I love it lol - also it’s exactly what I wear on shift 😍

CJEM debate: clinical decision rules–thinking beyond the algorithm link.springer.com/article/10.1... We need to think deeply about how we use decision rules in medicine Thank you so much @emlitofnote.bsky.social @lwestafer.bsky.social @reverendofdoubt.bsky.social for joining me in this debate

for the oncologists out there: which types of presumed new cancer diagnoses (non-liquid tumors) found in the ED require expedited inpatient work-ups vs outpatient referrals? i.e.: time from diagnosis to therapy is critical?

"Overall, we found no high- or moderate-level evidence to suggest that SEP-1 compliance was associated with improved mortality; however, there may be a signal of mortality benefit in certain populations." | Annals of IM www.acpjournals.org/doi/10.7326/...

Twitter / X is … spiraling.

Do clinical decision rules actually help with diagnosis in medicine? The latest #CJEMDebate explores the question with @first10em.bsky.social @emlitofnote.bsky.social @lwestafer.bsky.social @reverendofdoubt.bsky.social and @paulatkinsonem.bsky.social. #medsky link.springer.com/article/10.1...

Apparently the fad of using propensity matching is switching to the new fad of target trial emulation, regardless of the quality of data.

The fact that this paper got so much press despite its profound limitations and really not adding anything to the literature is more of a testament of how physicians have no research background or ability to interpret the academic literature pubmed.ncbi.nlm.nih.gov/39173173/

When EM has to absorb all of the social failings of society it’s going to lead to long wait times.

I’m 100% convinced that until hospital reimbursement is tied to ED boarding times, no meaningful changes will occur.

It ain’t easy… :( www.cbsnews.com/baltimore/ne...

Whenever I hear "tox/metabolic etiology,"... you should be able to identify the toxidrome or metabolic derangement causing [insert X] condition...

A total of 2.5 hours of shoveling my driveway over the last two days and my entire body hurts

I wish someone would’ve told me as a medical student and as a resent that working your @$$ off for years with dozens and dozens of first author publications (study design, data analysis, writing, presentations) means nothing at the early career level … I would’ve done things differently.

This editorial by J. Broder on imaging utilization in the ED is the best piece I've ever read on the topic: when there are no CDRs for abdominal pain, no time to see patients, unreliable exam findings, high rates of (+) imaging, expectations of "zero miss culture" pubmed.ncbi.nlm.nih.gov/39487590/

New paper from @abfriedman.com uses NHAMCS data from 2007-2019 for CT imaging rates of abdominal pain visits to the ED. 1. CT scan rates ⬆️ 26.2% to 42.6%! But... 2. Test positivity, i.e., an emergency general surgical diagnosis, ⬆️ increased 17.2% to 22.9%! pubmed.ncbi.nlm.nih.gov/39313946

New paper from Johns Hopkins (radiology/EM) questioning the use of "age over 65" for C spine imaging in trauma patients Of 9455 CTs performed in pts ≥ 65, 192 (2.0%) fractures were identified (113 females); 28 (0.30%) were in asymptomatic pts pubmed.ncbi.nlm.nih.gov/38940447/#:~...

Majoring on the minors: Regulatory organizations turn a blind eye to emergency department boarding in favor of rare conditions | #AcademicEmergencyMedicine pubmed.ncbi.nlm.nih.gov/39034656/

This concerns me. A 2015 paper showed that < 50% of VA ED physicians were board certified EM physicians... I did a quick skim of the paper, and they did not break it down by IM vs EM, unless I missed it... which is a HUGE problem for this paper.... pubmed.ncbi.nlm.nih.gov/25936477/

I think the idea that admissions are to solely reduce mortality doesn’t make any sense tbh…. sure, sometimes an admission may do that. The real question is: was the admission indicated or not indicated. Haven’t read the paper yet but… did it stratify by IM and EM docs in the ED?

Part of being anti-RFK Jr. is calling out doctors who spread pro-RFK Jr. propaganda. If you partner with and/or support these doctors in any way, you are enabling RFK Jr no matter what you say about him yourself. Sorry.

Never underestimate the POWER of a Vaccine Scientist. If RFK Jr. is voted DOWN for head of HHS (and he should NOT be confirmed), it's not because of Congress, it will be because people like Dr. Peter Hotez spoke out.🙏💜

Fml ….

#ADAPTtrial released & the results are interesting… Compared to SOC, Procalcitonin guided antibiotics in sepsis resulted in: - FEWER antibiotic days: 10.7 vs 9.8 (p=0.01) BUT - HIGHER 28 day mortality: 19.4% vs 20.9% (p=0.02) though this did not meet the pre-specified non-inferiority margin 🤔 1/

Omg… www.propublica.org/article/thom...

NYPD officials say a massive, citywide hunt for overtime pay is underway.

EAST guidelines for ED thoracotomy were written in 2015. WTA (West) guidelines were just updated in 2024 and are presented below: Adult emergency resuscitative thoracotomy: A Western Trauma Association clinical decisions algorithm journals.lww.com/jtrauma/full...

Who benefits from resuscitative thoracotomies following penetrating trauma: The patient or the learner? A tough read, but the results should be noted... pubmed.ncbi.nlm.nih.gov/37716863/

No, it's not. Musk and Ramaswamy wrote an op-ed saying they wanted to cut all programs with expired authorizations. That includes the programs in Rattner's list. www.cbsnews.com/news/musk-ra...

Eliminating the NIH is a particularly rich idea coming from a biotech billionaire whose companies literally specialize in scooping up other people’s inventions to commercialize them, good luck with that strategy Vivek

Monumental day for a bluesky debut with the opening of our new Pediatric Emergency Department #DukeChildren’s #PEM #pediatricreadiness

Doctors commit their lives to improving the health of others, but who’s helping us improve our financial and career well-being? Enter Offcall, a new platform redefining what it means to care for physicians. I’m thrilled to participate in this and encourage you to sign up! www.offcall.com

So I'm finally allowed to tell you about what I've been working on for the past year: It's called Offcall. It's built by physicians for physicians, and we're starting with one of the biggest problems we've heard amongst physicians: salary and workplace transparency.

How to write a scientific paper in four slides. Full guide here: www.surgeryredesign.com/s/WritingFor... YouTube format here: youtu.be/fgeahUrXVaY?... #meded #medsky #research

I really wish patients could listen in on the conversations emergency physicians have with consultants about their care…

Wtf…. (Posted on X too)

I find myself opening up X less and less frequently and instead scrolling through BlueSky #MedSky

There’s an attitude that goes around medicine that is harmful. It’s an air of superiority over having an earnest discussion surrounding the financial impact of training decisions and specialty choices. Don’t drink this Kool-Aid.

Craft V3 is out!!! www.theverge.com/2024/11/28/2...

#Bluesky passes 23M users 🦋

This is a pretty incredible #WikeGuidelines on UTIs. Wow—a must-read!!! Interestingly, "male" is no longer defined as a 'complicated UTI'! #MedSky jamanetwork.com/journals/jam...

As an academic emergency physician, navigating whether a traditional research career is for me vs working part-time clinical/part-time industry vs ED administration, I'm using LinkedIn a lot more! Here's my latest #LinkedIn post on what I use to stay productive :) #MedSky www.naturl.link/xsg4Wt

Excited to move to @bsky.app I am an emergency physician & healthcare executive, who serves as chief of a safety net ED at a trauma center in Massachusetts w/ interests in #emergencymedicine, #climatechange, #healthpolicy, & #cycling. Interested in views I am not exposed to & that challenge me.

As a society, we have utterly failed our patients with psychiatric illness. Psychiatric illness + poverty + substance use is essentially a social death sentence.

A list of all the wonderful guests and cohosts I've had on the show. As more people join BlueSky, please let me know if there's someone I need to add! go.bsky.app/MKpZp1t

New WTA resus thoracotomy (RT) algorithm. 2 new/key points: -Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism). -RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS}

Bluesky now has over 20M people!! 🎉 We've been adding over a million users per day for the last few days. To celebrate, here are 20 fun facts about Bluesky: