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Dr. Steve Schauer, PGY16

@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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Come listen to @armyemdoc tonight at 5:30 on zoom! Open to all HPSP students or those interested in the EM or Intensive Care fields!

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How do we train up to excel at mass casualty (MASCAL) management before big exercises?

Some units treat the exercise as training and exposure, instead of validation. We shouldn’t get a pat on the back for merely surviving chaos. We should aim to be managing these well, which means preparing in advance.

This may also mean getting another opportunity to refine mistakes made during the exercise through another iteration, instead of saying, “yeah we will fix these next time” (6-12+ months away).

How can a senior medics or provider prepare their units to succeed in these exercises BEFORE dozens of roleplayers covered in moulage pour through?

Let us know what classes, tips, tricks and drills you find useful to help prepare the team for their roles and responsibilities.

🚨One big mistake is newer medics getting tunnel visioned on medicine and treatment sucked into patients before triage.🚨

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A normal pH doesn’t always mean a normal ABG.

The real skill is recognising when the numbers *don’t fit together*—and looking for the metabolic disorder hiding underneath.

In ABG Series #4, I break down a practical approach to metabolic disorders, anion gaps, delta gap, compensation, and the ‘second disorder.’

📖 Read the full clinical approach → Link in bio

Follow @humans.of.em for practical, evidence-based ED, ICU & acute care learning.

#EmergencyMedicine #CriticalCare #ABG #AcidBase

@resuscitateindia @icuinternalmedicine @drpeterkas @docreilles @thepracticeshift @armyemdoc @drmansi_01 @defineshock @drvirenkaul @neurologistdiary @em_rounds_with_pk @dr_basil_salim_medical_updates @criticalcarenow @icuinternalmedicine @critical_care_time @drvirenkaul

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Welcome to the RSR Darkroom. 🩻 Join the RSR guys, Chris and Gary, for our FREE Friday newsletter:
🔎 Practical imaging approaches 🩻 A case walkthrough ⚖️ One medicolegal case. Three takeaways. 🎟️ Offers on RSR courses
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💬 Comment “DARKROOM” and we’ll send the signup link straight to your DMs. Link is also in Bio!
A clearer read. Every week.
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#RSRDarkroom #EmergencyMedicine #radiologyeducation

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When every second matters, research drives readiness.

@usarmy Lt. Col. Dr. Steven Schaeur discusses the latest research on calcium levels in trauma patients at #MHSRS2026.

This work will help inform treatment approaches and strengthen evidence-based trauma care, improving outcomes for warfighters when it matters most.

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Thoughtful Thursday. With the results of COVALENT trial I had to rethink my approach to VL for intubations.
Did that study change your practice and if so are you still using a bougie????

Drop me a DM if you haven’t read this paper and I’ll send it your way!

#DnR #ems #emt #paramedic #airway

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What is the status on status? In this single-center retrospective study, O’Keefe et al looked at initial dosing of benzodiazepines (BZDs) for the management of status epilepticus (SE) in the emergency department. Remember that SE is defined as continuous seizure activity or seizure activity without recovery of baseline mental status for a minimum of 5 minutes.
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Guideline recommended dosing of BZDs in SE include IM midazolam of 10 mg for patients >40 kg, or 5 mg if 13 - 40 kg; IV lorazepam 0.1 mg/kg up to 4 mg with the option to redose; or IV diazepam 0.15-0.2 mg/kg up to 10 mg with the option to redose. The primary outcome was the incidence of treatment escalation between patients who received below guideline-recommended doses vs. those that received guideline recommended doses of BZDs.
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There were 144 patients included in the study, with 88.2% of patients receiving below guideline recommended dosing for their initial dose (🤯). The patients in the initial underdosed group were significantly more likely to require treatment escalation, had longer mean hospital length of stay (LOS), longer mean ICU LOS, with no significant differences in mean ventilator dependent days or incidence of adverse events. In the cumulative 20-minute dose comparison, there were 43.8% and 56.2% of patients in the underdosed and guideline-dosed cohorts, respectively. There were no significant differences between groups.
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Bottomline - patients who did not receive an adequate initial dose of BZDs were more likely to require treatment escalation, driven in this study by the use of second-line anti-seizure medications, and experience longer hospital LOS and ICU LOS. For more check out PMID: 42013624.
#emergencymedicine #pharmacy #pharmacist #pharmacystudent #pharmacyresident

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I didn’t realize how often we miss toxicity from everyday products until I started looking for it. That “unexplained” hypoxia That arrhythmia or weakness. Sometimes the clue is sitting in the patient’s medicine cabinet.

It’s time to shift our practice and ask beyond, “What medications do you take?”

Start asking about the OTC products, supplements, and how much they’re actually using.

Which of these have you seen? What would you add?

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You do not need a diagnosed TBI to have blast exposure documented in your medical record.

As of October 1, 2026, new ICD-10 codes specifically identify low-level and high-level blast overpressure exposure without diagnosed injury.

If you’ve spent years firing heavy weapons, conducting breaches, or working around explosives, talk to your medical provider about documenting your exposure history.

Save this post and share it with your medic, PCM, or anyone who needs their blast exposure on record.

DHA Coding Quick Reference:
https://health.mil/ICD10TBIQuickReference

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Adam, the CTOMS Training Director, supervises instructors during scenarios in the middle of an advanced tactical medical course for medic students.

For more information about how we can customize tactical medical training programs for your agency or department, contact training@ctomsinc.com.

#CTOMS
#TCCC
#TECC
#LeaveNothingToChance
#ControlTheChaos A tactical medicine training director in a camo uniform and black cap stands inside a simulated combat environment, supervising an advanced trauma course.

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Acute heart failure ≠ automatic Lasix.
The phenotype matters.
Cardiogenic, vasogenic and cardiac-congestive presentations can require very different first steps.
I explored this controversy in my new Clinical Controversies article in Annals of Emergency Medicine.

📖 Read the full article — link in bio.
#EmergencyMedicine #AcuteHeartFailure #FOAMed #POCUS #CriticalCare

@criticalcarenow @criticalcarereviews @journalfeedem @sangrialovingairwaydoc @emswami @heystevemd @docreilles @emrapshow @drpeterkas @annalsofem @defineshock @theicuchannel @icuinternalmedicine @neurologistdiary @yourheartdoc @drjeffyoo @rishimd @goldenhouroflife @mystoryrising @gallodemoraesmd

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As an emergency physician, I see a lot of patients with cancer come through the ED with dyspnea, chest pain, and concern for PE. Because their baseline risk is higher, we often have a very low threshold to go straight to CTPA.

That is why this study caught my attention.
In the HYDRA trial, using the YEARS algorithm in selected patients with active cancer was noninferior to a CTPA only strategy and avoided CT imaging in 22% of patients.

That could mean fewer unnecessary scans, less radiation, less contrast exposure, and potentially less time spent in the ED. But there are important methodological limitations here, including changes to the noninferiority margin and a substantial number of patients excluded from the primary per protocol analysis.

So this is interesting. It is clinically relevant. But it is not a reason to change practice.

⚠️Please read the paper yourself before changing how you evaluate patients. My goal with these posts is to highlight and summarize new evidence, not replace critical appraisal, clinical judgment, or guideline based practice.

📚Reference:
Akerboom B, Martens ESL, Stals MAM, et al. YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer: A Randomized Clinical Trial. JAMA. 2026;336(8):655-663. doi:10.1001/jama.2026.10676.

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