#FOAMEd

[teachingrounds]

As of March 20, 2025...

...there are 378 known case of #measles, 64 hospitalizations, and 2 deaths form this #vaccinepreventabledisease. These are the latest numbers in the #measlesoutbreak from the CDC.

[taimoorkhan]

Myocarditis in Emergency Practice

Myocarditis, an inflammatory condition affecting the heart's myocardial tissues, is a significant cause of sudden cardiac death and dilated cardiomyopathy. With diverse etiologies ranging from viral and immune-mediated causes to toxic exposures, diagnosing and managing myocarditis can be challenging. In this blog post, we will explore the important points regarding the etiology, pathophysiology, presentation, diagnostic testing, and treatment options for myocarditis, with a focus on the perspective of emergency physicians.

Myocarditis can be caused by infectious agents (bacterial, parasitic, viral), immune-mediated conditions, and toxic exposures. Viral causes include enteroviruses, influenza, hepatitis viruses, HIV, herpes viruses, and Parvo B-19. Immune-mediated causes include systemic lupus erythematosus (SLE), scleroderma, and giant cell types. Toxic agents such as doxorubicin, antiretroviral medications, clozapine, and cocaine can also trigger myocarditis.

Myocarditis follows a three-step process. In the acute phase, infectious, autoimmune, or toxic agents directly damage cardiac myocytes. Subsequent myocyte destruction triggers immune system activation and secondary inflammation. In the later stages, the immune system mistakenly attacks the myocytes themselves, leading to progressive myocardial damage.

Myocarditis presents with a wide range of symptoms, necessitating a high index of suspicion for timely diagnosis. Symptoms may include dyspnea, palpitations, orthopnea, and chest pain. Dyspnea is the most common presenting symptom, while chest pain can vary from pleuritic to anginal. Patients may exhibit symptoms of congestive heart failure, ranging from fatigue and peripheral edema to cardiovascular collapse. Skin manifestations can be present in cases triggered by medication exposure.

Diagnostic testing for myocarditis overlaps with other cardiopulmonary evaluations. Electrocardiogram (ECG) abnormalities, such as sinus tachycardia, ST-segment elevations, T-wave inversions, AV blocks, widened QRS durations, or prolonged QT intervals, may be observed. Troponin assays may be elevated, but their absence does not rule out myocarditis. Additional blood tests, including CBC, CRP, and ESR, are often abnormal but nonspecific. Imaging studies like chest radiography and echocardiography can provide valuable information.

TThe treatment of myocarditis primarily focuses on supportive care to prevent further damage to the heart. Stabilizing the patient's ABCs (airway, breathing, circulation) is the priority. Supplemental oxygen and non-invasive positive pressure ventilation may be required for hypoxia or pulmonary edema. Heart failure therapy, including diuretics and nitroglycerin, can be administered if systemic perfusion allows. Cardiac dysrhythmias may necessitate treatment with antidysrhythmic medications. Antimicrobial therapy is required for cases associated with bacterial or parasitic infections. In severe cases, advanced interventions such as intra-aortic balloon pumps, extracorporeal membrane oxygenation (ECMO), or ventricular assist devices (VADs) may be necessary.

Myocarditis presents a complex diagnostic and management challenge for emergency physicians. The diverse etiologies, varied clinical presentations, and overlapping diagnostic tests make timely diagnosis crucial. Supportive care, stabilization, and targeted interventions are key elements of treatment. While further research is needed to refine diagnostic and therapeutic approaches, understanding the etiology, pathophysiology, presentation, and treatment options can aid emergency physicians in effectively managing myocarditis cases.

[kaapstadmk]

Yep.

Friendly reminder that college textbooks are a racket. New "revisions" are published every other year for the books used in common/popular classes, or in classes for degrees with "high earning potential" (i.e. you'll be able to pay it off later, one day). And yet, these revisions are small things - rearranging graphic locations, end-chapter questions, etc. Not significant information changes.

And yet, low traffic classes will have old, out of date textbooks that are missing new information (s/o to my paleontology elective! 12 year old textbook, which was prior to the discovery of tiktaalik, a crucial intermediary fossil)

You can get them used at places like ABE Books, or, even better, you can find e-copies of them on Library of Genesis and, if it's still functioning, z-library. You can often check them out from Internet Archive as well

Additionally, there are many sites hosting open-access textbooks that are designed to be free and disseminated (I don't have those links on hand. It's been a while). FOAMed is an access and equity need, of which podcasts are a crucial part.

Lastly, can't find the journal article you need? Articles stuck behind a paywall? Don't forget about your friend Sci-hub!

(Remember, journal article authors and peer reviewers aren't paid. Sometimes they pay to publish. The only one getting any profit is the publisher, and publishers often sell journal bundles the same way cable sells channels - a few choice journals and a whole lot of junk ones to "justify" charging exorbitant fees to academic institutions, based on number of journals subscribed)

Something about the way bibliopunk/punk academia is treated on here Bugs Me and I think it can be best summed up as this:

You can't just throw the "punk" descriptor onto whatever you like and call it an aesthetic

Punk is not an aesthetic

Punk is a mindset, it's a philosophy-- it's a rebellion against societal systems

When I say bibliopunk, I don't mean sweater vests and old library photos and quotes from classics.

Bibliopunk, to me, a punk librarian, is about freedom of information. It's about making sure everyone and anyone can have the resources they need to learn, whatever that means for them. It's no late fees and fighting against censorship. It's defunding the police and funding community resource centers that specialize in making sure there's a place where people can go to ask for help, to read books on any subject they can think of, to connect with events and organizations that exist to help THEM. It's about making zines and learning how to bookbind, because fuck the idea that traditional publishing and Amazon are the only people that can make something a book.

Punk academia, which is used colloquially here, is related to this-- it's saying fuck the academic systems that keep out the poor, the people of color, and the disabled. Fuck your Ivy Leagues, education is whatever the hell you make it. College should be free, classes should be accessible WITHOUT being forced to give up all of your personal financial and health information, curriculums need to include as many varying perspectives as they can because fuck the idea that a cishet abled white man is the authority on any given topic.

Bibliopunk, punk academia, and any other Tumblr "aesthetic" with the punk descriptor is not just a moodboard of photos you stole from Pinterest.

Because what's more punk than a public library?

[stemlyns]

Can salbutamol relieve pain in renal colic? We review a phase II randomised controlled trial exploring intravenous salbutamol as an adjunct analgesic in the emergency department.

[flicklikesstuff]

What.?

(Edit: We got her folks! One more to go!!)

[rockspider556]

why do ppl do drugs when you can just experience the absolute high of meeting someone who isn’t just unhinged about your fandom but is also feral about your otps

[aetheristical]

this took me 2 hrs lol

[teachingrounds]

DID YOU KNOW...?

Measles was officially eliminated from the United States in 2000, meaning new cases only occur when someone contracts measles abroad and returns to the country. Achieving measles elimination status in the United States was a historic public health achievement that has been overshadowed by decreasing vaccination rates over the same time span. Two unvaccinated adults brought measles to Texas in January 2025, and the virus has been spreading through travel and un- or under-vaccinated communities since then.

[hexcrispy]

he broke off the gay situationship and then proceeded to grow out AND dye his hair

NOW THIS is a homosexual if i’ve ever seen one

[yenshui]

another take of this meme but with tht one foaming guy & aang

[stemlyns]

Review the top trauma and resuscitation trials discussed at ICEM 2025. Expert summaries and critical appraisals from St Emlyn’s cover transfusion strategies, airway management, oxygenation, fibrinogen, and more.

[floweroflaurelin]

The Gambler’s Prayer

—

Please tell me you’ve all seen the reel Jimmy posted… 👀🐤🙏

[i-am-a-fish]

I LOVE FOAMING HAND SOAP!!!!!!

[skelewife]

i don't know if tumblr has seen this yet but this is honest to god my favorite video

[teachingrounds]

This week we're talking about the impact on human health of mutations in two tumor supressor genes: BRCA 1 and 2.

The BRCA 1 gene on the long arm of chromosome 17 encodes breast cancer type 1 susceptibility protein; the BRCA2 gene on the long arm of chromosome 13 makes BRCA2 protein. These proteins combine with PALB2 (partner and localizer of BRCA2) or with other molecules to make the BRCA1-associated genome surveillance complex (BASC) to survey and repair damaged DNA. Everyone inherits two copies of each BRCA gene, but if they inherit two mutations, or if they inherit one and over their lifetime the other also becomes nonfunctional, then the person is susceptible to multiple cancer syndromes.

BRCA1 was discovered at University of California, Berkeley, in 1990, and BRCA2 was discovered at The Institute of Cancer Research, London, in 1994, but both were first sequenced by the University of Utah and Myriad Genetics in 1994 and 1996, respectively.