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

Not addicted to Twitter yet? Not a problem. Here are five recent tweets that’ll give you a sense of what is going on in the emergency medicine Twitterverse.

1. The emergency medicine Twitterverse has an egalitarian feel, and people from all levels of training and experience frequently make valuable contributions and interact as a community. When a big name joins the conversation, it brews real excitement. So, when Indiana University pulmonary embolism guru Jeffrey Kline, MD, began tweeting in February, his presence was immediately noticed and appreciated. Dr. Kline has only tweeted a few dozen times, but each tweet has packed a punch. “Causes of a false negative #D-dimer: symptoms greater than 72h, distal clots, lipemia with turbidimetric assays and blocking proteins” and “Clinician gestalt is as good as a validated computerized method for estimating PE probability; not so for ACS. Ann Emerg Med 2014 63:275-80” are just two representative tweets from this evidence-based medicine luminary. Welcome to Twitter, Dr. Kline (@KlineLab).

2. Leon Gussow, MD (@poisonreview), a professor at the University of Illinois, frequently tweets links to his blog, which zeroes in on relevant and topical toxicology cases that have appeared in peer-reviewed journals. He reviews these papers with expertise that few can rival. His recent post, “Central pontine myelinolysis associated with ethylene glycol intoxication http://ow.ly/2EpoL6,” is a review of an article from the Journal of Emergency Medicine. One great pearl from Dr. Gussow’s review: osmotic demyelination syndrome (the new proposed name for central pontine myelinolysis) resulting from hyperosmolar insults such as ethylene glycol and other toxic alcohols has similar neurological sequelae as some of the other more “classic” causes. However, in some of the toxin-related cases, there are reports of possible associations with better outcomes, which may be helpful in keeping some hope alive for favorable prognoses in such challenging cases.

3. A relatively new FOAM resource is REBEL EM by Salim Rezaie, MD, FACEP (@srrezaie), assistant program director and clinical assistant professor of emergency medicine and internal medicine at the University of Texas Health Science Center at San Antonio. Dr. Rezaie’s site is a growing resource for EM board review and other general EM topics. Sal also wins the award for best new acronym with his eponymous Rezaie’s Evidence Based Evaluation of Literature in Emergency Medicine (REBEL EM); well played, sir. His Twitter feed has quickly become a staple and is part of the reason Dr. Rezaie will be appearing on an upcoming episode of Mel Herbert’s EM:RAP. This tweet actually comes from fellow EBM junkie and FOAMite, Ken Milne, MD (@theSGEM), and it links to a splendid article on Dr. Rezaie’s site cowritten by some bright minds in EM, each of whom suggested articles that were “Game Changers in EM”. The article contains four short but remarkably in-depth and thoughtful reviews of four major articles of the past decade: the ADAPT trial on discharging patients with low-risk chest pain; Perry et al. on the sensitivity of CT for subarachnoid hemorrhage within six hours of headache onset; the 2012 Cochrane review on antiemetics for pediatric acute gastroenteritis; and the recent and landmark addition to therapeutic hypothermia literature, Nielson’s study comparing 33°C versus 36°C as target temperatures for post-cardiac arrest care. It’s always nice to have a slew of great papers discussed at such a high level in one easy-to-read article.

4. Flight paramedic (and pre-med!) Derek Sifford’s (@flightmed1) post “BMJ: Statistics at square 1. So far, the most comprehensive free stats tutorial/review I have found! http://bit.ly/1ohGBUC #FOAMed #EBMed” is a real find. Whether you need a review on the difference between populations and samples or you want to know just what exactly the t-test, chi squared, or an exact probability test is, you’ll find the explanations and simplified equations in this one free resource. On a side note, admissions directors shouldn’t need a personal statement from Mr. Sifford: just read his Twitter feed!

5. Finally, “Epitaph for nitric oxide for ARDS (Crit Care Med) http://goo.gl/fb/aoQHc – vive la #FOAMed” is a post from the anonymous account @EgertonYDavisIV (although this homage account to the fictitious alter ego of the legendary Dr. William Osler seems to be associated with the Life in the Fastlane blog, the standard bearer for EM blogs Down Under and the world over). The tweet links to a great article in the PulmCCM.org blog, created by Matthew Hoffman, MD. The author analyzes a new review in the journal Critical Care Medicine, “Inhaled nitric oxide does not reduce mortality in patients with acute respiratory distress syndrome regardless of severity: systematic review and meta-analysis.” The meta-analysis aggregates data from 1,142 patients with acute respiratory distress syndrome (ARDS) and comes to some harrowing conclusions. Just as devastating as the authors’ conclusion that nitric oxide has no mortality benefit for patients with ARDS regardless of how poorly the patients’ lungs were performing at the time of administration is the association between nitric oxide and the development of renal impairment. Taken together with the cost and hassle of nitric oxide administration, this article (and its recirculation in the FOAM world) may finally put this well-intentioned, but apparently futile, modality to rest.

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.