This morning, I'll be giving a talk at #ACEP26 called:

Dr. Milne & the Terrible, Horrible, No Good, Very Bad ER Shift

Think of it as a season of The Pitt set in a rural critical access hospital. @dennisrenmd.bsky.social

Zlatan Coralic suggest in sepsis give the Zosyn first, graham negative bugs have a higher mortality so more important even though infusion.

But better to give Vanc at same time (it’s ok).

#ACEP26
#FOAMed

But we will rebuild it.

We have the technology.

With dudes showing off intubating in pubs.

With cringe niche conferences that are fun.

With telling people everything they know is wrong. And that that is wrong.

And with Simpsons references just for Seth and I.

#foamed #acep26

Yikes, just stuck my head in the bad place. Pretty much the only tweets from the conference are group/organizations/vendors. Almost none from individuals. Who is gonna engage if there isn’t a community? Social media EM was based on #FOAMed, not advertising.

How the mighty have fallen.

#acep26

Note to all #emergencymedicine conferences: you must have sleepy puppies from now on.

@acepnation.bsky.social
@ohioacep.bsky.social @naemsp.bsky.social

#acep26 #emsky

Thank you to all those who attended my Clinical Pearls talk today at #ACEP26

You can download my slides here.
thesgem.com/wp-content/u... #MedSky

Tomorrow (Tuesday)! At the podcast recording booth at #ACEP26 – we'll be there 10-11am, so come by say "hello" afterwards!

You know you’re back in America when you’re riding sad and frail rail public transit. 😜
#ACEP26

higher LOS, resource use by NPs may outweigh the (salary) cost savings, lots of limitations and intra-group variation

@thesgem.bsky.social at #ACEP26

some limitations but overall this SRMA shows peripheral pressors are probably pretty safe

@jamanetworkopen.com jamanetwork.com/journals/jam...

@thesgem.bsky.social at #ACEP26

another small RCT showing IM ketorolac is no more effective than oral ibuprofen

@thesgem.bsky.social at #ACEP26

(I think for that back of the envelope NNH calculation you should subtract the placebo 13.7% from the 19.8%, so 1/6.1% =16.393)

@thesgem.bsky.social at #ACEP26

more RCT (preprint) data showing tamiflu doesn’t help for sicker (eg oxygen, pressors, intubated) hospitalized patients (0, 5 or 10d) with flu

@thesgem.bsky.social at #ACEP26

900k ED visits/y for asymptomatic elevated BP
0.7% adverse outcomes after DC

which is not long term hypertension – may be reasonable to start BP meds

this obs study showed 1 mo supply assoc w slightly better 30d CV outcomes

@thesgem.bsky.social at #acep26

comprehensive review of c-collars in trauma- surprise!- no definitive evidence of benefit, + evidence of harm

@thesgem.bsky.social at #ACEP26

violent words, threats, and actions against ER health acre workers are both common and underreported

lots of intoxication

this study was among agitated patients so the numbers aren’t representative bit having observers record violence = shows underreporting

@thesgem.bsky.social at #acep26

2026 lit review:

SRMA of 4 RCTs:

no improved functional outcomes for tpa/TNK in minor strokes, 5x higher risk of symptomatic ICH (still low but risk >> 0 benefit

@thesgem.bsky.social at #acep26

2026 lit review:

no, prenatal APAP is not linked to autism — the big study that includes a sibling analysis make the potential association go away

@thesgem.bsky.social at #acep26

2026 lit review:

SRMA: all the usual things except bicarb seem to help in hyperK

no, prenatal APAP is not linked to autism

@thesgem.bsky.social at #acep26

Ok, puppy area was the best part of the conference so far.

#acep26