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brookswalsh.bsky.social
brookswalsh
@brookswalsh.bsky.social
1.7K 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.
Posts Replies Media Videos
brookswalsh.bsky.social
Another example for caution for the use of AI in medical history -taking (let alone decision-making).
AI can resort to racist tropes and context while also being plain ol' stupid: "their white mother?!"

Open-access - take a look!
link.springer.com/article/10.1...
Figure 12 is a photograph of six pygmies from Congo: ‘Chief’ Bokane (22), ‘Princess’ Quarke (22), Mogonga (18), Masutiminga (22), Matuka (23), and Amurape (31), who were coercively brought to London by the game hunter James Harrison in 1905, as part of an eight-person group, half of whom died during the exhibitions (Gibbons 2013). Kidnapped pygmies from Congo. Scott Russell and Co (1905) 4.1. 'A black and white photograph from the early 20th century shows the first group of African American children taken to South Africa. They stand on a ship deck with their parents, dressed as if trying not to make themselves too distinct from regular humans, but still clearly different due to skin color' 4.2. 'An old photo of African children and their white caretaker on the deck... 4.3. "Old photo of black children being taught on an African ship in the early morning... 4.4. 'A historical photograph of Black people from the Ashare tribe in rural South Africa, wearing long coats and trousers with their children standing between them on an ocean liner ship docked at England's port in the early 20th century. The photo is showing two men dressed as crew members behind five young African boys and girls. One man stands to the left side of the camera facing forward while another boy stands next to him holding his hand out towards the viewer. All visible faces are smiling. 4.5. 'Historical photograph shows black children being sent to Africa, dressed in long coats and trousers, posing for the camera with their white mother standing behind them in the style of a fancy mother.
November 16, 2025 at 1:40 PM
brookswalsh.bsky.social
As H3N2 bears down on the US, where *should* we be with oseltamivir/baloxavir prescribing in kids?
The evidence for mortality/hospitalization has always seemed at odds with the strength of the society guideline recommendations.
jamanetwork.com/journals/jam...
This multicenter, cross-sectional study of children with influenza in EDs found that, for children at higher risk of severe influenza illness, influenza antiviral prescribing decreased during the COVID-19 pandemic compared with prepandemic levels, despite unchanged treatment guidelines. Interventions are needed to support guideline-concordant prescribing in this population.
November 15, 2025 at 8:25 PM
brookswalsh.bsky.social
And then you have this gunner, trying to cram in every SAT word he can and WHAT THE HELL IS HE SAYING
Ross Douthat on his poser intellectual BS again, I ain't copying all this malarkey
November 13, 2025 at 1:26 AM
brookswalsh.bsky.social
Picture based on "girlsplaining" meme where an overenthusiastic girl is yelling in a bored guy's ear: "Actually CN and CS gas used by police don't use capsicum so they're not pepper spr..."
November 12, 2025 at 4:50 PM
brookswalsh.bsky.social
I mean, *I'm* with you on this
November 11, 2025 at 5:13 PM
brookswalsh.bsky.social
Great accompanying article by Durgun highlights the context , importance, and limits of this research.
For example, how are these rates associated with cases of so-called "excited delirium?"
jamanetwork.com/journals/jam...
Additionally, little data exist regarding policies targeting co-occurring illnesses and their effects on rates of legal intervention injury. For example, injuries and deaths attributed to agitated states, such as excited delirium, are closely associated with legal intervention injuries, like restraint-related asphyxia,5 and the nature of that co-occurrence has been significantly debated these last 2 decades.
November 11, 2025 at 4:31 PM
brookswalsh.bsky.social
Black individuals injured by law enforcement at 5 times the rate of White people.
No change in that rate after deaths of Michael Brown or George Floyd.
jamanetwork.com/journals/jam...
Despite expectations that policy responses to major protests against racialized police violence would lead to substantial change in the rate of legal intervention injuries, the findings of this cross-sectional study suggest that any shifts for the overall population were relatively modest, ranging from a decrease by approximately one-third to an increase of one-fifth. Our findings of a decreasing RR for Hispanic or Latinx individuals compared with White individuals should be interpreted cautiously, as misclassification of Hispanic or Latinx patients in US medical data is high and may vary as EDs with different classification practices enter and exit the NEISS-AIP sample. While we cannot draw conclusions about the direction of change to the RR for African American or Black individuals, it is clear that it remained persistently high over the entire study period, with point estimates always exceeding 5.
November 11, 2025 at 4:26 PM
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