everyone learns about TCA overdose in med school, but not bupropion XR overdose time to level up bupropion XR overdose is increasingly common & VERY dangerous ongoing drug absorption creates a "toxin bomb" wherein patients look OK initially, but deteriorate later on... (#1/2) #EMIMCC

CS:GO Bomb Defuse Timer Countdown Animation

ALT: CS:GO Bomb Defuse Timer Countdown Animation

static.klipy.com

Should you be scared of the dark? If you think lower odds of survival from out-of-hospital cardiac arrest (OHCA) is terrifying, then yes. jamanetwork.com/journals/jam... 🧵 #medsky #emimccm #foamed

Out-of-Hospital Cardiac Arrest Survival at Nighttime

This cohort study compares daytime and nighttime survival of out-of-hospital cardiac arrest among US adults.

jamanetwork.com

Even with an initially shockable rhythm and witnessed by family or EMS, the odds of surviving a cardiac arrest are much worse at night. FWIW Petter doesn't much like this time of day either. @joshkimbre.bsky.social jamanetwork.com/journals/jam...

Phenomenal write up for anyone working in EMS/Code Team/RRT quality and safety. I will be referencing this. TCP is always thrown out as "what they should have done"-- but lit is showing this is a low success maneuver. I'll still do it-- but good to escalate chronotropes and prep for TVP.

Josh Kimbrell@joshkimbre.bsky.social · 10mo ago

Transcutaneous pacing (TCP) is an intervention for unstable bradycardia. Electrical stimulus is provided ~1/s to increase heart rate. With transvenous pacers and chronotropic meds, TCP is mostly limited to the prehospital setting and low-resource centers. We suck at TCP. #emimcc #medsky #cardiosky

Transcutaneous pacing (TCP) is an intervention for unstable bradycardia. Electrical stimulus is provided ~1/s to increase heart rate. With transvenous pacers and chronotropic meds, TCP is mostly limited to the prehospital setting and low-resource centers. We suck at TCP. #emimcc #medsky #cardiosky

If you're going to use transcutaneous pacing, dial up the milliamps! That dial goes up above 100 for a reason. Study headed up by Tanner Smida and @joshkimbre.bsky.social (COI: I'm co-author 8/13) www.resuscitationjournal.com/article/S030...

When intubating with VL, the cords should be as far away as possible, while still visible. Large cords=close camera=blocked tube delivery. #EMsky #EMS @mdaware.org @joshkimbre.bsky.social

Been away for awhile having the time of my life. I usually stick to medicine here but figured y'all could take a peek at my personal life today.

you couldn't waterboard this out of me

New RCT: Avoiding A-line in shock didn't affect mortality (trend towards *reduction*) & decreased line complications They avoided A-lines despite patients requiring pretty substantial doses of vasopressors Very #zentensivist Don't need to rush to an A-line www.nejm.org/doi/full/10.... #EMIMCC

MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP Mortality benefit easier to demonstrate w/ less resources available to salvage pts Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered) www.nejm.org/doi/pdf/10.1... #EMIMCC

Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.

Jack Iwashyna@iwashyna.bsky.social · 12mo ago

"One intangible advantage of capillary refill time is that performing it brings the clinician back to the bedside to reassess the patient. This act may be itself the holy grail of early sepsis management." great piece on #sepsis

New ACLS guidelines highlight the perils of failed capture during pacing. @joshkimbre.bsky.social Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...

I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...

The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine. This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become. Available: paramedicinejournal.org

📢 Check out our study in Academic Emergency Medicine:Systematic review of +32K patients in US EDs finds: ⚠️ 52% of females with STI undertreated 💊 64% of males without STI overtreated Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...

Wow 😳 Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them. In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC

JAMA Network Open@jamanetworkopen.com · last yr.

Among patients with opioid-associated out-of-hospital cardiac arrest, chest compression and ventilation CPR was associated with a higher odds of favorable neurologic outcomes at hospital discharge. ja.ma/4l7We4q

Very pleased to share short report just published in #EMAJournal @emajournal.bsky.social Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service onlinelibrary.wiley.com/share/author...

Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here: buffalo.zoom.us/j/9848537719...

Why is Transcutaneous Pacing so difficult, and how can we do it better? It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out! #EMSSky open.spotify.com/episode/2rji...

Episode 179 - Transcutaneous Pacing Pearls and Pitfalls

MCHD Paramedic Podcast · Episode

open.spotify.com

We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest. #EMSsky #emimcc www.sciencedirect.com/science/arti...

Measuring Intra-Arrest Transport in Out-of-Hospital Cardiac Arrest: A Methodological Study of Registry-Compatible Definitions

For out-of-hospital cardiac arrest (OHCA) with refractory arrest, transport to hospital with ongoing cardiopulmonary resuscitation (CPR)—“intra-arrest…

sciencedirect.com

We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023. - 72% male - 66% 60y or younger - 47% in cardiac arrest at EMS arrival - 83% documented successful www.sciencedirect.com/science/arti... #EMSsky #EMIMCC

Prehospital Cricothyrotomy for Emergency Airway Management

sciencedirect.com

If you have a patient arrive with a STEMI who took their daily 81mg aspirin that morning, how much more do you give them? I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost #Pharmsky #EMsky #Medsky

Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky

Study: Only 25% of pulse oximeters tested for skin-tone bias post-FDA guidance

These devices, crucial for measuring blood oxygen levels, have shown discrepancies in accuracy when used on darker skin, leading to potential health risks for non-white patients, the study states

ems1.com

Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).

Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025. "As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls. #EMSsky

"What do I do if I'm concerned about someone's drinking? Speak up!" Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned. #NAEMSP2025 #EMSsky

"It's okay to not be okay." Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone. Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky

@qipunks.bsky.social leading a debrief after learning about PDSAs through deliberate play at the quality and safety course at #NAEMSP2025.

Gabe Gan presenting a dissection of the anatomy of the run chart. This is one way to measure improvement in your system! #NAEMSP2025