The Practice of Medicine knows exactly when to humble you.
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Rick Pescatore, D.O.
@Rick_Pescatore
Dad. Doctor. Clinical details altered.
DoctorJoined January 2012
Rick Pescatore, D.O.’s Tweets
. in his first-ever InFocus column: An indispensable analysis of the ’s new decision pathway for #chestpain in the #ED. This consensus, he says, will guide disposition & be the standard to which management may be compared. #FOAMed bit.ly/InFocus-EMN
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I’ve only instituted ECPR a handful of times—cannulation skill and systems-level processes influence outcome just as much as patient condition.
This trial may throw water on fledgling ECPR programs, but in my opinion, that would be hasty.
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And the bomb is out!!! How to not do ECPR trial . #ecpr table 3 is the core of the issues
IV antibiotics are not magical, says Blake Briggs, MD, and an IV dose in the ED is costly, takes more time, and does not reduce readmissions. talks about -IV Antibiotics Before Discharge: Think Before You Stick. ow.ly/CKXM50Mxb2A
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Have you ever had a painful scratch on the front of your eyeball (corneal abrasion)?
If so, please take this 2min, confidential survey about your experience to inform medical leaders!
ivey.az1.qualtrics.com/jfe/form/SV_1R
. . . .
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Public health labs deliver results. 
twitter.com/RIHEALTH/statu…
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IME understanding pressure natriuresis and its influence on patients presenting to the ER w/hypertensive complaints brings significant benefit. Often paradoxical to learners, administration of fluid in these scenarios can benefit both patient and provider!
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I wrote about a precipice in the landscape of #emergencymedicine in my first article as board chair.
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🚨ED Approach to Post Cardiac Arrest Management
#FOAMed #MedTwitter #MedEd #FOAMcc #CriticalCare #ResusTwitter #emergencymedicine
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EM interns & residents:
The "52 Articles in 52 Weeks" 3rd ed. compendium is ready. Read 1 article a week to build your foundational knowledge. 👏 faculty team, led by Dr. Nicholas Dulin.
aliem.com/52-articles-52
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Pediatric constipation is an unbelievably common and important issue, driving ER and outpatient visits and a lot of practice variation worth limiting—-as well as no small amount of parental angst! (🙋🙋)
Thanks for covering this, !
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#Constipation brings lots of infants and children to the #ED with #abdominalpain, and @Lmellick covers #disimpaction and dietary education with Osman Altun, MD. #FOAMed #video bit.ly/EMNMellick
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Good teaching point today on shift about the high incidence of viral urticaria (not all hives are an allergic reaction!).
I appreciated recent article drawing attention to guidelines discussing 2nd-gen antihistamine use!
acepnow.com/article/the-de
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The Health Update is a great resource for clinicians managing withdrawal and/or wounds resulting from #tranq contamination: hip.phila.gov/document/3154/
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Great article on #xylazine. I've recently started seeing these consequences in the ED, and have learned from the toxicologic expertise of and the tox team.
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And to wrap up our #bestof2022, the best-read article for the whole year—drumroll, please!—was “Why I’m Leaving Emergency Medicine.” Sadly, the reasons this #EP decided to leave #EM after a decade of practice won’t surprise you. bit.ly/3NoiZS2
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In a patient with shock liver post-cardiac arrest (INR>10), what is the role for the use of Vitamin K or blood products? (No Warfarin)
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I like the idea of getting two for one with Linezolid replacing the need for vanc + clinda. Only concern is some of the biases noted in the Cochrane review, but ISDA seems to agree this is a reasonable thing to do. Keeping this in mind for the next one I see
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On shift discussing the BOX trial, which found no difference in post-cardiac arrest MAP targets of 77 vs 63. This was an informative trial for me, especially with previous data out of my alma mater suggesting MAP of 80 post-ROSC may be superior. nejm.org/doi/full/10.10
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Hmm—I may be behind the 8-ball on Linezolid vs Vanco for NSTIs. Has this entered your practice yet?
Pinging a few locals:
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linezolid for necrotizing soft tissue infection 
(emcrit.org/ibcc/necfas/#a)
(emcrit.org/ibcc/necfas/#a)5
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Recent ECG in a syncopal patient. Thankful for this that describes Brugada and measuring the beta angle—-frequently used with learners! hqmeded-ecg.blogspot.com/2015/03/is-thi
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EM's Next Priority: Geriatric ED Care - A Special Report from Emergency Medicine News @EMNews @ACEPNow @GeriatricEDNews @theGEDC @WestHealth journals.lww.com/em-news/Fullte
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Jim Roberts was a giant. He always relished the chance to spread knowledge and enhance excellence in our field, and for decades he helped cultivate conversations in departments across the country alongside the many talented+resourceful writers of
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Replying to
This is the dosing scheme we use and for the vast majority of patients you can just order and forget it. Extremely well tolerated. Expanded to floor patients back in I think April last year.
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I think triggerpoint injections are a phenomenal tool inside and out of the ED, and enjoy referencing this paper to learners, which explores the reversibility of TPI analgesia with naloxone.
My guess is there’s probably room for more TPI use in the ER
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My success with phenobarbital for alcohol withdrawal far outstrips my experience with escalating benzodiazepine doses, and the operational benefits are significant. My typical approach is 130mg mild, 260mg moderate, 10mg/kg severe. Short course of 100mg capsules for those dc’d.
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My latest article in . Why are we still talking about Contrast nephropathy? Bc hospitals still have 💩 policies in place. #MedTwitter #emergencymedicine
buff.ly/3WVTQlS
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TL;DR for AFRVR:
- All-comers: POCUS + IV Mg (my preference 🤷♂️)
- unstable or severe HFrEF: ⚡️
- Stable or NOAF: PIRATES for secondary causes, and treat those
- Primary AFRVR & Stable --> whatever you do, just don't put them into cardiogenic shock w/ your management choices
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Ugh. “Rage forever.” DYAC.
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Tagging a few who I’d love to hear current rate control pearls and practices from. The CCB/BB debate will rate forever, but is there room for more caution here?
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Important consideration, and something I’ve been thinking about lately. I suspect we should be routinely echoing prior to rate control in AFRVR, and my guess is it would lead to less CCB and more BB use.
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Replying to @TheSGEM @EMO_Daddy and 2 others
Except that AF is rarely present by itself. It is frequently accompanied by HFrEF, CAD, other structural heart disease etc. The study will not pick up the patient that will VF because their LVEF was 10%.
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I enjoyed ’s article in this month’s about the language we use + standby phrases to help break the ice with patients
I have a habit of saying “don’t run off or anything” to patients w/lower extremity injuries
Do you have any standbys?
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So proud of you Vince! Saving lives in & out of the hospital (and in & out of mummers gear!) 💪🏻 #einsteinproud
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At New Years Day’s Eagles game, a fan collapsed in the Upper Level. He was pulseless and turning blue. Luckily, ER Dr. Vincent Louis, freshly off of Broad Street and in full mummer gear, was in the same section and was able to perform CPR and chest compressions to save his life.
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Seeing how much the world accepts that it’s impossible to move on after watching CPR really makes me think about how we (medical professionals, especially those who work in Emergency departments) are expected to just move on immediately after a code.
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. in his first-ever InFocus column: An indispensable analysis of the ’s new decision pathway for #chestpain in the #ED. This consensus, he says, will guide disposition & be the standard to which management may be compared. #FOAMed bit.ly/InFocus-EMN
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I am humbled and grateful to take on the role of EMN Chair. I stand on the shoulders of giants, especially Jim, and am dedicated to continuing his great work of fostering important conversations in our specialty.
I hope you’ll join me on this next great adventure.
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.@Rick_Pescatore is the new chairman of our edit board! And in some heartwarming continuity, he will write InFocus, which Jim Roberts took on when he became bd chair.
Announcement bit.ly/3Gt0Srp, his vision bit.ly/3GwfVl1, his 1st column bit.ly/3CfgInQ
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