Catch up on some of emergency medicine’s best tweets and learn to pack a punch into 140 characters

A Twitter feed is like a sushi-boat restaurant: many options float by, and you take the ones you like, leaving the others for someone else to enjoy. The analogy continues. Sometimes there is more than meets the eye. Only when you delve in can you appreciate the whole experience. Perhaps most important, when enjoying the content, you have to trust the chef.

In this column, I’ll share some recent high-impact tweets, along with some commentary, to give you a sense of the depth that can be packed into 140 characters. Many links below are Free Open Access Medical Education (FOAM), while certain articles may be behind paywalls or accessible through your employer accounts.

1. Amie Hsia, MD (@DCStrokeDoc), neurologist and medical director of the stroke center at MedStar Washington Hospital Center in Washington, DC, tweeted: “@emlitofnote hit the mark in @JAMA_current with citing our averted #stroke paper: #tPA-treated does not equal #stroke http://bit.ly/16GitWt” There’s a lot to unpack here. In this tweet, Dr. Hsia agrees with a letter published in JAMA written by Ryan Radecki, MD (@emlitofnote), creator of the Emergency Medicine Literature of Note blog, and she provides the link. In his letter, Dr. Radecki points out that stroke mimics, such as transient ischemic attacks, would have, by definition, resolved without intervention. Patients treated “most expeditiously would be afforded the least opportunity to manifest clinical improvement.” Therefore, we can’t know which of the patients in the study had TIAs rather than true strokes, with TIAs likely being overrepresented in the cohort. Further, those who received thrombolytics (tPA) and subsequently had profound resolution of symptoms probably were not having strokes at all, as complete resolution of symptoms following tPA is rare, a point made in a paper by Dr. Hsia’s research group also referenced and linked in the JAMA letter. Dr. Hsia’s tweet demonstrates the power of virality of medical information on Twitter. While she has just 80 followers, this particular tweet was re-tweeted to more than 3,000 people. She also demonstrated good use of hashtags. Including #stroke and #tPA helped identify these tweets to anyone looking on Twitter for information on these topics.

2. University of Wisconsin emergency physician and chief flight physician Mike Abernathy, MD (@FLTDOC1), tweeted this beauty: “…I really like this! ‘Shock Index(SI) = HR/SBP If SI >0.9 Trauma pt at high risk for massive transfusion http://www.ncbi.nlm.nih.gov/pubmed/21307738.” This is a great example of using Twitter to reduce the window between research knowledge and clinical application. Sure, the Shock Index (SI) has been discussed in the literature since a landmark paper in Resuscitation in 1992, but how many emergency physicians actually use it? The tweet links to a newer paper (Vandromme et al. 2011 in the Journal of Trauma) detailing a new way that the SI can be applied: to identify normotensive patients at risk of requiring massive transfusion. Applying this knowledge might give a trauma team a head start, saving precious seconds and minutes. Additionally, the website and app MDCalc (http://www.mdcalc.com) by Graham Walker, MD (@MDCalc), does the SI math for you and alerts you to the meaning of the number you calculate.

3. Kiwi-turned–Salt Lake City emergency physician Rob Bryant, MD (@RobJBryant13), tweeted: “TXA vial is tough to open & ironically sharp. If you cut yourself, pour a little on the lac, you’ll be fine pic.twitter.com/ExiGDAnpML.” The picture shows a small glass vial of tranexamic acid with a sharp edge after being broken off by hand. While the data for tranexamic acid for significant bleeding may still be a work in progress (the CRASH-3 trial is currently under way), a recent Annals of Emergency Medicine paper (Zahed et al. September 2013) suggests good outcomes for a usually less severe but certainly common emergency-department problem: epistaxis.

4. Emergency-medicine resident Lauren Westafer, DO (@LWestafer), tweeted: “AAEM practice guideline supports droperidol. Hip hip hooray! http://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf … (updated black box summary http://shortcoatsinem.blogspot.com/2012/12/not-black-boxed-droperidol-as-anti.html …)” The newly published American Academy of Emergency Medicine’s policy states that the black-box warning on droperidol is unwarranted for doses under 2.5mg IV or IM and that electrocardiograms for such doses are unnecessary for the evaluation of QT interval. The guideline also states that IM doses of up to 10 mg are as safe and effective as the other medications in common use. Dr. Westafer’s own summary on her blog, Short Coats in EM (http://shortcoatsinem.blogspot.com/), which she started as a medical student, has a great slide deck on the topic, as well.

5. The University of Nevada School of Medicine Department of Emergency Medicine’s website and Twitter account (@LasVegasEM) has been putting out great stuff lately. This post takes a welcome shot at backboards and cervical collars: “Check out a new post in our FOAM blog. Dogma in EMS: Spinal Immobilization. What are your thoughts?? http://www.lasvegasemr.com/foam-blog.html #FOAMed” High-impact point: not only do backboards and c-collars provide no benefit, there may even be harm associated with their use, including respiratory compromise and difficulty with airway management. Other than for ease of transport, backboards should probably be banned!

Jeremy Samuel Faust MD, MS, MA, is an emergency medicine resident at Mount Sinai Hospital in New York and Elmhurst Hospital Center in Queens. He tweets about #FOAMed and classical music @jeremyfaust.