FOAM Supplement 2/7/2016

FOAM Supplement 1/10/2017

FOAM Supplement 1/3/2016

FOAM MegaSupplement

FOAM supplement 11/01/2016

@WUSTL_EM #FOAM #EMConf 10/12/2016

….And we’re back, after a brief hiatus the FOAM supplement is here once again!

Immune Complex:

Vent management

Case Presentations

EMS and the DEA

@WUSTL_EM #EMConf #FOAMed Supplement No. 41

@WUSTL_EM #EMConf #FOAMed Supplement No. 40


NonST Elevation ACS & ECMO

Source: 2014 AHA/ACC NSTE-ACS guidelines (emphasis mine)


MSK & Radiology of the Hip


@WUSTL_EM #EMConf #FOAMed Supplement No. 39

@WUSTL_EM #EMConf #FOAMed Supplement No. 38

@WUSTL_EM #EMConf #FOAMed Supplement No. 37



Trauma & Teamwork

Stroke Protocol


@WUSTL_EM #EMConf #FOAMed Supplement No. 36

1. Core Content: Cutaneous Disorders

 2. In the Hunt: Job Search in EM

 3. Tachy-Dysrhythmia Cases

Note: I’ve been told that a “small child with ADHD in City Museum could focus longer than you” - we hear a lot of the concepts from the first half of this lecture repeatedly. The second half is equally high yield - consider starting in the middle and looping back.

Just for our own Dr. Kolinsky:

4. MSK:Ankle/Leg/Foot

- Adam Rieves, PGY-1


@WUSTL_EM #EMConf #FOAMed Supplement No. 35

@WUSTL_EM #EMConf #FOAMed supplement No. 34

Palliative Care

This brief talk by Ashley Shreves, entitled "Diagnosing Dying" showcased on the intensive care network is an excellent resource for an emergency physician.


testicular torsion

emdocs covers the Pearls & Pitfalls of Testicular torsion in this post.

If you prefer a more bulleted format, Core EM covers the diagnosis & management of testicular torsion as well.

Sonoguide covers the basics of bedside testicular ultrasound.


Peds Interesting Case:   Hair Grooming Syncope

Believe it or not, the FOAMed world has tackled this one.  See this peds em morsels post on hair grooming syncope.

For an approach to cardiac syncope, our own blog has this post on the can't miss EKG findings in a young patient with syncope.



Where to start?  The crew at Boring/CanadiEM made this great infographic on the Top 5 updates to the AHA guidelines.

Rebel EM discusses the how-to of double sequential defibrillation for refractory Vfib arrest.

EMS world covers the history of heads-up CPR.

This post on Dr. Smith's ECG blog (entitled "A perfect resuscitation saves a patient") sounds like it may have been plucked from DK's dreams (although it does not include TEE).


Age Adjusted d-dimer

EM Cases covers Age Adjusted d-dimer in the Journal Jam podcast.

Age adjusted d-dimer was covered by Brian Cohn in our own Washington University Emergency Medicine journal club & podcast.


Ultrasound:  Right Upper Quadrant

The ultrasound podcast covers gallbladder ultrasound.

Check out this interesting case from Ultrasound Case of the Week.



Maia Dorsett (@maiadorsett)

@WUSTL_EM #EMConf #FOAMed Supplement No. 33


1. 4th year grand rounds: intubating the asthmatic

- EM Lyceum discusses adjuncts to the management of asthma in this post.

- The EMCrit Dominating the Vent series has this fantastic review.  Listen, watch and take notes (and then scan your notes into your phone for quick reference).

- Since great minds think alike, the topic of the Core EM podcast this week is none other than Ventilating the Intubated asthmatic.


2.  Abscesses

- The Mayo EM blog argues that we should not be packing abscesses.

- EM Lyceum covered the literature on abscess packing and the loop drainage technique in this post.


3. Surgical airway

there are a plethra of #FOAMed resources on surgical airway.   Consider watching this Vodcast by Rich Levitan on the decision to perform & how to perform a cricothyroidotomy.


4. Cognitive Errors & Stress Innoculation

This week em mindset covers cognitive load theory.  A useful read for any EM physician.

EMCrit covered David Grossman's On Combat in the EMCrit Bookclub episode.

Listen to what Mike Lauria has to say about stress innoculation.


5.  The Foot

Detecting the fractures: Radiopedia reviews an approach to radiology of the foot, with links to more extensive discussions of important fracture patterns.

Northwestern's Orthopedic teaching site also has this case-based review of foot cases.

Nerve blocks to help reduce them:

Ultrasound podcast covers the Tibial Nerve Block and Sciatic and Ankle Blocks.


Enjoy & please comment if you have additional resources to share,



@WUSTL_EM #EMConf #FOAMed Supplement No. 32

1. INteresting cases - TTP

- emdocs has this nice review of TTP physiology, diagnosis and management (including mention of cardiac complications).


2. Pediatric Airway

- emdocs has both this article on general pearls and pitfalls of the pediatric airway, and another on management of the pediatric patient with airway obstruction.

- If you prefer podcasts, check on this EM:RAP episode on difficult pediatric airways or this one from the pem.ed podcast.


3. Central Venous Catheter Complications

- Listen to EMCrit podcast 156 on avoiding central line complications and podcast 157 on central placement tips.


4. Gout

- If you're inclined, go ahead and review The American College of Rheumatology 2012 guidelines on the management of gout.

- The Mayo Clinic EMBlog has this excellent post on the diagnosis and treatment of gout in the ED.  Importantly, it discusses the importance of considering the important alternative diagnosis of septic arthritis.

- The Poison Review discusses colchicine dosing in acute gout and why you should probably stick to the lower dose.


5. Critical Care Scholar Track - Sepsis 3.0

Step one:  Before reading or listening to the podcasts and blogs, read The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) paper for free in JAMA.

Step two:  check out these blog posts and podcasts discussing the new definitions:

    - FOAMcast: Sepsis Redefined

    - REBEL EM : Sepsis 3.0

    - Scott Weingart discusses Sepsis 3.0 with Melvin Singer

    - PulmCrit discusses the Top 10 Problems with the new sepsis score.

.... and remember, CMS has not changed over to this new definition.  So when it comesto documentation, the SIRS-based, three-tier system of sepsis, severe sepsis & septic shock still stands.



Maia (@maiadorsett)


@WUSTL_EM #EMConf #FOAMed Supplement No. 31

1. Core Content - Endocrine

- emdocs comes through again, with an excellent summary of the ED management of adrenal crisis.

- A case-based study of adrenal crisis in a patient initially presenting with an acute abdomen, from PonderingEM.

- Check out this extremely thorough PDF from Life in the Fast Lane, all about Cushing Syndrome.

- From First10EM, an excellent primer on ED management of life-threatening hyperkalemia. (And don't miss the FOAMed Tour de Hyperkalemia at the bottom of the post!)

- It's more than just peaked T's, you know. Let the smart minds at R.E.B.E.L. EM set you straight on EKG changes seen in hyperkalemia.

- Hyperkalemia gets all the attention, but critically low potassium can be life-threatening as well. Let the folks at LITFL walk you through a case.

- And finally, from EM Cases, a discussion of the ED management of the myriad causes of hyponatremia.


2. Knowledge Translation

- Don't be that guy -- keep up with the evidence and use it to better your practice. Resources such as TheNNT, the TRIP database, and the Cochrane Collaboration are all invaluable resources. And don't forget FOAMsearch, your search engine for everything FOAMy out there.

- For more background, check out these two entries from the Skeptics' Guide. The first covers the history of evidence-based medicine in EM, and the second explores the role of FOAMed in knowledge translation.

- From EM Cases, a discussion with several FOAMed pioneers and predominant figures on how to integrate social media and FOAMed into the lifelong learning required of an emergency physician.

- From CanadiEM, two excellent examples of well-designed and composed infographics highlighting how we can translate clinical research knowledge into pearls applicable at the bedside. The first covers new CPR guidelines, and the second discusses some changing first aid paradigms beyond cardiac arrest.


3. QI

- Pediatric EM Morsels posted a summary of baclofen pumps, and most of it is applicable to adults, too.

- Take advantage of your EM:RAP access as EMRA members to check out this LIN session on intrathecal pumps, with a special section about baclofen withdrawal. (If you are having problems setting up your EMRA membership and EM:RAP access, contact your friendly neighborhood Social Media Committee member!)

- Two great links from R.E.B.E.L. EM regarding MTP use in trauma -- the first a holistic overview of the Ten Commandments of Trauma Resuscitation, and the second a very helpful summary of the PROPPR trial.

- Not to be outdone, emdocs also features two excellent posts covering hemodynamic management in the exsanguinating trauma patient, one about MTP and the other a "FOAMed Roadmap to Permissive Hypotension."


4. Radiology & MSK Injuries of the Hand

- From emdocs, don't miss these subtle but high-risk hand pathologies.

- If you missed it the first time, now's your chance to get an orthopod's perspective on tendinous hand injuries, from right here at EverydayEBM.

- Check out these two posts from LITFL covering various traumatic hand injuries.

- And finally, from our favorite orthopedic resource here at EverydayEBM, a plethora of ortho hand cases from our friends at Northwestern.


Never stop learning,

C. Sam Smith

@WUSTL_EM #EMConf #FOAMed Supplement No. 30

1. Core Content: Endocrine

- emDocs has all you ever wanted to know about DKA. Check out their posts on DKA resuscitation, myths in DKA management, and DKA in pediatric patients (with a focus on cerebral edema).

-emDocs also has the thyroid covered, with summaries of myxedema coma and thyroid storm.


2. Dealing With Racist Patients

- Start with the original piece from the New England Journal, available here as an open-access PDF.

- Don't miss this entry from Emergency Medicine Cases, a discussion of patient communication as a focus of patient-centered care.

- And another Emergency Medicine Case, this time focusing on communication with the difficult patient.


3. Hiking the Appalachian Trail

- To start, a brief Wilderness Medicine primer with links to Wilderness Medical Society resources, from LITFL.

- Don't let treating high-altitude sickness leave you breathless. Let the bright minds at LITFL break it down for you.

- Coming soon to a road or trail race near you: exercise-induced hyponatremia.

- Don't sweat it: emDocs has you covered when it comes to heat-related illness.

- Forget the Tox consult and bone up on snake envenomations (of the North American variety).


4. Critical Care Ultrasound

- From the Ultrasound Podcast, Part 1 and Part 2 of their 'cast on pericardial tamponade.

- Don't want to give away all the fun, but these three cases from Ultrasound of the Week might have some relevance to the topics covered by Enyo this week.


5. Gun Violence in St Louis

- A must-watch for any ED provider, Dr. Gary Slutkin's TED talk, in which he makes a case for treating gun violence as a contagious disease.

- From the BBC News, a piece entitled "The Delmar Divide," which really needs no explanation for anyone familiar with St. Louis.

- Find out what you can do to make a difference by visiting the homepage of Gun Violence as Public Health Crisis initiative from the Wash U Institute of Public Health.


Never stop learning,

C. Sam Smith

@WUSTL_EM #EMConf #FOAMed Supplement No. 29

1. Stevens-Johnson Syndrome

- emDocs has an excellent summary of SJS & TEN in the pediatric population.

- From the Northwestern EM blog, a case-based study of SJS & TEN in an adult.

- The HIPPO crew made this podcast of boards-review derm topics freely available -- take advantage!


2. Pediatric Orthopedic Emergencies

Upper Extremity:

- From Don't Forget The Bubbles, tips & tricks for diagnosing elbow injuries.

- All you ever wanted to know about supracondylar fractures from LITFL.

- Wrist and distal forearm injuries in peds and adults, from emdocs.

Lower Extremity:

- Once again Don't Forget the Bubbles brings it, this time covering ankle injuries.

- Peds EM Morsels breaks down Osgood-Schlatters Disease.

- Finally, check out this series of nine cases of pediatric orthopedic injuries from the Northwestern Orthopedic Teaching site.


3. pediatric interesting case conference: AMatoxin

- St. Emlyn's with the skinny on Amanita mushroom poisoning.

- An excellent discussion of various types of mushroom poisoning -- there's more than just amatoxin! -- from the magnificently-named EM Cephalgia.

- Not quite FOAMEd, but an interesting read nonetheless: A long-form journalism piece from Slate about death-cap mushroom poisoning.


4. Education Lecture: "Down The Tubes"

- Don't Forget The Bubbles gives us all we'll ever need to know about gastrostomy tubes in our pediatric patients, in a three-part series.

- Because "pull-start it like a lawnmower" isn't a viable option: Life In The Fast Lane jumps in with a case-based review of strategies for getting out that stuck Foley.


5. FOllow-Up Conference: Blood Cultures

- Our own Drs. Oberle & Dorsett tackled the lack of evidence to support routine blood cultures in cellulitis and pyelonephritis as part of our Hippocratic Medicine series.

- The smart dudes at Academic Life in EM also looked at the evidence (or lack thereof) in support of blood cultures for cellulitis and pneumonia.

- The JAMA Rational Clinical Exam Series is unfortunately *not* FOAMed, but luckily the Little White Coats provided us with a PV card summarizing the salient points of the installment "Does this adult patient need blood cultures?"


6. EMS Scholar Track: Fire

- Case study from LITFL highlighting the toxicologic dangers of smoke inhalation.

- Scott Weingart with an EMCrit piece highlighting the management of the combined carbon monoxide and cyanide toxicity that can occur in exposure to structural fires.


Never stop learning,

C. Sam Smith, PGY-4

@WUSTL_EM #EMConf #FOAMed No. 28

1. ENT Core Content [CSS].

There are lots of great resources out there to review PTA presentation & drainage:

- HQMedEd has this review of the procedure

- EMRes podcast on PTA drainage.

- Review/practical guidelines on "quinsy" management from the ENT FOAMed page.

-"Owning the PTA" from EMCurious Procedures Club


2. Imaging in Blunt Trauma

Head Imaging

- REBEL EM has this nice review and discussion on management of anti-coagulated patients with minor head trauma. [MD]

- emdocs reviews the literature and recommendations regarding management of the head injury patient on anticoagulants. [CSS]

- SGEM reviews the Canadian & New Orleans head CT rules. [CSS]


C-spine Imaging

- Clear the C-collar? Patient with midline neck tenderness but no neurologic deficits?  This study in the Journal of Neurosurgery suggests that you take it off. [MD]

- EMNerd discusses the problems of automatic MRI in CT negative C-spine injury patients. [CSS]


Chest & Abdominal Imaging

- A review of NEXUS chest imaging/validation from ALiEM. [CSS]


A Foray into Peds [CSS]:

- From Everyday E(B)M, Michael Galante reviews a clinical decision rule for imaging in Peds Blunt Trauma.

- Peds EM Morsels discusses clinical decision instruments for evaluation of low risk abdominal trauma.

- The SGEM reviews a recent paper comparing clinical gestalt with clinical decision instruments in Peds trauma.  You can link to the critical appraisal written by our own Dr. Cullison here.


3.  Interesting Cases

Diagnosis of Subarachnoid Hemorrhage

- From Everyday E(B)M, Kevin Baumgartner reviews the evidence behind the "6 hr LP rule". [MD]

- Need help navigating the differential diagnosis of diplopia?  Read the review, "Deciphering Diplopia"  from The American Academy of Ophthalmology. [MD]

- Review of Terson's Syndrome from the American Academy of Ophthamology. [CSS]

- Broomedocs discusses Shared Decision Making in the ED. [CSS]


Difficult Airways:  Approach to Fiberoptic Intubation [CSS]

- ALiEM has a PV Card for Angioedema.

- emdocs has this "Awake Intubation Rundown".


4.  The New Opium War[CSS]

- Scott Weingart interviews Sergey Motov on the Opiod-Free ED.

- Read this St. Emlyn's discussion on the difference between "pain" and "suffering"

- Go ahead an watch this TED talk on the "Mysteries of Chronic Pain."

- Emergency Medicine Cases discusses two cases of Opiate Misuse and Addiction in the ED: Case 1 and Case 2.



C. Sam Smith

Maia Dorsett