The ACEP Sessions

At ACEP last week, @drsamko tweeted a stat from the great Amal Mattu: the audience forgets 40% of new content from a presentation within 20 minutes, and 90% after a week.

I replied, "The Twitter audience never forgets!" 

If I had more room, I might have been a little more precise. Twitter makes forgetting less likely, as pearls from different lectures can be broadcasted, shared and debated. 

But Twitter is not Google or Pubmed. Once shared, Tweets, like good talking points from a lecture, have a way of disappearing into the ether. 

So I applaud GruntDoc for his reprinting 95 theses tweets from ACEP, on a more permanent form on his blog (look at what we've come to, when blog posts are considered durable). 

Here are a few of my own from ACEP #SA11 lectures and wanderings (largely stripped of hashtags, grouped by lecture, oldest first). If you make it all the way down, I have some (brief) thoughts on process of tweeting from conferences.

At infectious disease trivia session at #SA11. Learned: mortgage foreclosures led to neglected swimming pools, big rise in west Nile virus
Listeria! 2 month incubation period means maybe we haven't heard the last of cantaloupe scare. Pregnant pts particularly vulnerable
West coast heroin is not as pure as what we have in NYC. More incidence of botulism. They keep the antitoxin at airports!
Fidaxomicin for c. diff is $300 a day -But good compliance and better at preventing recurrence than flagyl. Beats a fecal transplant
@gruntdoc I think most of my patients would rather pay big $ for antibiotics than get poop transplant. Maybe I'm not explaining it well 

Cook keynote #SA11: diff between 2006,2010 landslides in house? Small movements in independents who aren't watching fox, msnbc
Cook's #SA11 talk is a primer on politics,polls,electoral math, nothing (yet) on healthcare or even policy. Maybe that's why he was chosen?
Finally Cook #sa11 talks medicine, saying economy so bad, Obama will likely lose - if republicans can nominate a "placebo."
Cook #sa11: "I know less about health care than anyone in this room..." But he knows the politics of healthcare repeal pretty cold.
Cook done speaking? his conclusion is "dunno future of healthcare repeal; lots of uncertainty." wish keynote wasn't just handicapping 

Watching @MDaware field questions by his poster (110) on residents' perceptions on teaching time vs value pic

Schoenberger on new ED gadgets: early gadget lit often written by investors, fans. But devices that take off don't depend on EBM
Schoenberger: McGrath video laryngoscope is too portable; easy to misplace this $10,000 instrument. Newer stuff cheaper, mountable
Schoenberger: King LT supraglottic device is replacing combitube in EMS purchasing. Single-use fiberoptic also show promise
@MDaware hmm maybe this speaker needs a better vendor rep; the high price of McGrath was a major talking point
Schoenberger: ultraportable sono smartphone based devices are cool but wait for an iPad device: that may be sweet spot for EM docs
Schoenberger is showing videos of S-cut trauma shears in staged competitions. So much destroyed leather!
Bmeye Nexfin noninvasive monitoring can tell (to some degree) cardiac output, stroke volume and SVR from a pulse-ox like device
There's a device coming out that will transmit EKG data through a shirt to an iOS device. Looking forward to getting rid of wires 
Schoenberger just gave a plug to @Medgadget, then @epmonthly to keep up with device news 

Interesting times at the @epmonthly board meeting this morning. Now off to ACEP's informatics section meeting
@RogersMatthew AR goggles!? We're still adapting to informatics as an approved subspecialty & writing an EMR pt safety white paper

Now at anesthetic lecture #SA11 learning evidence for bupivicaine, which seems to decrease opioid consumption days after drug is cleared
Kip Benko on supraperiosteal injection: topical first, insert bevel to bone, inject to get at the root (2/3 of tooth is hidden)
Benko on infraorbital nerve block: "needle doesn't have to get into the foramen to work - this isn't golf."
Benko showed beautiful diagram: mental foramen, corner of mouth, infraorbital foramem, and pupil all line up. That pic worth 140 char
Benko tips: inject palms up (see your palms) for best control. Distracting lessens inject pain, so pull lip or press qtip near site
Benko: easy to miss inf alveolar nerve, hit buccal or lingual instead, numbing wrong part. Angle in from over contralateral canine 

Next is one ive been looking foreward to: Badanowski & Rice, on medical liability in the age of electronic health records #EMR
known legal cases on #EMR: bad time stamp sync, delayed documentation, info entered on wrong charts, ignoring available info
So far this #EMR talk is short on specifics, no concrete actions to recommend. Are they still introducing the topic?
First real recommendation: have good backup plan when #EMR goes down; one makpractice case was lost by inadequate downtime system
@gruntdoc the poor readability of these slides is evocative of many poorly designed #EMR interfaces, may be intentional
Medical providers can be liable for use of faulty equipment; #EMR is no exception. You can't let known problems fester
Vendors make hospitals, EDs sign "hold harmless" clauses re: #EMR use or misuse #SA11 (they also gag users who try to speak out on dangers)
This #EMR talk degenerated into scaremongering. Just heard: "the lawyers are savvy, but the AMA is active." guess we're doomed 

favorite #SA11 exhibit slogan? So far QuickClot leads with "the bleeding stops here" (from the makers of Combat Gauze) picMy goodness, the T-ring people have the best exhibitor poster (warning: not safe for lunch) pic

At Newman's #SA11 talk on the NNT for common EM therapies... Always eye-opening how limited our interventions really are
Newman stresses absolute risk reduction, over relative. And shows mortality scales from 0-100% to really put benefit in perspective
NNT for rhogam in threatened AB: infinite!? Not a single case report of isoimmunization in 1st trimester, some in 2nd.
Newman's covered some of this lit on his smartEM podcast, and
Newman on NNT for packing after abscess I&D: no recurrence benefit, hurts more, prevents good cosmesis.
Steroids for meningitis? NNT of 20 to prevent hearing loss... Better than mortality benefit of lytics/PCI for STEMI (NNT 40) Newman #SA11
Antibiotics in COPD exacerbation? NNT = 3 to prevent bounceback. As good as Mg++ for asthma to prevent admission. Great interventions
Newman got passionate, urging EM doctors treating arrest patients to think about etiology rather than blindly following ACLS cookbook
After Newman laid down evidence-based but counter-culture facts, he urged action plan: educate pts, prioritize interventions

At @M_lin's talk, she suggests fragile elderly lac repairs be improved by suturing through steri-strips, to prevent new skin tears
Wise suggestions from @M_Lin: tegaderm to limit spread of tissue adhesive, and tissue adhesive to affix avulsed fingernails
@M_Lin: Fast-absorbing gut suture plus tissue adhesive is perfect for wounds that need a little extra tension (like on chin)
Ooh clever: Sono tough-to-reach extremity lacerations to look for foreign bodies by placing hand/foot in water bath. 

Off to hypertension lecture, mostly because I need a better way to reassure well patients that have no emergency
Bresler starts Rx for ED HTN if diastolic > 100 persistently. JNC recommends HCTZ (but what about K+?)
2010 AHA guideline: lowering systolic to 140mmHg in hemorrhagic stroke is probably safe. Big change
Show of hands at hypertension lecture: who's ever used fenoldopam? Mine was the only hand that went up #SA11 #practiceoutlier
Bresler treats his asymptomatic HTN ~220/110 pts with Clonidine x1, no Rx, which seems like treating numbers, not patient. 

As I did this cutting and pasting, I had a few Twitter-like thoughts come to mind:

  • Someday, academic speakers may be evaluated on Tweeted comments, and on the quality of Twitter discussion they stimulate, as opposed to those Likert evaluation scales handed out at the end of talks.
  • Tweeting (with geo-location enabled) lectured pearls may also be a way for students to demonstrate understanding / attendance to teachers / administrators. 
  • It's great that academic promotion boards are looking at social media influence alongside journal publications and other printed works. I wonder if the time-honored academic practice of double-dipping will find use, here. Just look at the mileage I'm getting from these tweets.