Jeffery Hill, MD MEd

An EPiC mental model. St Emlyn's Coordinating, consulting and managing an entire acute clinical service in real-time is fairly unique to emergency medicine. Are you EPIC?

Coordinating, consulting and managing an entire acute clinical service in real-time is fairly unique to EM.
Central to this is the emergency physician in charge (EPiC) role.
Following a busy 🌃 I'm resharing my mental model for the EPiC role.

🏥🚑🚑 🚑...
#EMedsky
www.stemlynsblog.org/an-epic-ment...

Simultaneous Acute Myocardial Infarction, Aortic Dissection, Pulmonary Embolism, and Pneumothorax Chest pain is a frequently misdiagnosed presenting symptom, with a broad differential diagnosis that includes critical, time-sensitive cardiopulmonary conditions that necessitate rapid and accurate identification.

My troponin bumped from the mere headline of this case report.

"Simultaneous Acute Myocardial Infarction, Aortic Dissection, Pulmonary Embolism, and Pneumothorax."

#medsky #emedsky #emimcc #openaccess

pmc.ncbi.nlm.nih.gov/articles/PMC...

Systematic Review Snapshot Hot off the Press: Is Subcutaneous Insulin Administration Safe and Effective for the Treatment of Mild to Moderate Diabetic Ketoacidosis? www.annemergmed.com/article/S019... #education #MedSky #EMSky #EMedSky #BlueSky

So after telling a decade of trainees that lidocaine with epi (adrenaline) is safe in digits, I've found an article that says "not so fast"
So if they have a history of vasculitis, or even Raynaud's, it can potentially cause necrosis.
So now I tell people to ask before using it in digits.

Welcome @mgottliebmd.bsky.social to the #foamed sky community… if it was okay to have a favourite researcher… !

For those going home to visit family this weekend:

• Samsung calls it Auto Motion Plus
• LG calls it TruMotion
• Sony calls it Motionflow
• Roku calls it Action Smoothing
• Google TV calls it Motion Enhancement
• Vizio calls it Smooth Motion Effect.

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My first skytorial:

Four pearls on the diagnosis of rhabdomyolysis!

When to suspect rhabdo includes:

- hyperthermia
- status epilepticus
- crush injury
- extreme exertion (marathon)
- found down
- compartment syndrone
- kidney injury of unknown etiology

My fave rhabdo tip: AST > ALT, consider rhabdo. AST doesn’t only live in liver. #foamed #medsky #emsky

This month's @annalsofem.bsky.social Journal Club wades into cefepime vs. pip/tazo.

Strong opinions on both sides – but the ultimate answer is we simply don't have strong enough evidence to rely upon for estimated harms in either direction .... #FOAMed #nephsky

www.annemergmed.com/article/S019...

Severe chest pain and dyspnea for the last three days.

#ECGSky #cardiosky #EPeeps

Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial - PubMed Ketorolac has similar analgesic efficacy at intravenous doses of 10, 15, and 30 mg, showing that intravenous ketorolac administered at the analgesic ceiling dose (10 mg) provided effective pain relief...

Less is sometimes more! 💪🏻🔥

NSAIDs have a ceiling dose. Ketorolac 10 mg may be just as effective as 30 mg but side effects like bleeding are dose-related. #medsky #pharmsky #EMSky #SkyRx

pubmed.ncbi.nlm.nih.gov/27993418/

The force ghosts at the end of Return of the Jedi

Seeing big Twitter accounts that stopped posting in 2023 suddenly come back now that this place is popular

5.) Residents attend the huddle

Residency is a cognitive apprenticeship. Let senior residents participate in/attending high level department flow organizational meetings

pmc.ncbi.nlm.nih.gov/articles/PMC...
bit.ly/4hX2gUX

@tchanmd.bsky.social

4.) Let them know what your thinking

Residents are role modeling your behavior and always watching your behavior and watching what you are dealing with. If you are moving pts around the dept or arranging for transfers let them know what challenges you are overcoming

3.) Work on micro skills

Being efficient is not just one thing - it's gathering data quickly (EMR + pt), having accurate orders, thinking 3 steps ahead, anticipating and overcoming roadblocks

Work on just 1 or 2 things per shift

pubmed.ncbi.nlm.nih.gov/34027282/

High-efficiency Practices of Residents in an Academic Emergency Department: A Mixed-methods Study - PubMed Several discrete behaviors were found to be associated with enhanced resident efficiency. These results can be utilized by EM residency programs to improve resident education and inform evaluations by...

2.) Be strategic with how you interrupt

A supervising attending behavior can negatively impact a residents efficiency. (-2.71 RVU/hr)

pubmed.ncbi.nlm.nih.gov/34027282/

1.) Don't have unreasonable expectations

Don't expect a PGY-1 to operate at a PGY-3/4s efficiency

Keep track of efficiency metrics of your residents - and feed that data back to residents so they know where they are and where they need to be.

pubmed.ncbi.nlm.nih.gov/31078348/

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Lets chat about teaching EM residents to be efficient...

I think there are 5 rules that are helpful

1.) Don't have unreasonable expectations
2.) Be strategic with how you interrupt
3.) Work on micro skills
4.) Let them know what you’re thinking
5.) Residents attend the huddle

#EMedSky

Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.

Honey, stop what you're doing, new hyponatremia research just dropped!

What's it say?

It looks like slow correction is associated with worse outcomes, like death and length of stay!

Was it just a small study?

No, it was a meta-analysis of almost 12,000 patients!

jamanetwork.com/journals/jam...

This is the most important chart published in America this week.

(By @dylanlscott.bsky.social)

Hey all:
I created a new starter pack for #MedEd enthusiasts! If you know of anyone missing, I’ll add you or them until we get to 150 - just reply to this message!

go.bsky.app/8hfHZr

Thanks for helping build back this community! #MedEd

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Who’s the most evil cartoon character ever created and why is it Peppermint Patty in Charlie Brown Thanksgiving?

Indeed. Their focus seems to be mostly instagram and by extension Threads. My best woodworking community seems to be in instagram though maybe that’s because that’s where I cultivated that community? Regardless I’m glad to leave X and Twitter behind

YouTube video by Dr Amit Pawa Interscalene Brachial Plexus Block

So as I am starting all over again here, I thought I’d look back on some of my previous work/content.

Let’s begin with a Plan A Block

The Interscalene Brachial Plexus Block

Useful for shoulder/Proximal humerus surgery/Pain

Check out the video

#AnSky #RASky

youtu.be/fX_uupfw-Lw?...

Picture of post from my account where I said "I love Family Medicine!" with a "He/Him" label and a "Family Medicine" label

Welcome all the new #Medsky users! If you haven't already be sure to subscribe to @medsky.social! It's a tool for Medsky users to give themselves labels based off of their medical specialty, and there's over 280 to choose from!

Subscribe and pick up your label to show off your specialty pride!

Also I think woodworking is pretty dope and wrote a book combining my interest in medicine and woodworking called ‘Workshop Wound Care’ available from lostartpress.com and French booksellers now too apparently? On its way to German booksellers once the translation is complete. #woodworking #EMedSky

Hello Bluesky.

I’m an EM doc who loves MedEd, dabbles in research looking at the impact of boarding on resident education, and mostly looks to train great docs hi you would be happy to have care for you and your loved ones.

#EMedSky ?