Virtually There, Oct. 9th at ACEP

Thanks to our agents on the ground, today I learned all sorts of things from ACEP12 without actually being there.  Here are the highlights, and an updated list of top Tweeters.  Thanks so much to everyone who has been putting in the time to tweet!

Twenty-four hours ago there were 1.1k Tweets featuring #ACEP12.  Today, there are 2.0k from 289 contributors. 900 tweets in 24 hours is great, but in a conference with > 5000 attendees perhaps we can do even better.  How do we get more people online?

Top 10 Tweeters, cumulative on 10/9 (by volume), per Hashtracker: 

1. Gruntdoc
2. Movinmeat
3. Umanamd
4. Takeokun
5. Nickgenes
6. Jeremyfaust
7. rfdsdoc
8. ems_fire_md
9. acepmtgs
10. kubed

Tweet Highlight Reel

I haven’t been able to figure out Storify embedding yet, so in the mean time, follow the link for some of today’s most memorable tweets.

New/old stuff I’ve learned today (lessons in CAPS) – including one great new resource: Sonocloud! (see bottom)

• Nickgenes needs 100 signatures to start an ACEP Social Media Section. Help a guy out!
• Apparently, we ED docs do a crummy job at post-RSI sedation.  I guess this isn’t new, but sucks to hear it again.  5/10 RSI patients surveyed stated they were awake throughout and 2 reported 10/10 pain during subsequent procedures  (from the Bukata/Hoffman session, via Gruntdoc) – CONTINUE SEDATION AFTER RSI!
• Basically, no difference in increased HR between Albuterol and Levalbuterol (Xopenex).  Reaffirmed.  IF TACHYCARDIA IS A CONCERN, L-ALBUTEROL IS UNLIKELY TO PREVENT IT (via Gruntdoc)
• 1 gram Tylenol IV equivalent to 10 mg Morphine IV, at 129 times the cost (via Gruntdoc).
• US guided scalene nerve block quicker and as effective as procedural sedation for shoulder reduction, minus the risks (via Gruntdoc).  NEED TO LEARN SCALENE BLOCK.
• West Nile Virus is spreading while Malaria distribution isn’t changing as much.  Dunno why.  (via Nickgenes).  AVOID MOSQUITOS.
• “…when docs look at the same problem for themselves they typically choose less awful treatment, even if means pal[liative] care…” (via Gruntdoc from the Hoffman/Bukata session). MUST BE MORE HONEST WITH OUR PATIENTS.
• “Undertriaged elderly patients 2-4 times more likely to die. 90% are fall victims.” (via WCintheED).  BE CONSERVATIVE WITH THE ELDERLY, ESPECIALLY FALLS.
• Still no good answer for risk of calf vein DVT.  Mostly benign, but jury out on anticoagulation (via Gruntdoc).  KEEP DOING WHAT YOU’VE BEEN DOING.
• Thinking about PE’s… Appears that with new imaging technology we’re picking the smaller non-significant PE’s and treating all.  Thus, may be reaching a point where risks of anticoagulation actually outweigh benefits in some settings (via Gruntdoc and nycTrauma). PROTOCOLS MAY BE CHANGING.
• ECG Stuff:
  • Digoxin toxicity: Atrial tachycardia with block is classic (via emlitofnote).  PVC’s are the most common finding (via WCintheED)
  • Atrial fibrillation with wide complex is WPW until proven otherwise; avoid nodal blockade (via emlitofnote and Kubed)
• Leslie Nielsen is named Dr. Rumack in Airplane! after Dr Rumack from the Rumack-Matthew nomogram (thanks Kubed!)
• Tox:
  • Birnbaumer: Zero osmolar gap doesn’t r/o methanol or ethylene glycol ingestion. Compound fully metabolized when metabolites kill you (via ercowboy).  HISTORY MATTERS.
  • IV NAC no better than PO NAC.  And fewer adverse events with PO (via Umanamd and ercowboy).  Asthma as key risk factor for IV complications. BUT PO IS HARD TO SWALLOW?
• Sonocloud – Established by Ultrasoundpod as free resource for US clips (via Takeokun)

Of course, the feed was overflowing with good info today.  I’ve only included points that came from more than one contributor or that were attributed to specific speakers, and that seemed particularly relevant to my practice.