We often see vague ED assessments: listing symptoms, or a long list of differentials rather than a suspected diagnosis (or most likely couple of candidates). Is that standard practice? I've been told it's because it's better not to commit in case it's litigated, but I've always thought that was a rather weak argument. Of course, if you don't know, you don't know; but I was taught that including your thought process is more easily defensible than not?

The other argument I could guess at is that the ED is for symptomatic treatment only, but that seems inaccurate and a discredit to the work they do.

Then again, I don't usually need ER notes to be that detailed, but I've always erred on the side of including more information/thoughts if I have them rather than purposefully omitting things.

Any thoughts on best practices?

With the political situation today I think it's time to invest in a home kit for my family to be better prepared for a realistic scenario with a new pandemic, lack of medications etc. Obviously I have access to all prescription medications as a MD. What would you personally include in such a kit?

I don't want a political discussion or a discussion around if this is needed or ethicac (self prescribing is legal where I live).

Link to NPR article

“Second child dies from measles-related causes in West Texas, where cases near 500”

If the death rate for measles is typically 1-2 per 1000 cases, the math ain’t mathin’

SIADH is one of the worst things I like to treat. I've seen our nephrologists use various combination of the following: fluid restrict, lasix, salt tabs, urea packets. So far, in addition to fluid restriction, using urea packets seems like the easiest treatment since it doesn't involve diuresis nor does it increase BP with the extra salt load.

These days when I see SIADH i just slap on urea packets BID or TID. They seem to work well. Before I systematically use them for every SIADH I see, are there any downsides to them?

We know little about this 2nd child, except the child was unvaccinated. BUT: I’d like to comment on the first child, and RFK Jr’s proclamation about the first child, which is highly likely to be bullshit. 

According to the Mennonite Church USA website, the group with the first measles outbreak in Texas are Old Colony Mennonites - this old order group tends to be agrarian, and avoids modern lifestyle. Although not as communal as old order Amish, they live with a “village” philosophy and freely give mutual aid.

I have cared for old order Mennonites as a physician. It is highly unlikely that the Mennonite child was malnourished. Old order Mennonites do not eat junk food. Many farm or garden and preserve much of their own food. Their children eat healthy, well-balanced diets and have normal growth patterns. Along with the Amish, they probably have the healthiest childhood diets in the US today. A family in such a colony would prioritize their children’s diets even if impoverished, and would freely seek and receive food from within their community if needed. 

RFK Jr. believes in “functional medicine”, and has stated that he personally takes “a ton of supplements."

RFK Jr. likely thinks if you don’t take supplemental Vitamin A daily, then you must be malnourished. 

Meanwhile, the hospital caring for the majority of children with measles in Texas has stated this: many of their hospitalized children were admitted with unexpectedly elevated LFTs and even jaundice. This was attributed to excess supplementation of Vitamin A, resulting from parents home-treating, or trying to give prophylaxis with too many daily doses. 

Good read: https://www.mcgill.ca/oss/article/medical-critical-thinking-health-and-nutrition-pseudoscience/american-plan-eliminate-vaccines

Some questions:

1. If this holds true, will even diseases like rabies come back?

2. We already see leakage of this movement in Europe and elsewhere, what will the effects be on global immunity?

3. Which diseases will come back with most fervor? Right now it's measles, likely to stay on top with its insane R0; what will be number 2?