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Dr. Steve Schauer, PGY15

@armyemdoc

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EM-tensivist
C2RASH Lab Director
Could me memes, could be EBM, maybe both
(My own opinions, not medical advice)
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Our Prolonged Care book in collaboration with @medcoe is finally out affer some printing delays! Thanks to all my co-authors! #emergency #emergencymedicine #criticalcare #icu #science #data #research #army #armymedicine #armyemdoc #navy #airforce #marines #military #combat #war #book by @armyemdoc
33
a year ago
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Residency auditing rotation season is coming soon... come join us in the Department of Emergency Medicine at @bamc_official -Level 1 public trauma center -Over 80,000 visits per year -Over 5000 trauma activations -17 resident spots per year from all 3 services -No 🍪-cutter schedules... we have multiple scholarly tracks so you can tailor your training to your career goals: ultrasound , EMS/Disaster, research, Hyperbaric/Undersea, toxicology, critical care, operational, advocacy and Leadership -Fellowship trained faculty from nearly all subspecialties to teach and mentor -TONS of research opportunities, including multiple research labs that run prospective human subjects trauma research and large animal investigations -Funding to present at academic conferences -Multiple community medicine rotations -International medicine rotations in Honduras DM me for more info! #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #sanantonio #texas #airforce #navy #medicine #military #bamc taken in San Antonio, Texas by @armyemdoc
2
2 years ago
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New systematic review 📃 🔥 off the press... Plasma may benefit bleeding trauma patients—but does that mean it should be given for isolated TBI? BLUF: Evidence supporting plasma for patients with TBI and hemorrhagic shock should not automatically be extrapolated to isolated TBI. Plasma remains appropriate when clinically indicated for hemorrhage or coagulopathy, but routine empiric administration for isolated TBI may be putting the cart before the horse. This systematic review included 15 studies and 183,253 patients. Despite the large total population, the evidence was highly heterogeneous and rated very low certainty (lots of retrospective and registry-based studies). The most favorable signal came from a secondary analysis of the PAMPer trial. However, those patients were enrolled because they were at risk for hemorrhagic shock and were only subsequently found to have CT-confirmed TBI. The apparent benefit was concentrated among direct scene transports and does not establish that plasma benefits isolated TBI without bleeding or shock. The remaining evidence was inconsistent: • Two small randomized trials of empiric early in-hospital plasma found no mortality benefit. • One trial reported more delayed traumatic intracranial hematomas with plasma. • Another reported higher mortality and more new intracerebral hematomas. • Observational studies produced mixed findings and were substantially limited by confounding by indication—patients receiving plasma were frequently sicker, bleeding, coagulopathic, or hemodynamically unstable. More randomized data are needed before isolated TBI alone becomes an indication for plasma. https://doi.org/10.1111/trf.70403 #emergency #emergencymedicine #ems #prehospital #brain by @armyemdoc
2
2 days ago
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New review 📃 🔥 off the press... What if trauma analgesia came in an inhaler instead of an IV? Low-dose inhaled methoxyflurane—often called the “green whistle”—is a self-administered, non-opioid analgesic widely used outside the United States. BLUF: Methoxyflurane appears to be a rapid, portable, and well-tolerated option for acute traumatic pain—but additional military-relevant and comparative studies would be helpful to define its role in U.S. military and civilian trauma systems. This scoping review included 22 studies: • 13 randomized trials • 5 systematic reviews • 4 observational studies Across studies, methoxyflurane provided rapid, clinically meaningful pain relief—often beginning within 3–5 minutes, with the greatest benefit occurring during the first 10–20 minutes. Potential advantages include: • No IV access required • Compact and lightweight • Patient-controlled administration • Minimal monitoring and logistical burden • No controlled-substance handling • Potential usefulness during transport, mass-casualty care, and austere operations Most adverse effects were mild and transient, including dizziness and somnolence. The kidney and liver toxicity historically associated with methoxyflurane occurred with much larger anesthetic exposures and has not been clearly demonstrated with short-term analgesic dosing. Important limitations: The available studies were heterogeneous, several were open label, and long-term or repeated-exposure safety remains incompletely characterized. Direct comparisons with TCCC analgesics such as ketamine and oral transmucosal fentanyl citrate are lacking. Methoxyflurane is also not currently FDA approved in the United States. https://doi.org/10.1093/milmed/usag446 #emergency #emergencymedicine #prehospital #medic #science by @armyemdoc
17
3 days ago
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New 📃 🔥 off the press... Giving empiric calcium after trauma sounds simple—until you realize you may not know whether the patient’s calcium is low or high. BLUF: Prehospital clinical findings could not reliably determine whether a trauma patient was hypocalcemic or hypercalcemic. Empiric calcium may correct an unrecognized deficiency—but it may also contribute to iatrogenic hypercalcemia. Our prospective, multicenter study evaluated 1,047 trauma patients transported directly from the scene: • 235 patients were hypocalcemic on arrival • 39 patients were hypercalcemic • Calcium abnormalities occurred with and without prehospital transfusion • Among patients receiving blood, 56.6% were hypocalcemic—but 7.4% were hypercalcemic • Even among patients receiving no blood or IV fluids, 16.1% were hypocalcemic and 3.7% were hypercalcemic • A higher shock index was associated with both low and high calcium, meaning shock severity could not reliably identify who needed calcium • Of the 11 patients given prehospital calcium, five arrived hypercalcemic—including two who received neither blood nor IV fluids This was an observational study, most patients were enrolled in a system with aggressive prehospital whole blood use, and EMS documentation may have been incomplete. These findings show association, not causation—but they support the need for rapid point-of-care calcium testing and more selective supplementation. https://doi.org/10.1016/j.ajem.2026.09.029 #emergency #emergencymedicine #prehospital #ems #science by @armyemdoc
9
5 days ago
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📃 🔥 off the press: Antithrombotic-associated intracranial hemorrhage The Neurocritical Care Society and Society of Critical Care Medicine have released a focused guideline update on reversal strategies for adults with intracranial hemorrhage. BLUF: 4F-PCC is preferred over andexanet for factor Xa inhibitor–associated ICH, while platelet transfusion should be reserved for select patients. Most recommendations remain conditional, based on low- to moderate-quality data, emphasizing the need to individualize treatment. Key recommendations: • For factor Xa inhibitor–associated ICH, the guideline conditionally favors 4-factor PCC over andexanet alfa. • Andexanet improved hemostatic efficacy but did not improve mortality or functional outcomes—and was associated with more thrombotic events. • Avoid platelet transfusion for spontaneous intraparenchymal hemorrhage in patients taking antiplatelet therapy when neurosurgery is not planned. • Platelet transfusion may be considered for aspirin-treated patients requiring neurosurgery. • The panel could not recommend for or against DDAVP, platelet transfusion in traumatic ICH, or anticoagulant reversal for small-volume hemorrhage. https://doi.org/10.1007/s12028-026-02601-4 #emergency #emergencymedicine #icu #criticalcare #science by @armyemdoc
9
6 days ago
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IV does not automatically mean better. BLUF: Before ordering the IV formulation, ask whether the oral route can accomplish the same goal more efficiently. This applies to both the ED and ICU. In the ICU in particular, using the gut for as much as you can has benefits in maintaining motility and the gut lining. Many medications commonly used in emergency medicine have high oral bioavailability, including linezolid, levofloxacin, metronidazole, fluconazole, doxycycline, TMP-SMX, moxifloxacin, clindamycin, ciprofloxacin, and amoxicillin. Other common ones include IV versus PO acetaminophen (PMID 26157186, 34775679, 34775679) and ODT ondansetron (PMID 15804995, 25197110). When oral therapy is clinically appropriate, it can provide similar systemic drug exposure while avoiding IV placement, preparation, supplies, infusion time, and repeated nursing administration time consumption. Next time you are on shift, observe how long it takes a nurse to prepare and administration and IV antibiotic infusion versus tossing some pills in their mouth. Now multiply that by dozens of times and you can easily see how this little change can have orders of magnitude time-savings for the nurses. Bioavailability does not guarantee identical onset, dosing, or suitability—route selection still depends on the medication and clinical situation. PMID: 24799810 #emergency #emergencymedicine #icu #criticalcare #science by @armyemdoc
15
7 days ago
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Oral ketamine is a great alternative option as it provides non-opioid analgesia with a slower-onset (less psychotropic effects) and longer duration. https://doi.org/10.1002/jppr.1969 #emergency #emergencymedicine #icu #emtensivist #science by @armyemdoc
28
9 days ago
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As an emergency physician, I spend a lot of time seeing heart failure when it has already declared itself. What I like about the new European Society of Cardiology (ESC) framework is that it forces us to think about heart failure much earlier. Heart failure is no longer just a diagnosis made when symptoms appear. The new framework follows the disease across four stages, from risk, to pre heart failure, to symptomatic disease, and finally advanced heart failure. That shift matters because prevention and early treatment now sit much more clearly inside the heart failure conversation. Over the next four slides, I break down what each stage means and what the treatment focus is. Stage A may be the most important stage because the patient does not have clinical heart failure yet. There are no heart failure symptoms, no structural cardiac abnormality, and no elevated biomarkers consistent with pre heart failure. But the patient has risk factors that place them on the path toward heart failure. This is where prevention becomes treatment. The ESC guidelines emphasize aggressive risk factor control, including a systolic blood pressure target below 130 mm Hg when appropriate. SGLT2 inhibitors and finerenone also have important roles in selected high risk patients. The nuance here is that these medications are not for every person who happens to have a cardiovascular risk factor. The indication depends on the individual disease profile, including conditions such as atherosclerotic cardiovascular disease, diabetes, and chronic kidney disease. Do not wait for dyspnea and edema before thinking about heart failure. In this stage, the patient still has no heart failure symptoms, but something objective has changed. That may be structural heart disease, abnormal cardiac function, or elevated biomarkers such as natriuretic peptides or troponin. This is an important distinction because the heart may already be showing evidence of disease before the patient feels sick. Treatment becomes more specific here. The new ESC recommendations move beta blockers earlier for selected patients with LVEF below 50 percent, while ACE inhibitors or ARBs are recommended in patients w by @armyemdoc
23
13 days ago
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Let's hear it in the comments... #emergency #residency #icu #football #meme by @armyemdoc
5
13 days ago
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Can patients with low-risk pulmonary embolism go home directly from the emergency department? BLUF: A diagnosis of PE does not automatically require admission. Risk-stratify, initiate anticoagulation, and ensure a safe outpatient plan. ACEP’s 2026 clinical policy upgrades outpatient PE management to a Level A recommendation. Selected patients with acute PE who are at low risk for adverse outcomes—as determined by PESI, sPESI, or Hestia criteria—can be safely discharged from the ED on anticoagulation with outpatient follow-up. The systematic review included nine studies, all of which supported outpatient treatment for appropriately selected patients. Serious adverse events were uncommon, generally occurring in 2% or fewer patients. Important considerations: • No single risk-stratification tool is preferred. • A score should not replace clinical judgment. • Assess bleeding risk and any other indication for hospital-level care. • Confirm medication access, adequate support, and dependable follow-up. • Hestia explicitly incorporates medical and social reasons for admission that PESI and sPESI may not capture. The policy excludes pediatric patients, pregnancy-associated PE, and VTE occurring with cardiac arrest. https://doi.org/10.1016/j.annemergmed.2026.06.010 #emergency #emergencymedicine #data #science #guideline by @armyemdoc
0
14 days ago
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📃 🔥 the press... Got sepsis-induced thrombocytopenia? Could thrombopoietin agents help? Thrombocytopenia is common in critical illness and is associated with bleeding, transfusion, organ dysfunction, and mortality. This narrative review identified 11 studies evaluating thrombopoietin or thrombopoietin-receptor agonists in critically ill patients. BLUF:  Thrombopoietin-directed therapy may accelerate platelet recovery in sepsis-associated thrombocytopenia and could potentially improve clinical outcomes. However, the evidence is heterogeneous and preliminary. Larger randomized trials are needed before routine use. The early signal is interesting: • Several sepsis studies found faster platelet recovery, often beginning by day 3 and peaking around day 7. • Some studies reported fewer platelet transfusions and improved coagulation profiles. • One randomized trial and one retrospective cohort reported a possible survival benefit. • A meta-analysis of 10 randomized trials involving 681 patients found improved platelet counts by day 7 and a possible reduction in transfusion requirements. While this is promising, the data is too limited for primetime use. Most sepsis evidence involved recombinant human thrombopoietin - not specifically romiplostim - despite the similarity of action.  Most of the rhTPO agents studied are unavailable in the US.  It remains unclear if the same benefits would be noted with romiplostim. These agents also take several days to work, so they cannot replace immediate hemorrhage control or platelet transfusion. Thrombotic risk remains a concern, and no clinical trial has evaluated thrombopoietin therapy for trauma-associated thrombocytopenia. DM me for the full paper. Yes, I know the publication date says 2025 but it just hit PubMed this month.  There was a release delay secondary to the two government shutdowns. https://pubmed.ncbi.nlm.nih.gov/42658912/ #emergency #emergencymedicine #icu #criticalcare #science by @armyemdoc
0
14 days ago
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