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brookswalsh.bsky.social
brookswalsh
@brookswalsh.bsky.social
1.6K followers 1.9K following 1.2K posts
ER doc.
Okay at reading ECGs
Proud to have helped eliminate "excited delirium" in EM.
Aiming to correctly use the subjunctive in Spanish more often.
And I am never, ever sick at sea.
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brookswalsh.bsky.social
Ironically, a 2021 Annals editorial attacked media coverage of the ketamine issues, and took issue with how the media described ketamine as an "animal tranquilizer."
www.annemergmed.com/article/S019...
In multiple articles, ketamine was referred to as a “date-rape drug,” when, in fact, its presence in drug-facilitated sexual assault is extremely uncommon.28 In others, it was called an “animal tranquilizer,” a gross misrepresentation considering that numerous medications are Federal Drug Administration-approved for both veterinary and human use. These technically correct but highly misleading facts undermine the truth about ketamine and its vital importance as an analgesic and sedative to the global medical community.
November 6, 2025 at 2:51 PM
brookswalsh.bsky.social
Oof.
@carlelliott.bsky.social brings up the Annals editorial where patients with ExD are repeatedly compared with "wild beasts?"
e.g. "So why not treat people like wild beasts?"
www.annemergmed.com/article/S019...
By 2016, a deputy editor of the Annals of Emergency Medicine could compare agitated patients to “wild beasts” and write, “Let’s take ’em down with a ketamine blow dart.”5 But is this crazy? There is ample precedent for taking down beasts in the wild with ketamine. Remember those nature shows in which biologists shoot tranquilizer darts into rhinos or lions or polar bears? It should be no surprise that ketamine has been and continues to be the most common ingredient in such animal blow darts.3 So why not treat people—when the situation requires it—like wild beasts? But with intramuscular ketamine injection rather than an actual blow dart rifle. We all know from our procedural sedation practice that ketamine has rapid onset after intramuscular injection (usually 2 to 5 minutes) and that immobilization and cardiorespiratory stability are key features of the resulting trancelike dissociative state.4 Isn’t this the ideal formula for “taking down” a wild beast of a patient?
November 6, 2025 at 2:39 PM
brookswalsh.bsky.social
Even if excited delirium were to be proven tomorrow to be a valid and useful diagnosis, we already know that "death from ExD" always involves dangerous restraint practices, i.e. prone restraint or positional asphyxia.
Even more significant has been the collapse of the diagnosis of “excited delirium,” a medical condition supposedly characterized by extreme agitation, violence, inappropriate behavior, and feats of superhuman strength. In 2018, it was still plausible (if controversial) to cite the grave risks of excited delirium as a justification for forced sedation with ketamine. Today, however, excited delirium is widely seen as a pseudodiagnosis used to explain away deaths that have occurred at the hands of the police.20 No major medical organization supports its legitimacy.
November 6, 2025 at 2:20 PM
brookswalsh.bsky.social
jfc the comments on this post on FB.
Hundreds of HCWs bragging about torturing patients.
November 5, 2025 at 10:05 PM
brookswalsh.bsky.social
November 5, 2025 at 6:40 PM
brookswalsh.bsky.social
#EzraDouthglesias fighting to stay relevant today
(credit @mcopelov.bsky.social for term)
November 5, 2025 at 3:46 PM
brookswalsh.bsky.social
October 30, 2025 at 6:11 PM
brookswalsh.bsky.social
"ICE has used the device despite internal concerns ... due to deaths involving the use of the WRAP by local law enforcement.
AP has identified a dozen fatal cases in the last decade where local police or jailers used the WRAP and “restraint” played a role in the death."
apnews.com/article/immi...
The AP found that ICE has used the device despite internal concerns voiced in a 2023 report by the civil rights division of DHS, in part due to reports of deaths involving the use of the WRAP by local law enforcement. And the AP has identified a dozen fatal cases in the last decade where local police or jailers around the U.S. used the WRAP and autopsies determined “restraint” played a role in the death.
October 29, 2025 at 9:00 PM
brookswalsh.bsky.social
My Spanish teacher on iTalki:
Aide to mayoral candidate Mamdani saying in Spanish "No no no ok ¡ya córtalo!"
October 29, 2025 at 7:21 PM
brookswalsh.bsky.social
Or catastrophic liver failure!
Animal Naming Test – a simple and accurate test for diagnosis of minimal hepatic encephalopathy and prediction of overt hepatic encephalopathy
October 27, 2025 at 2:19 PM
brookswalsh.bsky.social
Updates in ACLS that validate my existing practice and thus must be correct:

Start with *at least* 200J for DCCV of AF.

Adult Advanced Life Support: 2025 AHA Guidelines
share.google/3v4qr9KPEKPy...
For synchronized cardioversion of atrial fibrillation in adults using any currently US-approved bipha-sic waveform defibrillator, an initial energy setting of at least 200 J is reasonable and incremented in the event of shock failure, depending on the bipha-sic defibrillator used
October 27, 2025 at 2:14 PM
brookswalsh.bsky.social
You go Osler
October 26, 2025 at 11:56 PM
brookswalsh.bsky.social
I'm not an academic lawyer - is *this* his field?
Yarvin argues for American monarchy at closed-door debate Curtis Yarvin, who is known for his anti-democratic views, argued to “end the democratic experiment” against Yale Law School professor Jed Rubenfeld in front of the Yale Political Union Tuesday evening. Jerry Gao & Emily Akbar 2:46 am, Oct 08, 2025 Yale Daily News
October 26, 2025 at 4:31 PM
brookswalsh.bsky.social
Narcan and dextrose *still* not recommended in cardiac arrest management.
October 26, 2025 at 4:28 PM
brookswalsh.bsky.social
Bicarb and calcium *still* not indicated in routine arrest.

Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/cLM5RhSXki5q...
October 26, 2025 at 3:58 PM
brookswalsh.bsky.social
"The routine use of mechanical CPR devices is not recommended for adults in cardiac arrest.The routine use of mechanical CPR devices is not recommended for adults in cardiac arrest."
share.google/m71mP8d1RRdQ...
October 26, 2025 at 3:51 PM
brookswalsh.bsky.social
New ACLS guidelines highlight the perils of failed capture during pacing.
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
More recent studies have underscored persistent challenges for clinicians in achieving and maintaining both electrical and mechanical capture during pacing False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024;28:928–936. doi: 10.1080/10903127.2024.2321287
October 26, 2025 at 3:45 PM
brookswalsh.bsky.social
10 years ago I wrote a controversial blog post that attacked the myth of The Life-Saving™️ mechanical CPR device.
Nice to see the AHA catching up!

"We had a LUCAS save!" - No, you didn't.
share.google/7oAmIkYnCZSM...
But the LUCAS..." But regardless of these completely negative results, people are protesting. They point out that, yeah, maybe this study didn't show a difference. "But the LUCAS..., " they point out... "...delivers better CPR!" "...can shock during CPR!" "...can do better CPR during transport!" "...doesn't get tired!" Despite all that, which is likely true, no difference was found in a high-quality trial where the researchers has every opportunity to demonstrate these . This is how clinical research goes - the slaying of appealing theories by means of ugly facts.
October 25, 2025 at 10:35 PM
brookswalsh.bsky.social
"Fellow athletes did not initiate cardiopulmonary resuscitation in any competitive young athlete-victim"
Sports-related sudden cardiac arrest: a video analysis of presenting features, management and outcomes
pubmed.ncbi.nlm.nih.gov/41135968/
Meme of Coach Taylor from Friday night lights saying clear eyes full hearts early continuous compressions
October 25, 2025 at 6:17 PM
brookswalsh.bsky.social
Candidate has voters raising questions about a tattoo
October 25, 2025 at 5:50 PM
brookswalsh.bsky.social
There is *literally* a Hospital for Sick Children that opened in 1875 in Toronto
October 24, 2025 at 5:00 PM
brookswalsh.bsky.social
"You’re yelling, so you can breathe,” said one of the officers who forcefully restrained her.

Grant gasped, moaned and settled motionless onto her stomach while handcuffed to a hospital bed.

Her death was later ruled a homicide."
Eric Jaeger, a paramedic and national expert in the use of restraint, said the most alarming revelation from the videos is that Grant’s persistent pleas for help were seemingly ignored or dismissed. He cited the officer who used her yelling as proof that she could still breathe.“That’s some version of, ‘If you can speak, you can breathe,’ which we’ve said is a myth,” said Jaeger. “When someone’s saying, ‘I can’t breathe,’ you have to take that seriously.”
October 21, 2025 at 11:33 PM
brookswalsh.bsky.social
Death from prone restraint, also known as positional asphyxia, can occur in your ER or in your ambulance.
As noted in the autopsy, this can happen fast.
ANATOMIC DIAGNOSES: 1. Physical restraint Video documentation of restraint 1. a. Decedent's chest and abdomen against side of hospital bed with pressure placed on posterior neck and back i. Intramuscular hemorrhage, left rectus capitis posterior major ii. Somnolence and dyspnea during and following restraint Subsequent cardiac arrest (13 minutes following cessation of restraint)
October 21, 2025 at 11:02 PM
brookswalsh.bsky.social
I'm often asked by nurses "What are we giving the patient for the fever?" I often respond with the name of the specific antibiotic or antiviral I'm ordering, but this is not met with humor.
Not giving APAP to a febrile patient is, in medical culture, tantamount to flippant negligence.
I suppose you could try and educate the patient, but I suspect that will go nowhere. I think the literature is clear that, with a few exceptions, treating a fever at best does nothing to alter the course of infection and, at worst, leads to more prolonged disease and complications. Fever relief only makes the patient more comfortable. I have been saying don’t treat fevers for decades and made zero impact whatsoever on the treatment of fevers. Hell, when my kids were febrile, my wife gave them Tylenol, completely ignoring me.
October 21, 2025 at 6:02 PM
brookswalsh.bsky.social
Confirmed
October 16, 2025 at 7:14 PM