brookswalsh

@brookswalsh

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@brookswalsh· 23d

Who the $&#@ is looking at a patient's sputum in the ER?! (Discussing new COPD guidelines with wifey over breakfast, as one does)

Sputum purulence in the studies and guidelines referenced above is defined by visual assessment of sputum color, where yellow or green sputum is considered purulent, in contrast to white or clear (mucoid) sputum.
[1] This is a bedside clinical determination — no laboratory test is required.

brookswalsh@brookswalsh· 24d

Stop scrolling and post 2 characters who bring you happiness.

brookswalsh@brookswalsh· 24d

"Sir, a second ex-wife has hit ICE."

brookswalsh@brookswalsh· 25d

If we don't give them the ratings, they'll go to Moody's, right down the block.

If we don't work with them,

they will go to our competitors.

Not our fault.

Simply the way the world works.

brookswalsh@brookswalsh· 26d

Lesson 1 - Try to live your life such that an ex doesn't feel motivated to expose your crimes. Lesson 2 - Donate to the @pressherald.com. Im not going to subscribe, but i sent them a couple $ for dropping their paywall for this crucial local journalism. www.pressherald.com/2026/07/16/i...

“He was asking me to lie for him and to cover for his character,” Ashley Brouillette said. “I told him that I was not going to lie for him. And then he tried to say that it was a justified shooting because the guy tried to hit him with his car.”

She said she has seen videos of Brouillette on the scene of the shooting and confirmed that was him on scene, telling him: “nowhere in there does it show that this man charged at you with a car.”

brookswalsh@brookswalsh· 28d

Increased ER visits, but decreased revenue. The stock of a major private healthcare system went down because of decreased government investment in the health of its citizens. It's almost like a right to healthcare would be good for business too? share.google/bGn98AvEm9V8...

HCA said it experienced a payer mix shift in the quarter, driven by an increase in uninsured volume, primarily due to patients who had lost coverage on health insurance exchanges. It estimated that this payer mix shift had an unfavorable impact on income before income taxes of about $400 million during the second quarter.

The company said it did see positive factors during the quarter, including growth in admissions, equivalent admissions and emergency room visits, increased benefit from Medicaid Supplemental Payment Programs and improved expense trends.

brookswalsh@brookswalsh· Jul 13

The No Surprises Act provides recourse for emergency physicians seeking appropriate compensation. Which is why this pair of stories, from @nytimes.com and @statnews.com is concerning. Is the NSA being weaponized in certain cases to drive disproportionate payments? @aineyoremd.bsky.social

It takes a surgeon around three hours to remove a cancerous prostate gland. Most sit behind a console, using joysticks to control a surgical robot with tiny clamps, scissors and other tools on its four arms.

An assistant stands at the bedside to place the robot’s arms, suction out fluids, and swap instruments at the surgeon’s instruction.

For those services, the standard fee paid by most health insurers is 16 percent of the surgeon’s earnings. But across the country, assistants are sometimes earning up to 25 times what the doctor makes, according to data reviewed by The New York Times and interviews with officials who manage large health plans.

RRobert Behounek walked into the Albuquerque emergency room last fall with telltale signs of a heart attack.

For weeks, he’d been having trouble breathing and terrible swelling all over his body. What began as searing pain in one of his arms was now a relentless ache in his chest. The receptionist at Albuquerque ER & Hospital asked for his health insurance card, but he didn’t have insurance. She told Behounek that his visit could cost upward of $1,600.

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“I said, ‘I don’t have that. Can you just bill me afterward? I’m worried I’m having a heart attack,’” Behounek recalled. “She just said, ‘There’s nothing we can do for you. We can’t see you here unless you pay the cost first.’ I said, ‘But you guys are an ER,’ and she said, ‘We’re not that kind of ER

brookswalsh@brookswalsh· Jul 10

On top of the professionalism of the DCFD, I want to recognize the proper grammatical use of "myriad" by @meganranney.bsky.social in this context. Dozens of us salute you Megan. #FewerNotLess

Dr Ranney notes that "the causes of consciousness are myriad" during interview on CNN.

brookswalsh@brookswalsh· Jul 7

Scratch a NYT/WSJ story on the "struggles of young people in a difficult economy" and you always find it's just elite nepotism. From a Business Insider article on the same person: www.businessinsider.com/moved-from-n...

My mom owns a wellness hotel in Costa Rica, and I work with her in business development and marketing. I am prepping to take over the company at some point.

brookswalsh@brookswalsh· Jul 5

This is a great review of the current understanding of deaths from "excited delirium," are during prone restraint, for people in custody. Clear discussion, extensive references. And open-access! www.sciencedirect.com/science/arti...

The evidence indicates that deaths in custody are predominantly multifactorial, resulting from the interaction between physical restraint, intense physiological stress, intoxication with psychoactive substances and individual vulnerabilities such as obesity or underlying cardiac disease. The concept of “excited delirium” remains highly controversial, lacking validated diagnostic criteria or specific biomarkers and is frequently used as a diagnosis of exclusion in medico-legal contexts. Physical restraint, particularly prolonged prone positioning with thoracic or cervical compression, may precipitate metabolic acidosis and restraint-associated cardiac arrest, even in the absence of significant hypoxemia. Experimental studies in healthy volunteers fail to reproduce real-world custodial conditions and should not be used to negate associated risks.

brookswalsh@brookswalsh· Jul 3

"Desde que empezó la llamada guerra contra las drogas, o quizá desde que el águila se tragó a la serpiente, este país quema lo mejor que tiene —naturaleza, humor, talento— como si mañana no fuera a necesitar combustible." I just like reading stuff by Laia Jufresa.

brookswalsh@brookswalsh· Jul 2

"No refuge could save the hireling and slave From the terror of flight or the gloom of the grave" #IWTYO

And where is that band who so vauntingly swore, That the havoc of war and the battle's confusion A home and a Country should leave us no more? Their blood has wash'd out their foul footstep's pollution. No refuge could save the hireling and slave From the terror of flight or the gloom of the grave, And the star-spangled banner in triumph doth wave O'er the land of the free and the home of the brave.

brookswalsh@brookswalsh· Jul 2

"Hundreds of hospitals already struggling with thin margins could close or slash services, millions of working-class families may be pushed into medical debt, insurance premiums could rise, and tens of thousands of people could die each year because of lost coverage under Medicaid and the ACA."

brookswalsh@brookswalsh· Jul 2

"The King County medical examiner’s office has found that a man in Federal Way police custody at a local hospital died as a result of a heart attack and “prolonged restraint in prone position." From the @seattletimes-rss.bsky.social www.seattletimes.com/seattle-news...

brookswalsh@brookswalsh· Jun 30

"When will extreme heat end in Connecticut?" Well, it won't. Every year for the rest 9f our lives (and our kids' lives etc.) we will confront worsening heat crises. And extreme heat will kill more and more of us. www.nhregister.com/weather/arti...

brookswalsh@brookswalsh· Jun 25

Dang. Pretty much the main thrust of the document.

In all the non-slave-holding States, in violation of that good faith and comity which should exist between entirely distinct nations, the people have formed themselves into a great sectional party, now strong enough in numbers to control the affairs of each of those States, based upon the unnatural feeling of hostility to these Southern States and their beneficent and patriarchal system of African slavery, proclaiming the debasing doctrine of the equality of all men, irrespective of race or color--a doctrine at war with nature, in opposition to the experience of mankind, and in violation of the plainest revelations of the Divine Law. They demand the abolition of negro slavery throughout the confederacy, the recognition of political equality between the white and the negro races, and avow their determination to press on their crusade against us, so long as a negro slave remains in these States.

For years past this abolition organization has been actively sowing the seeds of discord through the Union, and has rendered the federal congress the arena for spreading firebrands and hatred between the slave-holding and non-slave-holding States.

By consolidating their strength, they have placed the slave-holding States in a hopeless minority in the federal congress, and rendered representation of no avail in protecting Southern rights against their exactions and encroachments.

brookswalsh@brookswalsh· Jun 21

What does this old piece of equipment from our basement have to do with current events in Colombia today?

brookswalsh@brookswalsh· Jun 17

Tim curry as a Soviet submarine officer saying " You'll receive the Order of Lenin for this, Captain.!"

brookswalsh@brookswalsh· Jun 15

Meanwhile, EM be like:

Tweet from official ACEP account that itself is a quote-tweet of a white house account:
ACEP strongly supports policies that prioritize access to emergency care in rural communities. ACEP President-Elect Dr. Ryan Stanton @EverydayMed emphasizes the importance of the patient-physician relationship at the White House roundtable on rural health.

brookswalsh@brookswalsh· Jun 12

A major consulting firm's report on the advantages AI provides in healthcare was flawed by *AI hallucinations* of those advantages. www.ft.com/content/b382...

Headline FT article:
KPMG report contained AI hallucinations on benefits of . . . AI
Bogus case studies on UBS and transit systems exaggerated adoption of the technology

A claim by KPMG that NHS Greater Manchester uses AI agents to predict hospital readmissions, triage patients and automate referrals "doesn't really align" with the press release it appeared to be based on, a spokesperson said.

Footnotes show the assertion stemmed from a communiqué about an AI tool designed to combat lung cancer. In it, there is no mention of agentic AI carrying out such tasks.

brookswalsh@brookswalsh· Jun 11

Normie doctors (like me) look at this CV and are blown away at the drive, the talent, and the resilience needed to become a pediatric CT surgeon. Basically GOAT level. Random twitter racist : bUt hE bRoWn

M.B.B.S., 1999, Madras Medical College

Internship

General Surgery, Government General Hospital, Chennai, India, 2001

Residency

General Surgery, Maimonides Medical Center, Brooklyn, NY, 2009

Fellowship

Research Fellowship, Fetal Care Research Foundation, Chennai, India, 2002

Research Fellowship, Division of Hepatobiliary Surgery, University of Southern California, 2003

Research Fellowship in Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University, CA, 2006

Thoracic Surgery, Yale University/Yale New-Haven Medical Center, New Haven, CT, 2011

Pediatric and Congenital Cardiac Surgery, Stanford University, CA, 2013

Certifications

American Board of Thoracic Surgery, 2012

American Board of Thoracic Surgery, Subspecialty: Congenital Cardiac Surgery, 2014

brookswalsh@brookswalsh· Jun 10

Flier: Even his daughter has kind of had it with his BS.

Flier tweets:
When I last lectured in ⁦@BrighamWomens⁩ Bornstein auditorium, walls were adorned with portraits of prior luminaries of medicine & surgery. Connecting to a glorious past. Now all gone. Hope everyone is happy. I’m not. (Neither were those I asked- afraid to say openly). Sad.

His daughter, a medical student, replies:
Have to disagree with you, dad (and mom). Long thread coming with my thoughts about it. First point: The current generation of doctors does not much resemble that old wall.

brookswalsh@brookswalsh· Jun 5

Seems like they're also emphasizing the faulty understanding of what exponential growth is. Classic XKCD:

Cartoon from xkcd which emphasizes that exponential growth involves the whole curve, not just the top steep part, includes the flat bottom part as well

brookswalsh@brookswalsh· Jun 5

I mean

First lady Melania Trump climbs into her motorcade vehicle wearing a Zara design jacket with the phrase "I Really Don't Care. Do U?" on the back as she returns to Washington from a visit to the U.S.-Mexico border area in Texas, at Joint Base Andrews, Maryland, U.S., June 21, 2018. REUTERS/Kevin Lamarque

brookswalsh@brookswalsh· Jun 4

brookswalsh@brookswalsh· Jun 3

Scene from the West Wing TV series where the "Cartographers for Social Equality" show a Peters projection map to CJ and Josh.

brookswalsh@brookswalsh· Jun 1

Tbh

I Feel Bad For You / I Don't Think About You At All | Know Your Meme https://share.google/MlZTFIizYPZKU7kSP

brookswalsh@brookswalsh· May 27

Whoa 20 years since I started planing my first publication. tbh I was just looking for an excuse to hang around the ED, and the department was like "You can't just hang out, think of something to do." journals.lww.com/pec-online/a...

Survey of Parental Willingness to Pay and Willingness to Stay for ‘‘Painless’’ Intravenous Catheter Placement Brooks Myrick Walsh, BA,* and Joel Michael Bartfield, MD
https://journals.lww.com/pec-online/abstract/2006/11000/survey_of_parental_willingness_to_pay_and.3.aspx

Objectives: This study examined how much parents are willing to pay and/or willing to stay to make their child’s intravenous (IV) catheter placement painless. Methods: A prospective survey was conducted using a questionnaire administered to a consecutive sample of parents presenting to an emergency department (ED). Eligible subjects were parents accompanying a child 8 years of age or younger. A hypothetical visit to the ED, requiring an IV for their child, was described. Parents were asked if they would prefer to make the IV catheter placement painless and if so, how much of an increase in out-of-pocket cost (none, $15, and $100) and/or length of stay they would be willing to incur (no time, 15 minutes, 1 hour). Statistics were chiefly descriptive. Associations of demographic elements with willingness to pay and willingness to stay were analyzed using x2 and t tests, where appropriate. Results: One hundred eight subjects were available for analysis. Most parents were mothers (71%), white (53%), and with previous IVs (70%). Most children were boys (55%) with no previous IV placements (55%). The choice of a painless IV placement was independent of demographics and IV experience. Most parents (89%) chose a painless IV placement. Of these parents, 65% chose a willingness to stay of 1 extra hour, and 77% a willingness to pay at least $15; 37% of parents would pay $100. Willingness to pay was dependent on both income (P = 0.014) and ethnicity (P = 0.0013). Willingness to stay was independent of both income (P = 0.24) and ethnicity (P = 0.07). Conclusions: Parents are willing to spend both time and money to make their child’s IV placement painless. This information should be considered when choosing therapies to reduce the pain of IV placement.

brookswalsh@brookswalsh· May 26

From the first citation: Wouldn't it be sorta more plausible that increasing recognition of neonatal pain was somewhat correlated with increasing recognition of *autism*?