Pediatric Emergency Medicine Physician 🚨 🏥 Emergency Management and Threat Mitigation💥 Special & High Consequence Pathogen Programs 🦠Disasters/CBRNE ☢️ 🧨
465 patients checked into our ED in a 24hr period. No inpatient beds, 16 hour wait times just to be seen, up to 30% leave without being seen. Very sick patients boarding in ED for days. Mainly driven by RSV, Flu, & COVID. No end in sight.
Thank you for attending my TED Talk.
@EM_RESUS
Also please tell parents of children that they may very likely vomit blood they swallow. Let them know this isn’t unexpected and not a reason to come back to ER. Happens all the time.
Hi
@CVSHealth
- went to one of your LA locations today for COVID & Flu vaccines. Staff did not wash or foam hands between patients. I asked if they had, they said “no, I don’t have to”. I pressed some more and they claimed “it is not one of their policies”. (1/4)
@lapublichealth
I hope this isn’t the future of primary & preventative care in the US. “It’s not our policy” in response to the most basic of safety measures is gross. 1st priority should always be - Do no harm. If anyone from
@CVSHealth
would like to chat, I would be open to a discussion (4/4)
As
@CVSHealth
moves into the primary/preventative space, I am saddened this is what is coming for patients. I acknowledge, many MDs are guilty of inadequate hand hygiene, but to respond “it’s not policy” to 🧼 🙌 in between patients when called out on it is just depressing. (3/4)
I asked if they could please disinfect or ask another employee to give me the vaccine. They said no. Only after I politely introduced myself as a doctor and asked if they would do it as a favor to me did they reluctantly wipe their fingers partially with 1 alcohol prep pad. (2/4)
Some asked, this is a dedicated peds ED. Not talking about adults here, just kids. The country as a whole & emergency/critical care pediatricians answered the call when adult patient surge was occurring. Sadly, now seems the world has moved on and nobody seems to want to help us.
Very concerning the lack of infection control & informed decision making here.
@realDonaldTrump
appears to be wearing a cloth mask. Other passengers wearing masks with exhalation valves.
@SecretService
can be infecting each other inside a hermetically sealed car.
#COVID19
@yoncabulutmd
@CVSHealth
@lapublichealth
@cvspharmacy
It was very disappointing. To be called out on hand hygiene by a patient, then to boldly claim they don’t have to and that it’s not policy!?! Not the type of culture we want to hand primary and preventative medicine over to.
The list keeps growing… to my friends in healthcare, best of luck. To everyone else, if you feel sick it’s probably
#COVID19
, skip the holiday plans. Yes, testing is limited but pls don’t come to the ED just purely for testing, we are swamped.
Working Christmas Eve in the ED right now. Everyone has
#COVID19
. Currently have a positive 4 month old, 4 year old, and a 8 year old. Some will be admitted to the hospital. Be safe this holiday, get vaccinated.
Working Christmas Eve in the ED right now. Everyone has
#COVID19
. Currently have a positive 4 month old, 4 year old, and a 8 year old. Some will be admitted to the hospital. Be safe this holiday, get vaccinated.
@mitdoc
Thank you for lending a helping hand, we need more folks like you and programs to help quickly mobilize people like yourself during patient surges and disasters. Currently programs are all very slow, clunky, and ineffective.
@NAndersonMD
@haircut_hippie
@NAndersonMD
clearly you did not finish the required 6 online “self learning” modules on why we need so many amazing 🤩 administrators. Please submit prior to tomorrow at 3pm or we will be forced to suspend your privileges. p.s. Don’t work on them in clinic, complete at home!
@farid__jalali
Respectfully, a Ebola “pandemic” in the US is extremely unlikely. Could we have clusters of cases? Absolutely, its happened before, and why teams like mine train. But I would suggest “insert 20 other major looming healthcare problems here” before the second part of your sentence.
@josh61077
@choo_ek
It’s everywhere, pediatric referral centers can’t accept transfers from the community. Community hospitals with no or limited peds services getting stuck with kids. Have had to say no to transfers countless times in the past few weeks.
Connecticut Children’s in talks with National Guard and FEMA to setup a field treatment tent to accommodate the surge of respiratory patients being seen. Children’s Hospitals across the country are starting to feel the crunch.
@TheWRAPEM
@npdcoalition
@pedspandemic
As the surge in children's respiratory illnesses, including rhinovirus and enterovirus, continues across the country, a Connecticut children's hospital is considering installing a field tent to deal with the influx of patients.
@chungk1031
I’ve seen kids get scanned again within hours because images from other center not sent. I have has to beg sending center to send a courier with CD by car. Should be legal requirement for transferring EDs and inpatient transfers to not provide an instant cloud sharing option.
It’s unbelievable in 2022 I have to spend whole days blindly cold calling hospitals & FAXING stuff to try and find peds ICU beds. How does county/state wide bed coordination fall on the treating ED/ICU doc in🇺🇸?
#RSV
#FLU
#COVID
When I do finally find a bed though, it be like…
Witnessed this week that NEDOCS scores > 500 are possible. We now rarely dip below the disaster thresholds set by this tool.
Systems to evaluate for ED and Hospital overcrowding are obsolete in US healthcare, every day is a disaster by current measures.
#PedsInCrisis
#pedsICU
@grahamwalker
Ohhh and let’s not forget about other terrible diseases like multiple sclerosis. Still very early stage, however mRNA therapeutic research is now majorly jump started.
Some have asked how hospitals 🏥 can run out of oxygen in
@CountyofLA
? It isn’t purely a raw oxygen supply issue but a fluid dynamics problem. A typical pre-COVID era hospitalized patient may require 2-6 Liters Per Minute (LPM) of oxygen.
@lapublichealth
(Thread continued)
Had to stop by the
@Petersen_Museum
to check out the
@Tesla
next gen.
#roadster
. Despite my best efforts, photos don’t do it justice.
@elonmusk
can I please get a discount on this slightly used floor model 😂?!?!?
@DShadowgazer
Be sure to water those little epiphyses twice a day, make sure they get good southerly sun exposure and plenty of bed time stories... and then probably just get a full skeletal survey to check on their brothers and sisters.
@RodGerardo
@DGlaucomflecken
Woah, woah woah… Poiseuille’s law and fluid dynamics became very important during the pandemic and I posted a thread about it here🤓 -
Some have asked how hospitals 🏥 can run out of oxygen in
@CountyofLA
? It isn’t purely a raw oxygen supply issue but a fluid dynamics problem. A typical pre-COVID era hospitalized patient may require 2-6 Liters Per Minute (LPM) of oxygen.
@lapublichealth
(Thread continued)
I rarely call out doctors on this app.. but this guy is a total embarrassment to the profession. What Drew fails to mention is he “dropped suddenly” s/p blunt force trauma to the chest.
Shameful to use this rare 🏥 tragedy to stoke the 🔥 of his newfound 💉 conspiracy following
#COVID19
in kids by the numbers from
@COVKIDProject
.. having worked much of the holiday season, this is consistent with my observations. Numbers in the ED have exploded over the course of a just 1 week. Daily results won’t even fit on the screen.
Not a bad run, 27 months seeing COVID pts in the ED before contracting the illness myself.
Day 0: Sore throat, slight hoarse voice. Mild headache. Lower extremity myalgias. Feel like I may have low grade 🤒 but like all good pts don’t have a 🌡. HR 110 at rest. No cough, no SOB.
@RealDanODowd
@WholeMarsBlog
I treat child victims of MV accidents daily in my job as a emergency room doctor. Tesla’s ADAS/FSD features would have prevented the double pediatric trauma I had this AM and countless others.
@RealDanODowd
🤡 clearly has a unspoken agenda & I stand firmly with
@Tesla
.
@elonmusk
Happy Doctors Day - thank you for your service over these difficult past 2 years. Sincerely, Administration.
Sharing from a colleague at another institution.
@DJSnM
Would have expected more mainstream press over this.. guess there is just too much going on right now. Can we expect a video in next few weeks focusing on this incident and issue of space junk/collision risk? Pleaaase!!??
Excerpt from my conversation with
@tesla_community
today.
My response to people justifying texting at red lights and
@Tesla
FSD / AI tackling object permanence, building 3D vector spaces so our distracted tired brains don’t have to.
Full Episode:
@WholeMarsBlog
@elonmusk
Talk about real world problem solving at the 2:40 mark on the raw footage vid. FSD appropriately moved right after passing UPS truck to not obstruct traffic. It then waits to make left despite 2 cars moving into oncoming to make left first. Handled that situation just as I would!
Spent 6 hrs trying to get a high risk pt tecovirimat in the ED today. Dozens of ☎️ calls, couriering the med from another 🏥, countless hoops to jump through. Finally got
#TPOXX
for pt, how? bc emergency medicine brute force solves the problems of a teetering healthcare system.
@farid__jalali
It’s a long answer. I will say though nobody from EVS other than those who have gone through a robust training program would be entering the room. Select vetted people that volunteered for the training.
(1/2) Today I suspect a case of Trachelas pacificus🕷bite. 18mo old found crying w/ this spider next to her. Itchy painful hive/allergic reaction localized to ankle. 2 pinpoint red bite marks. No systemic symptoms. Mom killed spider & brought to the ED.
#MedTwitter
#Toxicology
Loving my new doctor
#NFT
avatar!
Amazing 3D art by
@TheProjectURS
!
Thank you to
@CryptoHarang
and the rest of the international team for a great drop and a novel smart contract lottery to avoid gas wars!
@JO7eth
👀 👇
When I began analyzing the
#COVID19
#pandemic
12mo ago I probably wouldn’t have believed we would get
#vaccines
in arms this quick. Remarkable achievement by all involved. The logistical challenges are immense & ongoing but we will get there. I stand w/
#science
. It takes a team!
Forget the subject matter for a moment. Ripping down postings in public spaces on USC property by a student is elementary school behavior. As a faculty member, I hope USC only matriculates and graduates students capable of civil discourse. Temper tantrums need to be remediated.
We are aware of a social media post of a person removing posters from what appears to be a building on our campus. We know this is upsetting to many of you and encourage everyone in the USC community to respect others’ views/act with civility towards each other. (1/2)
@Sisu4Democracy
@josh61077
@choo_ek
I'm glad they were able to find a bed. Federal law (EMTALA) requires all emergency departments to evaluate and stabilize patients regardless of their ability to pay. Does not matter if it is a children's hospital or not. Emergency med physicians have training in Kids and Adults.
A big thank you to the Department of Pediatrics
@StonyBrookMed
for allowing me to shed an importantly spotlight on Disaster Preparedness, Management, and Medicine at Grand Rounds today!
@SBU_ERM
Tried the "extra-oral" mandible reduction technique last night for the first time. Worked great, safer, and waaaaay less awkward for Doctor and patient.
via
@ALiEMteam
Curious, how many cases of infant and toddler myocarditis have you treated
@MdBreathe
? It’s on my differential diagnosis just about every time I go to work. It’s my job to “detect” signs/symptoms of myocarditis in non-verbal children and therefore order “invasive testing”.
Sound familiar general pediatricians and subspecialists?!?! You are being used and abused.
Will you wake up and join the fight or continue being trampled on? Please like and RT.
@ab_peds
is in on this scam, they must reform or be made to reform.
With the “grandfather rule” the ABIM protects the old boys club of physician elders (who run ABMS) and they themselves don’t have to re-certify. 1 test for life for the elders. The rest of us pay their generous salaries with MOC fees.
To clarify on exhalation valve.. I am not suggesting passengers putting
@realDonaldTrump
at further risk. Suggesting that if one of the passengers is infected (possibly asymptomatically) they are increasing probability of infecting each other. Photo is from
@CDCgov
The limiting factor becomes how to get X amount of gas through Y amount of piping at Z amount of pressure. This challenge is partly explained by the le Poiseuille Law & Bernoulli’s principle. Apologies in advance to fluid dynamics experts if I am not 100% on point here (Cont.)
11 yo F to ED w/ complaint of acute unilat. vision loss. Had 10 days of viral symptoms, COVID antigen pos. in ED. POCUS shows unilat. ONS swelling + elevated optic disc. Extensive workup w/ MRIs & labs otherwise - . COVID associated optic neuritis.
@grepmeded
@ccmcpocus
@Pocus101
England setting up 7 mass 💉 centers. Goal of 14 million given before end of Feb. We have the capability to do similar. Ppl are willing to travel for 💉. It was obvious this Fall that published state plans were woefully inadequate, where is our national leadership and resources?
@grepmeded
@DGlaucomflecken
I diagnosed drusen on POCUS a week or so ago, the Optho on call looked at my US and gave me mad props. A rare feel good moment. Fist bumps were exchanged, outpatient follow ups were arranged.
Check out the new
@TheWRAPEM
Peds Surge Playbook! Designed to provide resources for common challenges experienced during pediatric surge.
Proud to have contributed a small part in a huge collaborative effort.
@pedspandemic
@npdcoalition
@paediatricblast
Slept terribly, splitting headache and nausea this AM, tired. Prolly nothing. Just a random migraine.. BUT a perfect use case for a Rapid Antigen test b4 interacting with others. Negative! Go grab some b4 the holidays to have ready. Much more likely to use if u already have them!
Hospitals were not built and engineered with these tremendous volumes and required flow rates in mind, this is one way in which we “run out of oxygen”. Oxygen storage tanks, concentrators, and supply also an issue.
#LosAngeles
@TheWRAPEM
@npdcoalition
@CA_EMSA
@latimes
@CVSHealth
As an update… I just had a great conversation with a regional CVS supervisor who is a fellow healthcare professional and I am hopeful change comes from this. They have offered to keep me informed. I plan to give them ample time to look into the concerns before posting further.
Worked a late shift last night in ED. Thought maybe just some allergies or bad night sleep, but mildly suspicious. Grabbed a rapid test from closet, which immediately turned positive. Diagnosis confirmed with great specificity on Day 0 of symptoms.
@michaelmina_lab
👏
@grepmeded
@AaronGoodman33
Meanwhile the frequent prescriptions I see for oral Albuterol (yes, the kind you drink) are almost exclusively written by folks grandfathered in.
Much of my field’s training revolves around deciding when to do invasive testing in patients who are non-verbal or can’t fully articulate what they are feeling. You may have valid points or hypotheses but you fail to make them, rather you toss fear and apprehension onto twitter.
@elonmusk
We have known since the spring the rapid tests have major performance issues w/ false + and false -. All medical tests results need to be viewed through the lens of performance (sensitivity/specificity). Most public run testing centers are using PCR only.
Thinking of all the asthmatic individuals currently gazing out at heavy clouds of wildfire smoke, especially in NYC where inner city asthma cases have been skyrocketing for years. Stay indoors and keep your rescue inhaler nearby.
Picture is from a friend in the city.
Rapid
#COVID
antigen test before attending Friendsgiving, about $12 a test, bought at pharm and takes 15 min in the comfort of your 🏠 While not perfect, rapid tests excellent tool to decrease risk at gatherings. Vaccinations too of course! Not too late to go grab one yourself!
@KimiChernoby
But every time a physician completes a mandatory module on their off time, somewhere, a non-clinical administrator grows their wings and gets an ice cream cone with a pat on the head from their boss!
A resident just asked me if I provided disaster medical care during the Northridge earthquakes in 1994… I would have been 8 years old. Yikes, do I look that old? 🤨
In keeping with emergency medicine stereotypes..
I just went stunt flying. Experienced 8.2G and didn’t puke or G-lock. The Extra 330 is an engineering marvel that seemingly ignores the laws of physics.
Sharing a paper I coauthored, honored to work with this team!
Strategic Surge Responses in the COVID-19 era: Operational Themes, Innovative Solutions and Lessons Learned by Three Freestanding Peds EDs
@TheWRAPEM
@npdcoalition
@pedspandemic
@ChildrensLA
@sweetgreen
@lapublichealth
This event should have been immediately halted by upper management as it got out of hand and irresponsible. Once again my heart goes out to frontline employees they were put in this situation. This behsvior is what we need to combat to decrease community spread of
#COVID19
@reverendofdoubt
Slow down when you need to. When I moved into the hot seat I immediately felt the pressure to turn over rooms & go faster. Take time to do that extra assessment prior to d/c. Extra check Rxs written by trainees. Room-side round on your zone w/ the team when things seem crazy.
Pls state your argument more clearly rather than a sloppy statement followed by pic with a random statistic. What about hospitalizations, invasive testing, ICU days and MIS-C? Majority survive but a fair and complete risk/benefit analysis should be presented in your argument.