Today’s feed was full of excellent posts from a growing, diverse group of Tweeps leading to some lively conversations. Read on to see what we learned (by session/topic). Interestingly, of the Top 10 tweeters, numbers 9 and 10 (rfdsdoc and Precordialthump) with 100 tweets and a combined 297K impressions, are in an entirely different hemisphere. Talk about global reach…
Twenty-four hours ago there were 2.0k Tweets featuring #ACEP12. Today, there are 3.1k from 356 contributors (up from 289 yesterday). The Scientific Assembly added 1,100 tweets today and reached 360,000 readers with 4.4 million (!) impressions.
More good news:
- 75% of tweets are original material, with only 21% being retweets (not that there’s anything wrong with RT’s).
- 79% of tweets were posted by 50% of the contributors (up from yesterday).
Top 10 Tweeters, cumulative on 10/10 (by volume), per Hashtracker:
- Gruntdoc (who has also amassed 1.2M impressions!)
Tweet Highlight Reel
Seems I may not be able to embed Storify at all, so you’ll still need to follow a link to some of today’s most memorable tweets. Pearls, photos, fun trivia.
New/old stuff I’ve learned today –
- Shock/Weingart (via Gruntdoc and drrwinters, umanamd and many others)
- MAP of 65 mmHg is nice for the heart and kidneys, unless lactate not clearing, then target 80 mmHg. Don’t forget cerebral edema post ROSC may necessitate higher MAP.
- “Dopamine Sucks” per Dr. Weingart (emcrit). Norepinephrine (via central access) or Phenylephrine (via peripheral or Intra-Osseous) are preferable. Also, use Phenylephrine as second pressor to reduce NE dose if worsening tachycardia.
- Check ionized Calcium, may not need inotropes once iCa corrected. Also, look for bleeding, adrenal insufficiency, hypothyroidism…
- Transfuse PRBC only if HgB < 7.0, unless persistent signs of hypoxia/hypoperfusion (conflicts with Rivers)
- Intubation as a means to reduce metabolic demand – hard to keep up when you’re acidotic!
- Ketamine – How they go down is how they’ll trip. “Whisper sweet nothings” to make it good!
“How much to fill the tank? 1) fluid responsiveness (invasive vs non-invasive) 2) fluid tolerance (evaluate IVC) 3) empiric loading (4-6 liters)”
- For more items from Dr. Weingart’s two sessions, see the Tweet Highlight Reel above, and this excellent summary at Academic Life in EM.
- For Dr. Weingart’s handouts: http://emcrit.org/ACEP/
- Dr. Mattu would admit syncope if QTc > 500 on ECG and nothing else (via DocWagz).
- Things that work (from the NNT/Dr. Newman)(via EMNews and SkepticMedick)
- Aspirin for CVA
- Reperfusion for MI
- Aspirin for MI
- Things that don’t work, harm > benefit (same credit as above)
- Antibiotics for for bronchitis, strep throat, otitis media, and sinusitis (except some)
- Stress test for low risk chest pain
- Tech stuff by Nickgenes (via MANY contributors attending his sessions)
- Academic Life in EM
- Medscape (excellent FREE app)
- EMRA Antibiotic Guide (paid)
- PalmEM (paid)
- One Minute Ultrasounds
- Phone flash as penlight
- Radiology 2.0 as educational resource
- Uses Siri to search WolframAlpha for medical q’s
- Trauma (via alamrymd, Movinmeat)
- FFP:PRBC —> 1:2
- Tranexamic acid seems to mostly benefit hypotensive bleeders when given EARLY (within first 3 hrs of injury), possibly even pre-hospital.
- Total body CT (pan-scan) generally doesn’t change management (vs focused approach). Use only in patient that cannot be evaluated (unresponsive, etc).
- ABCD2 score is unreliable predictor of future CVA in TIA patients (via Gruntdoc)
- Significant conflict between speakers (also between participants) on necessity of LP to rule out SAH, vs CT alone. I’m not going to touch this one. At this point, depends on whose data you believe…
- tPA in CVA? Also, much discussion and no conclusion. Feeling seems to be that risks > benefits for many, especially NIHSS > 20.
- Worst headache of life, thunderclap onset (i.e. peak at onset), normal neuro exam => Pretest probability of SAH = 10% (wow!) (via Movinmeat)
- Some asides:
- Tweeters seemed unsatisfied with the Social Media session. Comments reflected an apparent lack of involvement in SoMe by the speaker/s and the session’s predominantly paternalistic tone.
- Many people echoed a call for next year’s SA to include a panel with people who actually HAVE a social media presence.
That wraps it up for today. Again, thank you to everyone who made the trip out to Denver, sat through all these sessions, and bothered to tweet throughout!