What is the 4-step cricothyrotomy method? This method uses... 4 steps: Scalpel-finger-bougie-tube 1. Scalpel to the cricothyroid membrane 2. Finger insertion into the trachea with downward traction 3. Insertion of a bougie into the track with the finger it in feeling for the tracheal rings 4. Insertion of the tube over the bougie It is a simplified method for performing the procedure that eliminates steps such as the use of trach hook. While this procedure was popularized by the US military through the Tactical Combat Casualty Care guidelines, it has been described for many years before the recent wars in Iraq and Afghanistan. There's obviously no RCT data on this method in humans, but cadaver, mannequin, and case series data demonstrate reliability and efficiency. PMID: 9950380, 8922017, 9774928 #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #trauma #airway #military #tccc #navy #airforce #marines #medx #medtwittershow more

Essential microskill for airway assistants! When intubating over a... bougie, the bougie is placed into the trachea and the assistant places the tube over the bougie Because bougies are straight and tracheal tubes have a curve, there is a tendency for the bougie to hit against the inside of the 15 mm connector on the end of the tube An essential microskill for airway assistants is to gently straighten the tube so the bougie goes through the connector rather than hitting against it (Video best with sound on)show more

Should we be reaching for lorazepam (Ativan) for seizures?... The short answer is no, our first line therapy should be midazolam (Versed). Midazolam has a faster onset time and is tolerated well in very high doses provided adequate airway support. One high-quality RCT found that IM midazolam worked as well as IV lorazepam. -PMID 22335736 The right starting dose of IM midazolam is 10mg. That said, at least they got the dose correct. The dose for seizures is NOT 1mg of lorazepam. The starting dose should be 4-8mg (0.1mg/kg). In one high-quality, using a higher dose resulted in LESS intubations than lower doses. This is because the seizures terminated faster. Use the same dosing for midazolam. -PMID 33664203, 9738086 #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #neurology #brain #seizure #medx #medtwittershow more

"Don't give nitrates to right-sided 🫀myocardial infarctions" This is... a myth that continues to get taught due to the theory that right-sided MIs are sensitive to preload, which nitrates reduce. A recent systematic review (n=1113) failed to substantiate this purported risk. #emergency #emergencymedicine #foam #foamed #foamcc #army #armymedicine #armyemdoc #meded #icu #criticalcare #meded #science #research #data #medx #medtwittershow more

ED boarding is when a patient is admitted but... physically remains in the ED. Unlike the floors or ICUs, there is no "capacity" in the ED. While nursing ratio recommendations exist, there is no method to enforce it given the nature of EM workflow. Is ED boarding really as big of a deal as he says? The short answer is: yes. My record for ED LOS exceeds a month, and the worst nursing ratios were 13 patients per nurse. The latter was in early COVID. One systematic review included 7 studies and over 75,000 patients. Here’s the gist of what they found: -higher rates of missing treatment interventions (9%) -higher rates of missing home medications (18%) -higher rates of missing lab studies (3%) -higher odds of orders not being filled on time (OR 1.84, 1.46-2.30) -higher odds of orders not being filled altogether (OR 2.58, 1.94-3.42 -higher odds of delirium in the elderly (OR 2.23, 1.13-4.41) -higher odds of drug-related adverse events (OR 1.04, 1.01-1.08) Another systematic review included 13 studies and focused on the elderly. Here’s the gist of what they found: -increased odds of death at 6 months (2.18, 1.10-4.31) #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #medx #medtwittershow more

What is a Bakri balloon? If you work in... rural or critical access EDs, this is a must know, IMO. Precipitous deliveries without obstetric support definitely ranks in my top 10 most nerve-wracking events. The overwhelming majority are autopilot events, but the rare complication can potentially lead to, not 1, but 2 patients at risk. Postpartum hemorrhage is a leading cause of maternal death. When uterotonics are ineffective, ACOG recommends placement of a Bakri balloon. This is a large balloon that is inserted into the uterus under direct visualization and inflated for balloon tamponade. These are decently effective, but displacement happens in nearly 10% of the cases. 1% will go on to need a hysterectomy. Thus, these should be viewed as a temporizing measure with rapid transfer to a hospital with obstetric services. Of note, there are newer vacuum devices on the market that may be more effective. Additionally, they are probably more physiologic. I have no personal experience with these vacuum devices, so maybe someone with experience with them can comment on ease of use. I have also never seen them in an ED. #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #obgyn #obstetrics #baby #mother #medx #medtwittershow more

Placing objects sounds simple… until robots have to do... it. This method makes it simple, fast & reliable. [Github ⬇️] Robotic object placement is tough, especially with stacking, hanging, or insertion. AnyPlace is a new two-stage method that uses only synthetic data and a vision-language model to teach robots where and how to place objects; even in the real world. Why this works ✅ Finds the right spot with help from vision-language models ✅ Handles stacking, insertion, and hanging with no real-world training ✅ Trained on synthetic data using Blender and IsaacSim ✅ Works in the real world without fine-tuning It shows that smart use of simulation and language models can make robotic placement tasks easier, faster, and more reliable. Github: Paper: Thank you for sharing Animesh Garg !show more

the other benefit to this method is now we... get to rig it in such a way where we can stretch the geometry of the rope as the anchor and the knot move down, the rope tiles as it scrolls giving the effect its moving with the anchor.show more

The procedure commonly known as "uterine cleansing" is called... "vacuum aspiration." This procedure involves emptying the contents of the uterus using a thin cannula and negative pressure. It is most often used in the following situations: *Retained tissue in the uterus after a miscarriage *Increased endometrial thickness *Diagnostic sampling The procedure is usually short and safe when performed with the correct technique. However, it is not actually a "cleaning" procedure. The uterus is normally a self-cleaning organ. This procedure is only performed when medically necessary. When performed with the correct indication, it saves lives. In medicine, what matters is not the procedure itself… but performing it at the right time on the right patient.show more

I built a directory of beaches in manus in... just two prompts it's ridiculous, BUT here's why *you* are more important than ever: it still relies on crawling the web and on other sites to provide the data. for an MVP of a directory, or pseo site, or saas etc that's fine. it's never been easier to whip up that idea in minutes but if you want long term success you need to be the source and not the fork - and that only comes from doing stuff ai can't replicate (yet) all of the data from this site was crawled from elsewhere. is it accurate? how often is it updated? what if those sources change? when it becomes so easy to do things like build a directory or vibe code a saas, doing the hard things is more important than ever i have another app in this niche that has around 10,000 monthly active users it's been going for years and years at this point on autopilot i did it by painstakingly parsing time series of sea temperature data from the us government with a bot that runs 4x a day - no ai 😭 (currently has 63.4m rows of data) this site is the source for manus and other tools and is very accurate. I've had many opportunities to sell the data into bigger companies and none of that would be possible taking the easy route anyway: tldr manus is amazing but humans working on the hard problems with ai as a copilot is still the way you winshow more

Oral intubation, also known as endotracheal intubation, is a... medical procedure that involves inserting a flexible plastic tube through a patient's mouth and into their trachea (windpipe). The tube keeps the airway open, allowing air to pass through and potentially connecting to a machine that delivers oxygen or air.show more

The UAE has successfully tested artificial rain technology in... the desert at 50°C. As reported by Business Insider, in the United Arab Emirates, to combat the 50-degree heat, they intend to use drones to make it rain. This method is known as "cloud seeding". The UAE has used drones that strike clouds with an electric current, which provokes them into a collision and precipitation.show more

Design Chief Priest One method I used was the... 3 column method. I basically added data to first two columns and "details" in 3rd column, so when you click details, full data is displayed in slide up modal. See it below. (Still testing)show more

2. Recipe with Visual Steps Prompt: "Provide a 5-step... recipe for a simple chocolate cake. For each step, generate an image showing the process: 1) ingredients laid out, 2) mixing the batter, 3) pouring it into a pan, 4) the cake baking in the oven, and 5) the finished cake with frosting."show more

GraphRAG-UI GraphRAG-UI is a user-friendly interface for GraphRAG, a... powerful tool that uses the Retrieval-Augmented Generation (RAG) approach to index and query large text data. This project supports the latest version graphrag-0.3.3 and aims to provide a convenient management and interaction method for GraphRAG, supporting the configuration of local large language models like Ollama, making it easier for users to leverage.show more

A uniquely Russian method of removing the detonator from... VOG projected grenade fuzes for use in improvised drone munitions. Hitting it with a hammer looks crazy, but the detonator is initiated by a primer at the other end. At least, theoretically! 1/show more

What kind of method is this for the polis... to catch a thief?🚔🚨show more

CLIMATE EMERGENCY - This man is lying! The spokesman... for Just Stop Oil states that the planet was the hottest it’s been in 100, 000 years! But this wasn’t a measurement. It was a computed average from a computer model! (Think Covid) And the data only goes back to 1940 🤡show more

This is the best method to get your car... out of the mud if it is stuckshow more

DIY Drawknife from an Ordinary Knife and Stick 🌲🔪... #camping #survival #bushcraft #outdoors What you’ll need: • Your favorite knife, the longer, the better • Any stick you like that is comfortable to hold in your hand Steps: 1. Insert the Knife: Hammer your knife into the stick at the spot where the rings are located. This spot is typically stronger and prevents the stick from splitting in half. 2. Reinforce if Needed: If the wood isn’t very sturdy, wrap it with rope to prevent splitting and ensure the knife doesn’t slip out. 3. Safety First: Using this method keeps your hands safe at all times. Give it a try and let me know how it works for you!show more