Anand Swaminathan

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Cremasteric Reflex in testicular torsion -Sensitivity ranges from 21-100% (PMID: 40537283) -Clearly, inadequate to rule out the diagnosis of torsion #emergencymedicine #urology #pediatrics #pediatricemergencymedicine

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Can we use the d-dimer to rule out aortic dissection? #emergencymedicine #emergency #emergencynurse #resuscitaiton #criticalcare

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Optimal ETT Shape w/ standard geometry blade (DL or VL) is 25-35 degrees (PMID: 17079788) -Straight to cuff w/ 25-35 degree angulation -Anything beyond that increased the risk of difficult or impossible tube delivery #emergencymedicine #emergency #resuscitation #airway #intubation #criticalcare #ems

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ABIs in Extremity Trauma -Normal ABI > 1.0. ABI < 1.0 should prompt immediate surgical evaluation + CT Angio -Critical part of evaluation. If abnormal should prompt rapid evaluation by surgery + CTA #trauma #emergencymedicine #ems #emergencynurse #criticalcare #resuscitation

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Is my patient on NIV tiring or improving? A drop in RR can signal improvement or worsening + have very different implications for management Follow clinical status: improved mental status, more alert = NIV working Follow tidal volume: drop in RR + TV = worsening; drop in RR + incr in TV = NIV working #emergencymedicine #criticalcare #resuscitation #airway #intubation #noninvasiveventilation #respiratorytherapy #emergencynurse #emergencynursing #prehospital #ems

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Calcium doesn’t stabilize cardiac myocytes in hyperK -Lab data shows that Ca restores Ca dependent propagation as opposed to restoring membrane potential -Fortunately, this doesn’t matter clinically as Ca2+ will reverse hyperK induced ECG changes -Ca2+ is still the treatment of choice in hyperK w/ significant ECG changes like QRS widening #emergencymedicine #emergencynurse #criticalcare #emergencynursing #resuscitation #prehospital #ems #emergencymed #emergency #pharmacology

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GI Decontamination w/ Gastric Lavage can play an important role in treatment of the overdose patient. - DONT use if limited toxicity in any dose, the ingested dose is unlikely to cause any significant toxicity, the patient has already had a lot of vomiting, there’s a good antidote available and the time from ingestion is greater than an hour. - Consider use if toxin is a potential life threat due to toxin itself, dose ingested or absence of an effective antidote. Some drugs to consider: MAOI, TCA, Colchicine, lithium #emergencymedicine #criticalcare #emergencynurse #resuscitation #emergencynursing #prehospital #ems #emergencymed #toxicology #icu

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Laryngoscope Grip -Proper technique makes lifting easy -Choke up on handle (fingers as close to where handle meets blade as possible) -2 Fingers on for placement then 3rd + 4th applied when lifting -This technique uses mechanical advantage to make lifting easy #emergencymedicine #airway #intubation #criticalcare #resuscitation #ems

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Calling a Good Consult 1) Introduce yourself/be polite: “This is Dr. Swami, one of the attending in the ED, I’m calling with a consult.” 2) Start with the end: “Dr. Gill, I’ve got a patient with a septic left knee that I think is going to need a washout.” Leading with the end makes it clear to the consultant why you are calling them. Follow with additional details. 3) Close the loop: “Can you let me know when the patient can expect to see you? Once you’re done with the consult, you can contact me at this number. Let me know if there’s anything else I can do to help. Thank you!” #emergencymedicine #criticalcare #resuscitation #emergencynurse

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Honey is Amazing! -Best proven cough suppressant -Effective bacteriostatic agent for burns #emergencymedicine #emergency #emergencynurse #pediatrics