finds: ⚠️ 52% of females with STI undertreated 💊 64% of males without STI overtreated Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...

Wow 😳 Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them. In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC

Very pleased to share short report just published in #EMAJournal @emajournal.bsky.social Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service onlinelibrary.wiley.com/share/author...

Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here: buffalo.zoom.us/j/9848537719...

Why is Transcutaneous Pacing so difficult, and how can we do it better? It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out! #EMSSky open.spotify.com/episode/2rji...

We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest. #EMSsky #emimcc www.sciencedirect.com/science/arti...

We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023. - 72% male - 66% 60y or younger - 47% in cardiac arrest at EMS arrival - 83% documented successful www.sciencedirect.com/science/arti... #EMSsky #EMIMCC

If you have a patient arrive with a STEMI who took their daily 81mg aspirin that morning, how much more do you give them? I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost #Pharmsky #EMsky #Medsky

Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky

Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).

Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025. "As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls. #EMSsky

"What do I do if I'm concerned about someone's drinking? Speak up!" Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned. #NAEMSP2025 #EMSsky

"It's okay to not be okay." Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone. Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky

@qipunks.bsky.social leading a debrief after learning about PDSAs through deliberate play at the quality and safety course at #NAEMSP2025.

Gabe Gan presenting a dissection of the anatomy of the run chart. This is one way to measure improvement in your system! #NAEMSP2025

Headed to San Diego for the @naemsp.bsky.social meeting next week? 📸 We will have FREE professional headshots on Thurs., 1/9/25 from 10-3 at our booth, #104! 📸 Pack your cutest shirt, fave lipstick and finest hair gel... we'll send you the digital image to enhance your budding #EMS career!

At least 20% of EMS patients report with pain, and only 15% of those with a pain score have pain reduced. Prehospital pain management is important, and we suck at it. How do we improve? Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025! #EMSSky

I thought this was worthy of a longer discussion so I made it into a blog post. #ECGsky #medsky #cardiosky #EPeeps

open.substack.com/pub/sensible... #EMIMCC #Cardiosky #Medsky

Proud to shareour study examining flexible-tip vs. traditional bougies by paramedics and EM docs using sim was published. Most (72%) participants would consider using it in the future and there was no sig diff in speed. #EMSsky #EMsky kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...

Check out the January Annals of EM www.annemergmed.com/current - lots of rapid sequence intubation and clinical operations in here #education #MedSky #EMSky #EMedSky #BlueSky

In the early days of “standardized” resuscitation JAMA (print edition) became the mode of communication - circa JAMA Supplement 1974. Can you identify some of the historical figures listed? #EMSsky #EmedSky #MedSky

Speaking of history lessons - “Rescue Breathing” Youtube video. Look at that pulse oximeter!! I carry one on my wrist today. Who wants to volunteer for the CURARE challenge? #EMSsky #EMedSky #MedSky youtu.be/qwnvjQCpU1k?...

Building off the story I shared yesterday about fighting potential Insurance Company AI with AI: Claimable uses AI to tackle insurance claim denials. With an 85% success rate, it generates tailored appeals via clinical research and policy analysis. 🩺 #HealthPolicy

"Gender equity in authorship of emergency medicine publications in Australasia" Ka pai on this article highlighting patterns in gender gaps @laurajoycenz.bsky.social and team doi.org/10.1111/1742...

Does prehospital blood save lives? NOLA EMS thinks so. Do the details matter?

Hey #EMSky #EMedSky & #stats crowd! I'll be in Berkeley from Jan to March, and would be delighted if I had the opportunity to visit some of you in the Bay Area/participate in seminars, etc. No formal hosting required. Special interest in clinical pathways & health services research, meta-analysis /1

Could LLMs enhance 🚑 dispatch? We took real dispatch categories and compared Chat-GPT to paramedic triage. LLM agreed with panel majority in 77% of cases. When the panel was unanimous, the LLM agreement was 94%. Great working with this team. #emimcc #EMSsky www.sciencedirect.com/science/arti...

THREAD So your Attention Score went down because people are rage-deleting their Twitter accounts. Why is that happening? Should I be worried? Should I see my doctor? Let's get into what the Attention Score actually is, how it's impacted by posts and deletions, WITH THE HELP OF MEMES. 1/20

Haunting article from ProPublica describes a rural oncologist killing patients: prescribing chemo for PTs without confirmed cancer leading to death, changing code status to DNR without consent, and overdosing patients on phenobarbital for a "comforting" death. www.propublica.org/article/thom...

1/ On the 5th day of Pharmacy Advent, let’s tackle a clinical dogma: Beta-blockers in stimulant/cocaine use Clinicians often hesitate to give BBs to pts w/ cocaine use d/t concerns over "unopposed α-receptor stimulation." Oldie but goodie, let’s dive in! 👇 #medsky #EMsky #pharmsky #HMsky #GPsky

@joshkimbre.bsky.social Very, very nice review. Underappreciated and vital problem to recognize. I hate to say this, but.... I SEE THIS ALL THE TIME. Maybe every time. I think people are afraid to use max outputs for TCP. Probably because they are inappropriately, painfully, pacing awake pts

false electronic capture remains a big problem with transcutaneous pacing 😳 issue: pacer captures the skeletal muscles but not the heart. this causes rhythmic twitching that can simulate a pulse & QRS complexes to confirm true capture: -POCUS - robust dp/fem pulse? -good pulse oximetry waveform?

Going to provide a brief #MedSky overview of false electrical capture during transcutaneous pacing (TCP) by paramedics in prehospital 9-1-1 response. 🧵 Articles of interest: www.tandfonline.com/doi/full/10.... www.tandfonline.com/doi/full/10.... onlinelibrary.wiley.com/doi/10.1111/...

1000 places 300+ went in first few days! Expert Critical Care Paramedic Speakers from NZ , Aus, Canada, S. Africa, USA and the UK. It’s going to be incredible! Book your place: collegeofparamedics.co.uk/COP/Events/E... #Paramedicinesky #EMSsky #EMsky