Aimee Mishler, PharmD, BCEMP, FAWM
@empharm.bsky.social
Emergency Medicine l Trauma l Wilderness Medicine | Climate Health & Sustainability
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
"The risk of myocarditis after COVID-19 infection is approximately 42 times higher than the risk after COVID-19 vaccination"
Of course, COVID's harms are not limited to myocarditis
Of course, COVID's harms are not limited to myocarditis
October 28, 2025 at 3:50 PM
"The risk of myocarditis after COVID-19 infection is approximately 42 times higher than the risk after COVID-19 vaccination"
Of course, COVID's harms are not limited to myocarditis
Of course, COVID's harms are not limited to myocarditis
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
🚨 JUST PUBLISHED 🚨
⚠️ The 2025 @lancetcountdown.bsky.social report reveals climate change inaction is costing lives and livelihoods, and harming the economy.
❤️🩹 Protecting people’s health demands all hands on deck.
Read more: www.lancetcountdown.org/2025-report/ #LancetClimate25
⚠️ The 2025 @lancetcountdown.bsky.social report reveals climate change inaction is costing lives and livelihoods, and harming the economy.
❤️🩹 Protecting people’s health demands all hands on deck.
Read more: www.lancetcountdown.org/2025-report/ #LancetClimate25
October 29, 2025 at 12:23 AM
🚨 JUST PUBLISHED 🚨
⚠️ The 2025 @lancetcountdown.bsky.social report reveals climate change inaction is costing lives and livelihoods, and harming the economy.
❤️🩹 Protecting people’s health demands all hands on deck.
Read more: www.lancetcountdown.org/2025-report/ #LancetClimate25
⚠️ The 2025 @lancetcountdown.bsky.social report reveals climate change inaction is costing lives and livelihoods, and harming the economy.
❤️🩹 Protecting people’s health demands all hands on deck.
Read more: www.lancetcountdown.org/2025-report/ #LancetClimate25
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
emcrit.org/pulmcrit/202... #EMIMCC Some @pulmcrit.bsky.social 's highlights about aha vs erc cardiac arrest guidelines #Emcritters
PulmCrit - 2025 AHA & ESICM guidelines on post-arrest care
The ESICM and AHA both just released new guidelines on post-arrest care. It's always interesting when two professionals produce "evidence-based"
emcrit.org
October 27, 2025 at 9:00 PM
emcrit.org/pulmcrit/202... #EMIMCC Some @pulmcrit.bsky.social 's highlights about aha vs erc cardiac arrest guidelines #Emcritters
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
hi, medical toxicologist that knows a lot about Tylenol here👋 Claiming that tylenol use in pregnancy causes autism is fearmongering
here's what you need to know 🧵
here's what you need to know 🧵
September 22, 2025 at 3:09 PM
hi, medical toxicologist that knows a lot about Tylenol here👋 Claiming that tylenol use in pregnancy causes autism is fearmongering
here's what you need to know 🧵
here's what you need to know 🧵
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
proposal:
all types of bradykinin-mediated angioedema involve a common vicious spiral 👇
tranexamic acid or aminocaproic acid should be universally effective in blocking this cycle & aborting attacks
there's no need for super-expensive drugs (icatibant et al.)
thoughts? criticism? #EMIMCC
all types of bradykinin-mediated angioedema involve a common vicious spiral 👇
tranexamic acid or aminocaproic acid should be universally effective in blocking this cycle & aborting attacks
there's no need for super-expensive drugs (icatibant et al.)
thoughts? criticism? #EMIMCC
September 22, 2025 at 4:35 PM
proposal:
all types of bradykinin-mediated angioedema involve a common vicious spiral 👇
tranexamic acid or aminocaproic acid should be universally effective in blocking this cycle & aborting attacks
there's no need for super-expensive drugs (icatibant et al.)
thoughts? criticism? #EMIMCC
all types of bradykinin-mediated angioedema involve a common vicious spiral 👇
tranexamic acid or aminocaproic acid should be universally effective in blocking this cycle & aborting attacks
there's no need for super-expensive drugs (icatibant et al.)
thoughts? criticism? #EMIMCC
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Don't forget to submit your didactic session to present at SAEM26 Annual Conference! Deadline is 10/2/25! buff.ly/nwLK5Mo
#SAEM #AEMP #AEMPlify #EMRx
#SAEM #AEMP #AEMPlify #EMRx
September 22, 2025 at 12:00 PM
Don't forget to submit your didactic session to present at SAEM26 Annual Conference! Deadline is 10/2/25! buff.ly/nwLK5Mo
#SAEM #AEMP #AEMPlify #EMRx
#SAEM #AEMP #AEMPlify #EMRx
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
🚨 New Post Alert!
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
September 18, 2025 at 1:00 AM
🚨 New Post Alert!
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
cosign this 😁
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
Time to Ditch Andexanet Alfa?
-ANNEXA-1: No mortality benefit, incr VTE
-Real world data: Rech 2025 (PMID:40700941) no improved outcomes, 9% incr VTE w/ andexanet alfa (NNH = 11)
Mounting evidence that andexanet offers no benefit while increasing complications
youtube.com/shorts/7DGcv...
#EMIMCC
-ANNEXA-1: No mortality benefit, incr VTE
-Real world data: Rech 2025 (PMID:40700941) no improved outcomes, 9% incr VTE w/ andexanet alfa (NNH = 11)
Mounting evidence that andexanet offers no benefit while increasing complications
youtube.com/shorts/7DGcv...
#EMIMCC
Andexanet Alfa + Thrombembolism #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
September 17, 2025 at 2:11 PM
cosign this 😁
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
The submission portal for SAEM Congress is now open. Submit your didactic session proposal today! #SAEMonline #AEMPlify
August 21, 2025 at 11:01 AM
The submission portal for SAEM Congress is now open. Submit your didactic session proposal today! #SAEMonline #AEMPlify
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
🚨 New Post Alert!
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
August 25, 2025 at 1:05 PM
🚨 New Post Alert!
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
Syncope is common in the ED—but which decision rule do you trust?
⚡ San Francisco Syncope Rule = fast but fallible
🧩 Canadian Syncope Risk Score = comprehensive but complex
🩺 Neither replaces clinical judgment
👉 Read here: https://wp.me/pdrP8b-5pF
#FOAMed #EMIMCC #MedSky
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
💉National Immunization Awareness Month!💉
Together, we can help raise awareness about the importance of vaccination. Many patients express interest in receiving vaccines when they are offered in the ER, creating a valuable opportunity for engagement with EM pharmacists!
Together, we can help raise awareness about the importance of vaccination. Many patients express interest in receiving vaccines when they are offered in the ER, creating a valuable opportunity for engagement with EM pharmacists!
SAEM August theme
National Immunization Awareness Month
buff.ly
August 24, 2025 at 3:02 PM
💉National Immunization Awareness Month!💉
Together, we can help raise awareness about the importance of vaccination. Many patients express interest in receiving vaccines when they are offered in the ER, creating a valuable opportunity for engagement with EM pharmacists!
Together, we can help raise awareness about the importance of vaccination. Many patients express interest in receiving vaccines when they are offered in the ER, creating a valuable opportunity for engagement with EM pharmacists!
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
📣Have you heard of antiamyloid therapies for Alzheimer’s disease? They cause ADEs called ARIAs that are non-specific, typically require MRI, & can mimic stroke
⛔ Concomitant thrombolytics/anticoagulants are contraindicated
Learn more in our JAMA IM Clinical Insight 👇
⛔ Concomitant thrombolytics/anticoagulants are contraindicated
Learn more in our JAMA IM Clinical Insight 👇
Antiamyloid therapies for #Alzheimer disease slow cognitive decline but pose serious adverse effects like amyloid-related imaging abnormalities.
ja.ma/3V32mjt
ja.ma/3V32mjt
August 18, 2025 at 8:34 PM
📣Have you heard of antiamyloid therapies for Alzheimer’s disease? They cause ADEs called ARIAs that are non-specific, typically require MRI, & can mimic stroke
⛔ Concomitant thrombolytics/anticoagulants are contraindicated
Learn more in our JAMA IM Clinical Insight 👇
⛔ Concomitant thrombolytics/anticoagulants are contraindicated
Learn more in our JAMA IM Clinical Insight 👇
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Burman et al: Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Link: link.springer.com/ar...
@neurocritical #neurocritcare
July 28, 2025 at 12:00 PM
Burman et al: Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Myth busting: Antibiotics don't reduce mortality in variceal hemorrhage!
I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va...
We probably don't need antibiotics at all🤦♂️
Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC
I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va...
We probably don't need antibiotics at all🤦♂️
Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC
August 11, 2025 at 7:29 PM
Myth busting: Antibiotics don't reduce mortality in variceal hemorrhage!
I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va...
We probably don't need antibiotics at all🤦♂️
Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC
I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va...
We probably don't need antibiotics at all🤦♂️
Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Donate to the SAEMF Challenge to give back to EM! Not only will your donation help advance EM practices and research, but it'll HELP AEMP MOVE UP THE LEADERBOARD in this SAEM competition! See link for more details or scan QR code to go to the donations page buff.ly/qvUCT8C
buff.ly/masr25D
buff.ly/masr25D
August 12, 2025 at 12:23 AM
Donate to the SAEMF Challenge to give back to EM! Not only will your donation help advance EM practices and research, but it'll HELP AEMP MOVE UP THE LEADERBOARD in this SAEM competition! See link for more details or scan QR code to go to the donations page buff.ly/qvUCT8C
buff.ly/masr25D
buff.ly/masr25D
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
🚨 NEW POST: MDCalc Wars 🛑💥
Are you using PERC and Wells correctly?
✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!
👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky
Are you using PERC and Wells correctly?
✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!
👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky
August 6, 2025 at 1:06 PM
🚨 NEW POST: MDCalc Wars 🛑💥
Are you using PERC and Wells correctly?
✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!
👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky
Are you using PERC and Wells correctly?
✅ Start with Wells to guide next steps
🚫 Don’t use PERC in moderate/high-risk
🧪 Use high-sensitivity D-dimer!
👉 Read now: https://wp.me/pdrP8b-5oN
#FOAMed #EMIMCC #MEDSky
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Gain insight into best practices for retaining highly skilled pharmacists in the ICU and the importance of reducing burnout in pharmacy teams in the latest SCCM Podcast. Listen now: sccm.org/pod544
#SCCM
#SCCM
August 6, 2025 at 5:01 PM
Gain insight into best practices for retaining highly skilled pharmacists in the ICU and the importance of reducing burnout in pharmacy teams in the latest SCCM Podcast. Listen now: sccm.org/pod544
#SCCM
#SCCM
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Welcome to AEMP's Pulse Dose! Weekly pharmacy pearls to upgrade your EM practice!
This week's topic: Local anesthetic systemic toxicity, or "LAST". Don't be the LAST to know!
#AEMP #SAEM #AEMPPulseDose #RxPearls #LAST
This week's topic: Local anesthetic systemic toxicity, or "LAST". Don't be the LAST to know!
#AEMP #SAEM #AEMPPulseDose #RxPearls #LAST
July 24, 2025 at 1:04 PM
Welcome to AEMP's Pulse Dose! Weekly pharmacy pearls to upgrade your EM practice!
This week's topic: Local anesthetic systemic toxicity, or "LAST". Don't be the LAST to know!
#AEMP #SAEM #AEMPPulseDose #RxPearls #LAST
This week's topic: Local anesthetic systemic toxicity, or "LAST". Don't be the LAST to know!
#AEMP #SAEM #AEMPPulseDose #RxPearls #LAST
📣 Hot off the press!
MTP review and update for the pharmacist!
#rxsky
#pharmsky
pubmed.ncbi.nlm.nih.gov/40580496/
MTP review and update for the pharmacist!
#rxsky
#pharmsky
pubmed.ncbi.nlm.nih.gov/40580496/
July 30, 2025 at 2:23 PM
📣 Hot off the press!
MTP review and update for the pharmacist!
#rxsky
#pharmsky
pubmed.ncbi.nlm.nih.gov/40580496/
MTP review and update for the pharmacist!
#rxsky
#pharmsky
pubmed.ncbi.nlm.nih.gov/40580496/
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
In patients with undifferentiated shock, always get a Rapid US for Shock + Hypotension (RUSH exam) to differentiate etiologies
Avoid diagnostic closure, particularly when the answer appears simple
youtube.com/shorts/MUptk...
#EMIMCC
Avoid diagnostic closure, particularly when the answer appears simple
youtube.com/shorts/MUptk...
#EMIMCC
RUSH Exam + Tamponade #emergencymedicine #criticalcare #resuscitation
YouTube video by EMSwami
youtube.com
June 5, 2025 at 1:32 PM
In patients with undifferentiated shock, always get a Rapid US for Shock + Hypotension (RUSH exam) to differentiate etiologies
Avoid diagnostic closure, particularly when the answer appears simple
youtube.com/shorts/MUptk...
#EMIMCC
Avoid diagnostic closure, particularly when the answer appears simple
youtube.com/shorts/MUptk...
#EMIMCC
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Ketamine in status epilepticus?
PMID:39674935 ketamine > no drug after midaz failed(flawed study)
PMID:40186980 midaz/ket > midaz. But, kids seized 34 min prior to meds, very low rate of sz break w/ midaz
Consider ketamine after 2 doses BZD fail but evidence weak
youtube.com/shorts/arX6s...
#EMIMCC
PMID:39674935 ketamine > no drug after midaz failed(flawed study)
PMID:40186980 midaz/ket > midaz. But, kids seized 34 min prior to meds, very low rate of sz break w/ midaz
Consider ketamine after 2 doses BZD fail but evidence weak
youtube.com/shorts/arX6s...
#EMIMCC
Ketamine in Status Epilepticus #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
June 13, 2025 at 1:39 PM
Ketamine in status epilepticus?
PMID:39674935 ketamine > no drug after midaz failed(flawed study)
PMID:40186980 midaz/ket > midaz. But, kids seized 34 min prior to meds, very low rate of sz break w/ midaz
Consider ketamine after 2 doses BZD fail but evidence weak
youtube.com/shorts/arX6s...
#EMIMCC
PMID:39674935 ketamine > no drug after midaz failed(flawed study)
PMID:40186980 midaz/ket > midaz. But, kids seized 34 min prior to meds, very low rate of sz break w/ midaz
Consider ketamine after 2 doses BZD fail but evidence weak
youtube.com/shorts/arX6s...
#EMIMCC
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Hypokalemia big killer in DKA
-All DKA patients total body K down
-Some w/ serum hyperK due to acidosis shifting K
-K < 3.5: replete prior insulin
-K 3.5-5.5: start insulin + K repletion simultaneously
-Skip bolus: no faster DKA resolution but incr risk hypoK
youtube.com/shorts/pTnt8...
#EMIMCC
-All DKA patients total body K down
-Some w/ serum hyperK due to acidosis shifting K
-K < 3.5: replete prior insulin
-K 3.5-5.5: start insulin + K repletion simultaneously
-Skip bolus: no faster DKA resolution but incr risk hypoK
youtube.com/shorts/pTnt8...
#EMIMCC
Hypokalemia in DKA #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
June 25, 2025 at 4:09 PM
Hypokalemia big killer in DKA
-All DKA patients total body K down
-Some w/ serum hyperK due to acidosis shifting K
-K < 3.5: replete prior insulin
-K 3.5-5.5: start insulin + K repletion simultaneously
-Skip bolus: no faster DKA resolution but incr risk hypoK
youtube.com/shorts/pTnt8...
#EMIMCC
-All DKA patients total body K down
-Some w/ serum hyperK due to acidosis shifting K
-K < 3.5: replete prior insulin
-K 3.5-5.5: start insulin + K repletion simultaneously
-Skip bolus: no faster DKA resolution but incr risk hypoK
youtube.com/shorts/pTnt8...
#EMIMCC
Reposted by Aimee Mishler, PharmD, BCEMP, FAWM
Massive Hemorrhage Protocol: More than just giving products
-Control bleeding: tourniquet extremity hemorrhage, pelvic binders, balloon tamponade
-Early transfusion
-TXA, AC reversal (PCC or FFP) + Ca
Don't forget to get consultants mobilized for definitive care
youtube.com/shorts/AIV4o...
#EMIMCC
-Control bleeding: tourniquet extremity hemorrhage, pelvic binders, balloon tamponade
-Early transfusion
-TXA, AC reversal (PCC or FFP) + Ca
Don't forget to get consultants mobilized for definitive care
youtube.com/shorts/AIV4o...
#EMIMCC
Massive Hemorrhage Protocol #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
June 28, 2025 at 2:36 PM
Massive Hemorrhage Protocol: More than just giving products
-Control bleeding: tourniquet extremity hemorrhage, pelvic binders, balloon tamponade
-Early transfusion
-TXA, AC reversal (PCC or FFP) + Ca
Don't forget to get consultants mobilized for definitive care
youtube.com/shorts/AIV4o...
#EMIMCC
-Control bleeding: tourniquet extremity hemorrhage, pelvic binders, balloon tamponade
-Early transfusion
-TXA, AC reversal (PCC or FFP) + Ca
Don't forget to get consultants mobilized for definitive care
youtube.com/shorts/AIV4o...
#EMIMCC