The wise thirsts for questions, not answers!

The following post displays comments from tweets about speakers at the 14th ICEM in Dublin in June 2012.

Some reflect evidence-based medicine, some just personal practice supported by expert opinion only.

We post these in order to generate reflection and lateral thinking.

Remember: The wise thirsts for questions, not answers!

Ruben Strayer:

Cricoid pressure is futile during during RSI

Modified/delayed RSI in order to improve pre-oxygenation prior to paralysis: sub-naesthetic dose of ketamine in agitated patient to allow oxygenation

A failed cricothyroidotomy performed at the right time is defensible but a successful one perfomed too late is indefensible

Apneic oxygenation: leave the nasal cannula on the patient while you are intubating (oxygen diffusion)

Ron Walls:

Is it ethical to teach direct laryngoscopy on critically ill patients given the superiority of video devices?

Emanuel Rivers:

52% of septic patients are coming from EDs but the mortality is the lowest in this group when compared to those originating from somewhere else

What is important is not the amount of fluid you give but how quick you give it

10% of septic patients have a normal lactate

Lactate as a marker of severity is great but in conjunction with other markers of sepsis

EGDT better late than never!

Ian Stiell:

Today’s EPs are not interested in EBM unless in the format of an app or in less than 140 characters

Tim Harris:

Urgent thoracotomy is to be performed in witnessed traumatic cardiac arrest. If you cannot do one, you should not be receiving trauma

Major trauma is rare and it is therefore difficult to become an expert

Tim Coats:

Gelofusine impedes coagulation more than normal saline

Mattu:

Chest pains in the elderly is associated with belching in 47% of cases

Cameron: 

Victoria immobilizes 50,000 C-spines for 20 unstable fractures per year

Greg Henry:

Management is doing things right, leadership is knowing the right things to do

Cadogan:

The purpose of research is to induce change, not to get published!

Jones:

Epinephrine is the second agent of choice after norepinephrine in sepsis (or vasopressin)

Cantor:

Procedural sedation good quality indicator of an ED

Greg Henry:

Give good news in public, criticise in private. Compliment ten times more than you criticise

Unattributed:

Midline bony tenderness lacks sensitivity and specificity for cervical fractures (U/K)

CT scan sensitivity for spinal injury 98% vs x-rya 58% (data from trauma centres) (U/K)

Anaphylaxis in the patient on beta-blockers: add glucagon –it will activate cGMP directly (U/K)

Since the 2005 ALS guidelines, the survival of OHCA has risen from 27% to 50% (U/K)

One needs to read 17 articles/day to keep current in EBM (U/K)

Patients with high BP post-arrest do better: it improves cerebral micro-circulation (U/K)

Experimental evidence suggests that therapeuthic hypothermia best started within 5 hours of the arrest (U/K)

If you are an idiot offline, you will be an idiot online (U/K)

If you have no internet presence at all then anyone can control your internet presence (U/K)

The visual connection with the patient is essential. If the physician cannot see the patient, the patient stays longer in ED (U/K)

If you train exclusively in one country, you will not appreciate where EM is globally! (U/K)

There is pressure on EPs to give up some of their work because there is not enough of them. Does anyone else do it better? No! (U/K)

We agree that children are not just small adults. But older children do behave like adults in trauma! (U/K)

Traumatic cardiac arrest: no adrenaline, no CPR.  O2, ventilate cautiously, bilateral thoracotomy! (U/K)

Recognising ambulatory care sensitive cases: a solution to overcrowding? (U/K)

 

Tweets collected by Janos P Baombe

One response to “The wise thirsts for questions, not answers!

  1. Ah…the memories. I can fill you in on some of those unattributed’s:
    Anaphylaxis in the patient on beta-blockers: add glucagon –it will activate cGMP directly (Darryl Macias)
    If you are an idiot offline, you will be an idiot online (Mike Cadogan)
    If you have no internet presence at all then anyone can control your internet presence (Mike Cadogan again)
    Traumatic cardiac arrest: no adrenaline, no CPR. O2, ventilate cautiously, bilateral thoracotomy! (Tim Harris)

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