Aimee Mishler, PharmD, BCEMP, FAWM

🦠 Tamiflu: Worth It?
📉 Reduces flu symptoms by <1 day
🤢 Nausea, vomiting, headaches common
🚫 No reduction in death or hospitalization in mild cases
So… treat everyone? Maybe not.
📖 Read more: https://wp.me/pdrP8b-5sK
👥 @emswami @marco_propersi @mramzydo
#FOAMed

The incidence of myocarditis and pericarditis has been documented in adolescents after COVID-19 vaccinations. This study aims to assess the risk of myopericarditis in adolescents following COVID-19 vaccination, using a meta-analysis of the published cases. We performed a comprehensive literature search of the following databases on July 5, 2023: MEDLINE, EMBASE, PubMed, and the Cochrane Library. We performed a meta-analysis using a random-effects model to estimate the incidence of myopericarditis per million of administered COVID-19 vaccine doses or COVID-19 infections. A total of 33 studies were included in the meta-analysis. The incidence of myopericarditis per million COVID-19 infections (1583.9 cases, 95% CI 751.8-2713.8) was approximately 42 times higher than that for COVID-19 vaccine administrations (37.6 cases, 95% CI 24.2-53.8). The risk of myopericarditis after COVID-19 vaccination was particularly high among the 16-19 age group (39.5 cases per million, 95% CI 25.8-56.0), males (43.1 cases per million, 95% CI 21.6-71.9), and those who received the second dose (47.7 cases per million, 95% CI 22.2-82.2). There were no significant differences in the incidence of myopericarditis per million COVID-19 vaccine administrations between Europe, the Western Pacific, and the Americas (p = 0.51). Adolescents faced a potential risk of myopericarditis after COVID-19 vaccination, but this risk is less harmful than that of myopericarditis following COVID-19 infection

"The risk of myocarditis after COVID-19 infection is approximately 42 times higher than the risk after COVID-19 vaccination"

Of course, COVID's harms are not limited to myocarditis

🚨 JUST PUBLISHED 🚨

⚠️ The 2025 @lancetcountdown.bsky.social report reveals climate change inaction is costing lives and livelihoods, and harming the economy.

❤️‍🩹 Protecting people’s health demands all hands on deck.

Read more: www.lancetcountdown.org/2025-report/ #LancetClimate25

PulmCrit - 2025 AHA & ESICM guidelines on post-arrest care The ESICM and AHA both just released new guidelines on post-arrest care. It's always interesting when two professionals produce "evidence-based"

emcrit.org/pulmcrit/202... #EMIMCC Some @pulmcrit.bsky.social 's highlights about aha vs erc cardiac arrest guidelines #Emcritters

hi, medical toxicologist that knows a lot about Tylenol here👋 Claiming that tylenol use in pregnancy causes autism is fearmongering

here's what you need to know 🧵

proposal:

all types of bradykinin-mediated angioedema involve a common vicious spiral 👇

tranexamic acid or aminocaproic acid should be universally effective in blocking this cycle & aborting attacks

there's no need for super-expensive drugs (icatibant et al.)

thoughts? criticism? #EMIMCC

Don't forget to submit your didactic session to present at SAEM26 Annual Conference! Deadline is 10/2/25! buff.ly/nwLK5Mo
#SAEM #AEMP #AEMPlify #EMRx

🚨 New Post Alert!
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky

cosign this 😁

four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)

that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic

(& Adnexanet alfa price is insane)

AEMP is seeking new practitioners to present the YIR at AEMP 2026 at SAEM Congress next year! Apply today! #AEMP #AEMPlify #EMRx

The submission portal for SAEM Congress is now open. Submit your didactic session proposal today! #SAEMonline #AEMPlify

🚑 The first EM Pharmacy Pearl for the year is out by PGY2 EM Resident, Jonathan!

#rxsky
#pharmsky
#pgy2em

🚨 New Post Alert!
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky

SAEM August theme National Immunization Awareness Month

💉National Immunization Awareness Month!💉

Together, we can help raise awareness about the importance of vaccination. Many patients express interest in receiving vaccines when they are offered in the ER, creating a valuable opportunity for engagement with EM pharmacists!

📣Have you heard of antiamyloid therapies for Alzheimer’s disease? They cause ADEs called ARIAs that are non-specific, typically require MRI, & can mimic stroke

⛔ Concomitant thrombolytics/anticoagulants are contraindicated

Learn more in our JAMA IM Clinical Insight 👇

Burman et al: Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study

Link: link.springer.com/ar...

@neurocritical #neurocritcare

Myth busting: Antibiotics don't reduce mortality in variceal hemorrhage!

I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va...

We probably don't need antibiotics at all🤦‍♂️

Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC

Donate to the SAEMF Challenge to give back to EM! Not only will your donation help advance EM practices and research, but it'll HELP AEMP MOVE UP THE LEADERBOARD in this SAEM competition! See link for more details or scan QR code to go to the donations page buff.ly/qvUCT8C
buff.ly/masr25D

🚨 NEW POST: MDCalc Wars 🛑💥
Are you using PERC and Wells correctly?

✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!

👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky

Gain insight into best practices for retaining highly skilled pharmacists in the ICU and the importance of reducing burnout in pharmacy teams in the latest SCCM Podcast. Listen now: sccm.org/pod544
#SCCM

Welcome to AEMP's Pulse Dose! Weekly pharmacy pearls to upgrade your EM practice!
This week's topic: Local anesthetic systemic toxicity, or "LAST". Don't be the LAST to know!
#AEMP #SAEM #AEMPPulseDose #RxPearls #LAST

📣 Hot off the press!
MTP review and update for the pharmacist!
#rxsky
#pharmsky

pubmed.ncbi.nlm.nih.gov/40580496/

YouTube video by EMSwami RUSH Exam + Tamponade #emergencymedicine #criticalcare #resuscitation

In patients with undifferentiated shock, always get a Rapid US for Shock + Hypotension (RUSH exam) to differentiate etiologies

Avoid diagnostic closure, particularly when the answer appears simple

youtube.com/shorts/MUptk...
#EMIMCC

YouTube video by EMSwami Ketamine in Status Epilepticus #criticalcare #emergencymedicine

Ketamine in status epilepticus?
PMID:39674935 ketamine > no drug after midaz failed(flawed study)
PMID:40186980 midaz/ket > midaz. But, kids seized 34 min prior to meds, very low rate of sz break w/ midaz

Consider ketamine after 2 doses BZD fail but evidence weak
youtube.com/shorts/arX6s...
#EMIMCC

YouTube video by EMSwami Hypokalemia in DKA #criticalcare #emergencymedicine

Hypokalemia big killer in DKA
-All DKA patients total body K down
-Some w/ serum hyperK due to acidosis shifting K
-K < 3.5: replete prior insulin
-K 3.5-5.5: start insulin + K repletion simultaneously
-Skip bolus: no faster DKA resolution but incr risk hypoK

youtube.com/shorts/pTnt8...
#EMIMCC

YouTube video by EMSwami Massive Hemorrhage Protocol #criticalcare #emergencymedicine #trauma

Massive Hemorrhage Protocol: More than just giving products
-Control bleeding: tourniquet extremity hemorrhage, pelvic binders, balloon tamponade
-Early transfusion
-TXA, AC reversal (PCC or FFP) + Ca

Don't forget to get consultants mobilized for definitive care

youtube.com/shorts/AIV4o...
#EMIMCC

YouTube video by EMSwami Advice for New Trainees 4: If You Don't Know, Ask #emergencymedicine #residents #internship

Advice for New Trainees #4: If you’re not sure, ask. So many questions come up and if you’re unsure of the answer, ask a nurse, another resident or your attending. This is what training is about

youtube.com/shorts/74nUd...
#EMIMCC

In the latest video in our partnership with @glaucomflecken.bsky.social, the BALANCE trial comparing 7 days of antibiotic treatment with 14 days of treatment in patients with bloodstream infection is explained. Access the article for free: nej.md/DrG19

a man with a surprised look on his face and the words how did this happen below him ALT: a man with a surprised look on his face and the words how did this happen below him

The ideal cutoff for adequate time-to-antibiotic delivery in septic shock is being discussed again 🤦‍♂️

Should we be required to give antibiotics in 1 hr? 3 hr? 15 minutes? 3.14159 minutes?

This is worth a short thread on the background of this topic

Buckle up, it's a mess... #EMIMCC #IDsky #1/6

✏️ AEMP's Education Committee is looking for presenters for their quarterly webinars and journal club series!
💊 Express your interest for presenting at the link!
🚑 buff.ly/8s8gXzF
#AEMP #pharmsky