emdatadoc
@emdatadoc
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Angel Li MD/MBA 2020 CUSOM. I like using technology to solve problems.
Joined June 2019
I made an ad-free android de-identified photo app. This app uses machine learning in real time to identify eyes and eyebrows and blocks them out. The image is saved with these overlay blocks. https://t.co/TEvPQuXXL1
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COVID-19 @iBookCC chapter: 🦠Protection: hand hygiene more important than fancy N95🤯 🦠Dx: neg RT-PCR doesn't exclude 😬 🦠Rx: less is more. avoid fluid & steroid. overall strategy = *usual* supportive care for viral PNA (link https://t.co/i58dGse1D6)
#COVID19foam #zentensivist
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Analysis from the former Director of the Office of U.S. Foreign Disaster Assistance (OFDA) on why there were undetected community transmissions.
Now seems highly likely that there has been undetected community transmission ongoing in parts of the upper West Coast for weeks, at least. How did we end up with major surveillance failure on par with Italy and Iran? Let's talk about how that happens.
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"Burnout is preventable. It requires good organizational hygiene, better data, asking more timely and relevant questions, smarter (more micro) budgeting, and ensuring that wellness offerings are included" https://t.co/DiF2nnxhvx
hbr.org
We often think of burnout as an individual problem, solvable with simple-fix techniques like “learning to say no”, more yoga, better breathing, practicing resilience. Yet, evidence is mounting that...
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I was diagnosed with #childhoodcancer stage III Wilm’s tumor when I was four years old. I received a nephrectomy, full abdominal and pelvic radiation, and a year and a half of chemotherapy including #vincristine. You all knew this was coming.... thread 👇🏻 #cancermeds4kids /1
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4. In general, do you see well? 5. In general, do you have serious problems with your memory? 6. Do you take more than 3 meds daily? >1 positive is high risk, pt will require more support for transition of care. https://t.co/ImFmxLitcV
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Identification of Seniors At-Risk Tool: 1. Before the injury or illness, did you need someone to help you on a regular basis? 2. Since the injury or illness, have you needed more help than usual? 3. Have you been hospitalized for one or more nights in the past 6mo?
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Elder Abuse 1. 10% of experience some form of abuse and neglect 2. Open wounds, internal injuries, fractures. Often head and trunk 4. Suspicion raised: multiple injuries, poor general hygiene, malnutrition and nonadherence to medical care. https://t.co/PyYhNvFacE
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Suicide in Geri Pts 1. Highest risk of death caused by suicide 2. Use more violent methods for attempt: firearms, jumping, hangings 3. Less of an impulsive act and more planned 4. Associated w/ chronic illnesses and multiple comorbidities https://t.co/PyYhNvFacE
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1/3 of Geri Patients with an acute infection don't present w/ a fever (>38C) 1. Healthy elderly pt have a lower temp at baseline 2. Diminished thermoregulatory capacity 3. Abnormal or diminished response to pyrogens https://t.co/7eA236vHwG
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Why do Geri Pts report pain differently? 1. Visceral pain is different "discomfort" vs acute precise pain 2. Pt believe it is a normal process of aging 3. Stoicism or minimization 4. Altered mental status 5. Decline in cognitive function https://t.co/BJZZ63W1u0
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Atypical Geri presentation of Acute Abdomen: 1. Confusion, lethargy or agitation 2. Tachypnea 3. Urinary urgency 4. Constipation 5. Poor appetite Often vague or 🚫abdominal pain Often 🚫fever or🚫tachycardia https://t.co/G8qg2D7l4n
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Atypical complaints of AMI in geri pts: 1. DYSPNEA 2. Confusion 3. Weakness 4. Indigestion 5. Most don't have crushing CP due to ⬇️ pain receptors https://t.co/euk4xBr86W
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Evaluation of a geri fall pt should include: PE: Head to Toe Diag: ECG, CBC, BMP, measurable med levels, and appropriate imaging. If the pt is anticoagulated have a very low threshold for head CT. Dispo: "Get up and go" https://t.co/ImFmxLitcV
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Common drugs associated w/ falls in geri pts: 1. Benzos (⬇️alertness and ⬇️reaction time) 2. Hypo-glycemics (⬇️ BG, ⬆️weakness) 3. anti-hypertensives (impaired cardiac filling, impair chronotropic response) 4. alcohol (cerebellar function, judgement) https://t.co/I1I0NAw0m9
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High risk meds for geri patients w/ Low-benefit 1. Benzos: agitation is more likely untreated pain or delirium NOT anxiety 2. Codeine: weak analgesic w/ strong SE 3. NSAIDS: impact renal function, gastric SE 4. Anti-cholinergic meds: can induce delirium https://t.co/IfgkAgtr9F
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Trauma: ALL geri trauma patients should be placed on supplemental oxygen. RSI meds: Avoid ketamine, Versed and Fentanyl dosing should be reduced 20-40% based on reduced hepatic clearance. Normal BP can indicate severe hypotension in an geri pt w/ HTN. https://t.co/QxYEcIrLmt
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A thread on geriatrics pearls based on geriatric competencies and ACEP 2013 ED guidelines. I've included the citations in tinyurl for more information.
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Consider AKI in pt w/ recent cannabis use presenting with abd or flank pain and/or n/v. UA, BMP, +/- CPK if you suspect rhabdomyolysis. #FoaM4Cook @CookCountyEM
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This has a lot of utility for healthcare providers who would like to document findings. This is version 1.0 and I would appreciate comments and suggestions for the next version. Apple version coming soon! (I need to get an iphone).
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