#EMConf

FOAM Supplement#EMConf #FOAM

Two-fer this week between the last two weeks' worth of conference!

Cardiology - Core Content & Guest Lecture

Again, thanks to Dr. Schneider for the cardiology FOAM

Part II: https://emcrit.org/emcrit/who-needs-an-acute-pci-ii/ (of note: the show notes for both podcasts are on part 1’s page)

Perimortum C-Section

Shoulder Radiology

CPC - You don't have to be 'appy about it

Pediatric Ortho

Atrial Fibrillation

Delayed ICH in the anticoagulated patient

 

 

 

FOAM Supplement!

Hi team, we had two weeks of special conference time, namely the highly successful Larry Lewis (not memorial) Symposium on the Opiate Crisis, and mock oral boards. 

Opiates

Oral Boards

Foundations: Pulmonary

Pelvic Ultrasound

EMS Grand Rounds

Toxicology: Alcohol Withdrawal

@WUSTL_EM #EMConf #FOAMed Supplement No. 21

This week we had our semi-annual combined educational conference with St. Louis University Emergency Medicine.  The topic was "Myth Busters" and it was an entertaining, rapid-fire format touching on many myths in emergency medicine.  A whole lot of topics were covered. Here are #FOAMed resources related to most of them.

 

s1q3 in PE

- Amal Mattu covers the ECG Findings of PE, and why you should be primarily be looking for inferior & anteroseptal T wave inversions.

 

Kayexylate in Hyperkalemia

- Emergency Medicine News had this article by the Swami about the lack of use & potential harms in hyperkalemia.

- EM Lyceum covers the management of hyperkalemia (and why kayexalate should not be a part of it) in this post.

- The WashU EM Journal Club covered the evidence of Kayexalate for Acute Hyperkalemia in May 2011.

 

Coags before Paracentesis?

- FOAMcast covers approach to hepatic emergencies, including current ACEP recommendations regarding coagulopathy and performing a paracentesis.

- emdocs covers the Approach to the Sick Cirrhotic Patient.

 

is Droperidol dangerous?

- Everyday EBM covers the evidence (or its absence) surrounding droperidol and the risk of cardiac arrhythmia.

- The Poison Review covers the evidence that ED sedation with droperidol is relatively safe and effective.

 

Is the osmol Gap useful in evaluating for toxic alcohols?

- You don't understand the Osmol Gap from EMNerd & EMcrit

- emdocs covers toxic alcohols, including the time course of changes in the osmolar & anion gap: "osmolar gap will be elevated early on as the parent compound of the toxic alcohol is still present; however, it will gradually decrease, and the anion gap will increase as more toxic metabolites are formed."

 

DOES Lying flat after lumbar puncture and drinking plenty of fluid prevent post-LP headache?

R.E.B.E.L. EM covers Post Lumbar Puncture Headaches.  Take home: Use a smaller needle and don't worry about laying flat.

 

Does Trendelenberg work in Patients with Shock?

BestBets covers the LACK of evidence that Trendelenberg position to improves hemodynamics during hypovolemic shock.

Life in the Fast Lane covers some of the complications of using the Trendelenberg for the hypotensive patient.

 

FAST exam in the stable trauma patient

Washington University emergency medicine journal club reviewed the evidence regarding the FAST exam in the hemodynamically stable trauma patient.

 

AV nodal blockade in Ventricular Preexcitation

Who's Afraid of the Big Bad Wolff? from Life in the Fast Lane

ECG Medical Training gives an Intro to WPW and Associated Arrhythmmias

 

Do all trauma patients need rectals?

NEJM Journal watch covered why you should consider skipping the rectal exam in trauma

Life in the Fast Lane covers the subject in Adding Insult to Injury?

 

Patients leaving AMA?

Taming the Sru discusses the "A.I.M.E.D." approach to the patient who wants to leave AMA

 

Tetanus prophylaxis

EMRap covers the Mysteries of the Tetanus Shot

 

Tramadol for pain?

Emergency Medicine PharmD covers Three Reasons Not to Prescribe Tramadol.

 

IV Acetaminophen for Pain

Emergency Medicine PharmD discusses whether there is a role for IV Acetaminophen for pain management in the ED.

 

Can you give a third generation cephalosporin to a patient with a penicillin allergy?

Yes. You Can. EM Literature of Note covers why its okay.

ALiEM busts the myth of the 10% cephalosporin-pencillin cross-reactivity risk (Thanks to @elewMD for sharing via twitter!)

 

Can you give ketamine to the patient with TBI?

The SGEM covers why you can go ahead and give ketamine to the trauma patient that you are about to intubate.

Taming the Sru discusses ketamine in TBI.

 

Other:  Myths in Emergency Medicine from emdocs

Enjoy,

Maia (@maiadorsett)

 

@WUSTL_EM #EMConf #FOAMed Supplement No. 20

1. Core Content: Pelvic Inflammatory Disease

- emdocs covers the Pearls & Pitfalls for diagnosis and management of Tubo-Ovarian Abscess.

- EM Lyceum has a nice review of Pelvic Inflammatory Disease

2. Sound Rounds

- The #FOAMed version of Sound Rounds?  Ultrasound of the Week, tidbits of wonderful case-based US learning.

3. Tox Experts: The Urine Drug Screen

-Peeing into the Wind?  ALiEM covers Urine Drug Screens: Post 1 (Benzodiazepines) and Post 2 (opiates)

- ALiEM also has this PV card to help you review agents that can cause false positive urine drug tests.

4. Palliative Care in the Emergency Department

- Hippocratic Medicine Series covered the importance of Palliative Care in the ED.

- We recommend reading this review article on Emergency medicine and palliative care by our alumnus, Derrick Lowery.

- This article discusses the role of cognitive bias and behavioral economics in patient decisions regarding medical information, including goals of care.  It's a fascinating read.

- EMcrit actually talked about the importance of end-of-life conversations in the ED way back when with Podcast #25.  [One caveat, palliative care and comfort care seem to be interchanged in this podcast, but they are NOT the same thing].

5. Traumatic Arrest

- Review the 2015 East Guidelines for Emergency Department Thoracotomy here.

- Rebel EM covers All things thoracotomy, including the role of FAST exam in predicting survivors.

- The late John Hinds discussed his approach to management of traumatic arrest on EMcrit.  This one is a classic.

- If you never have watched John Hind's SMACC talk Crack the Chest, Get Crucified, do so now.

- What do you really need for an ED thoracotomy?  Scott Weingart talks about the essentials in the Abbreviated ED Thoracotomy tray.

- Emergency Medicine Ireland covers Learning Points from a first time ED Thoracotomy (videos included).

Enjoy,

Maia (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 18 & 19

Conference October  21st [LJ]
1. Interesting Case Conference
Sometimes its important to know the atypical presentations of common diseases.  This week we discussed Kawasaki Shock syndrome.  emdocs discusses the reasons for delayed diagnosis in Kawaski disease. f you are having trouble remember all the diagnostic criteria, check out the ALiEM  card for Kawasaki's disease.

2. Abscess/Cellulitis and Antibiotics
- Dr. Willman gave a great presentation discussing the benefit of antibiotics in patients with abscess/cellulitis.
- EP Monthly promotes skipping the antibiotics unless systemic illness or severe immunosuppression is present.
- FOAMcast discusses the ISDA guidelines suggesting that Bactrim is probably sufficient as a single agent for MRSA and Strep Coverage.
- On a related topic, the SGEM discusses Clinda vs Bactrim for SSTI

3. EMS and the changing the healthcare landscape. 
Dr. Brent Myers discussed the coming tide of payment reform and its effect on EMS.  JEMS discusses EMS and bundled payments.

Conference October 27th [MD]
1. ECGs in PE
- We covered Amal Mattu's episode of ECG findings of PE.   Take home:  Inferior + Anteroseptal T waves inversions > think PE!
- Everyday EBM EKG Challenge No. 5 reviews an interesting case of  ST elevation in PE.
- Dr. Smith's ECG blog covers the ECG findings in PE

2. #RightCare in Emergency Medicine
- To Read More about the Lown Institute, check out their webpage or focus specifically on Right Care Action week here.
- If you did not get a chance to read the Wired article about David Newman, do so now and make sure to check out the NNT.com
- To read more about the silent epidemic of preference misdiagnosis check out these two blog posts at the BMJ: 1 and 2.
- Shared Decision Making is one technique to avoid Preference Misdiagnosis.  Read about Emergency Physicians Perceptions of Shared Decision Making in this article in Academic Emergency Medicine.
- Check out our own Hippocratic Medicine series about examples of the harms of overtesting or overuse, and stay tuned for an upcoming post on Lessons from #RightCare Week at the Barnes Jewish ED.

Enjoy,
Louis Jamtgaard (@Lgaard)
Maia Dorsett (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 17

1.  Core Content: Tick Born & Viral Illness
- emdocs covers Diagnosis and Treatment of Rocky Mountain Spotted Fever in the ED.
- What's the data surrounding tamiflu use for influenza?  EP Monthly reviewed it in this article and EM Lit of Note addressed here. The NNT.com also analyzed the numbers for treatment of influenza with tamiflu

2. Rural  & Farm Trauma
- Life in the Fast Lane discusses Trauma's Golden Hour.
- Here is a lecture from Free Emergency Medicine Talks about Farm Related Trauma.
- Refer to Life in the Fast Lane's post on management of open fractures to help with all those Auger-related injuries!

3. Difficult Case(s)
- Beware "unintentional blindness" - the "blocking" effect that occurs when you are performing a challenging task.  A great example is this NPR story on Why Even Radiologists Can Miss a Gorilla Hiding in Plain Sight.
- Radiopedia covers the LeFort Classification.
- The MayoClinic EM Blog covers management of Facial Trauma.
- Everyday EBM assesses the evidence surrounding antibiotics for mandibular fractures.
- EMCrit covers treatment of Aortic Dissection

4. Chest X-ray pathology - for a nice revew, work through this tutorial on Chest X-ray anatomy & pathology

5. Foot Problems
- Taming of the Sru covers the approach to the Foot X-ray.
- Use Northwestern's excellent Orthopedic Teaching site to cover Foot Cases.

Enjoy,
Maia  (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 16


1. Airway Cases - The Severe Asthmatic
- How to manage the ventilator once you've intubated: EMCrit on Ventilator Settings for the patient with obstructive airway disease. [MD]
- EM Rap covers Ventilator Basics in Ventilators 101  Part 1  and Part 2. [AR]
- Annals of Emergency Medicine covers whether Non-Invasive Positive-Pressure Ventilation Improve Outcomes in Severe Asthma Exacerbation? [MD]
- Annals of Emergency Medicine Systematic Review Snapshot covers whether IV Magnesium reduces hospital admission in patients with acute asthma. [MW]
- Our own blog covered the evidence regarding the use of ketamine in acute asthma exacerbation.

2. Termination of Resuscitation (in the Field)
- We recommend reading this retrospective study in JAMA regarding criteria for Prehospital Termination of Resuscitation for Cardiac Arrest.
- Journal of EMS covers Resuscitation past the 25 minute mark. [BS]
- This NPR story covers the post-resuscitation/death "Pause", making the ever-important case to stop what we are doing for a moment, not leave the room, and appreciate the person in the bed. [BF]

3. Emergency Deliveries
- Maternity Training International offers a wealth of educational resources (including instructional videos) to help you prepare for the emergency delivery. [MD]

4. C-spine Clearance
- A bit of an oldie for the FOAMed world, but here is a 2011 podcast from EMCrit on evaluation for C-spine injuries. [SM]
-(Free from EMRA members):  the July 2015 EM-RAP paperchase covers the most recent guidelines for C-spine clearance. [SM]
- Taming the Sru covers interpretation of C-spine CT. [SM]

Enjoy,
Maia Dorsett (PGY-4, @maiadorsett)
Sara Manning (PGY-4. @EM_SaraM)
Mike Willman (PGY-2)
Brendan Fitzpatrick (PGY-4)
Bridgette Svancarek  (EMS Faculty)
Adam Rieves (PGY-1)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 15

 1. Kawaski's Disease and Other Pediatric Rashes
- Life in the Fast Lane covers Kawasaki's disease.  For a quick reference, you can also see ALiEM's Kawasaki PV card.  Peds EM Morsels also covered delayed diagnosis of  Kawasaki's disease in the post.
- WikiEM has some images of basic pediatric rashes.
- UMEM Educational Pearls breaks down rashes into those that involve the palms and soles, desquamate, and have a Nikolsky's sign (helps narrow differential).  I would add that asking if their is mucocutaneous involvement also helps narrow things down.

2. Neonatal Fever Not #FOAMed, but here are some links to the papers discussed by Indi Trehan during his talk:
     Who to tap?  Performance of Low - Risk Criteria in Evaluation of Young Infants with Fever. 
     If LP is indicated, how do you maximize your success?  Maximizing Infant Spinal Tap Success and Ultrasound Evaluation of Spinal Anatomy in Newborns
    Once the LP is done, what do you treat with?Listeria and Enterococcal Infections in Patients 28 days and Younger - Is Ampicillin still indicated?

For #FOAMed resources:
Emergency Medicine Cases addresses pediatric fever without a source.  
PEM Currents Podcast covered The Febrile Newborn.

3. Tumor Lysis Syndrome & Other Oncologic Emergencies
- Test yourself on Tumor Lysis Syndrome basics with this Life in the Fast Lane post.
- emdocs covers Oncologic Emergencies in these posts:  Oncologic Emergencies I and Oncologic Emergencies II.
- Not really #FOAMed, but a good review.  Emergency Medicine Clinics of North America covered "Management of Pediatric Tumor Lysis Syndrome in the Emergency Department".
- Check out this interesting case related to hyperleukocytosis from Life in the Fast Lane.
- UMEM Pearls covers management of hyperleukocytosis/blast crisis

4.Tracheostomy Complications
 - See the Life In the Fast Lane Tracheostomy page .
 -  Management of respiratory distress in the tracheostomy patient as covered by  emdocs and First 10 in EM.

5.  UTI treatment in the ED
- Blake Bruton recommends this article from Emergency Medicine News entitled "Urine Dipstick testing: Everything You Need to Know."
- Best Evidence Topic Reports covers the sensitivity (or lack thereof) of the bedside urine dipstick in ruling out UTI in patient's who presents with urinary symptoms.

Enjoy,
Maia (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 14


Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference. Please post additional resources as comments below or tweet to @WUSTL_EM.


1. Core Content - Eye Emergencies
Dr. Philip Chan @PhilChan86 provided high yield information on causes of vision loss, a topic covered in the always helpful Life in the Fast Lane. Afterwards, head over to Academic Life in EM and work through the AIR Series, HEENT module, covering topics like "The Red Eye" and ocular ultrasound.

2. The Man and the Machine
Dr. Sean Cavanaugh gave us an amazing lecture covering his approach to LVAD patients, and how to troubleshoot common problems.  Summary? #Treat_The_Pt_Then_The_Machine


For more, head over to ED ECMO and get the basics from a review article by Dr. Partyka.

Once you have an idea about how LVAD's work, learn how to troubleshoot managing the crashing LVAD patient. Head over to EM Crit for a podcast and then to the Maryland CC project for video lecture. 

3. Approach to chest xrays
The Resident Focker family gave us a practical approach to chest xrays. Summary? #Haveasystem.  

A quick pocket tool for reading chest xrays can be found at Life in the Fast Lane. If you are an intern and new to radiographs, perhaps start with an interactive learning tool by Dr. Lieberman

4. QI: Early Septic shock, Sedation troubleshooting
Dr. Oberle reviewed the topics of early sepsis management, and common ED sedation complications. 


Dr. Oberle commented on recent publications regarding the benefit of earlier antibiotics in sepsis, see last weeks. #FOAM supplement for reference. In addition,  EM Lit of Note is also questioning the survival benefit. 

Want to be a master of the ED procedural sedation ? Start by using a Sedation checklist by EM Updates, then go on to watch the Sedation Trilogy  for sedation troubleshooting tips 

5.  Msk review: The foot part 1
Dr. Joy English gave us a nice introduction on foot injuries. Summary? #Useyourtools. Check out the The Ultrasound Site where they cover ultrasound diagnostics to potential foot and ankle injuries. 

The dude abides,

Louis Jamtgaard PGY-4
@Lgaard


@WUSTL_EM #EMConf: #FOAMed Supplement No. 13


Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference. Please post additional resources as comments below or tweet to @WUSTL_EM.

1. Core Content - Eye Emergencies
-  EM Lyceum reviews topical anesthetics for corneal abrasions, timing of follow-up for patients with floaters, and the use of ultrasound to assess intraocular pressure in this post.
- Check out the Root Atlas, the "internet's best eye videos", for some instructional videos for procedures such as foreign body removal [this website really is awesome]. 

2. Sepsis in the Prehospital Arena
- One of our residents, Michael Willman, suggested this meta-analysis on affect of antibiotic timing on mortality in severe sepsis and septic shock.
- Consider reading this commentary by Alan Jones' group on the challenges of prehospital sepsis detection.
- See the July 2015 WashU Journal Club summary of studies evaluating early goal directed therapy for the treatment of severe sepsis and septic shock.
- Want to support research? Check out the Crowdfunding Page for development of the "Think Sepsis" tool at the University of Pittsburgh for prehospital sepsis recognition.

3. Neuro MRI protocols
-See this article regarding the increase in MRI exams performed through the emergency department
- Emergency Medicine Cases covers Low Back Pain Emergencies in the ED
- Our own blog covers the sensitivity of imaging studies for diagnosis of CSF shunt malfunction
- Review indications for critical and urgent MRI exams, as well as the correct exam for the indication:
4. Aortic Syndromes & Ultrasound
- Test yourself with Ultrasound Case of the Week #55 and #49.
- EM Curious Ultrasound Leadership Academy covers Aortic Ultrasound
- UMEM Education Pearls covers the suprasternal notch view for detecting aortic dissection.

5. Trauma Simulation -
- I've posted the link to Cliff Reid's talk on Making Things Happen many times, but I'm posting it again because if you haven't watch it yet, then do so now.
- Wash U EM Journal Club covered TXA in treatment traumatic hemorrhage, and the findings were nicely summarized in this article by our own Wes Watkins, Brian Cohn and Bill Dribben in epmonthly.
-ER Cast covers management of neurogenic shock.

Enjoy,
Maia (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 12

Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference. Please post additional resources as comments below or tweet to @WUSTL_EM.


1. Evaluation of Pediatric Abdominal Pain
- Don't Forget the Bubbles had this post on the differential diagnosis for obstruction in the pediatric population.
- Our own EM Journal club covered non-operative management of pediatric appendicitis.
- St. Emlyn's covers the spectrum of pediatric emesis 
- FOAMcast covers pediatric GI emergencies.
- Test your pediatric X-ray prowess with this series of cases of obstruction vs. ileus.

2. Interesting Case Conference - Rocky Mountain Spotted Fever
- A good review on the Emergent Diagnosis of the Unknown Rash, including the deadly causes.
- Crashing Patient covers Tick-Born Illnesses

3. Neonatal Sepsis
- PEM blog reviews the evidence surrounding procalcitonin as a marker of serious bacterial infection in the febrile newborn and you can listen to a podcast about the febrile newborn.

4. Intraparenchymal Hemorrhage - EM Lyceum provides this comprehensive review on emergency management of ICH.

5. Pelvic Inflammatory Disease
- New England Journal of Medicine published this recent review on Pelvic Inflammatory Disease.
- EM Lyceum covers the history & physical exam findings, diagnostic workup & management of PID.

Enjoy,
Maia Dorsett (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 11

 Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference. Please post additional resources as comments below or tweet to @WUSTL_EM.

1. Resilience - We had a great grand rounds by Brendan Fitzpatrick about resilience and its importance to a long, healthy career in emergency medicine.  The importance of this topic is highlighted by this article  discussing the need for resident education on factors contributing to physician burnout.

There are a large number of TEDx talks on the subject (honestly, just google "TED talk and resilience").  Here are links a couple:
    How to Cultivate Resilience by Greg Eells
   Paul Robertson on Crisis is inevitable, Failure does not have to be

The concept of mental toughness and the role of stress inoculation training was discussed several times on with Michael Lauria on both emcrit and iteachEM.  These are great podcasts if you're interested:
  - Enhancing Human Performance in Resuscitation: Going with the Flow
  - Mental toughness Part I.
  - a link to the emcrit book club for On Combat
 - Stress Innoculation training covered on iTeachEM

2. Complex Diagnosis -  We discussed how our cognitive wiring both helps and hurts us in emergency medicine.  Sometimes we have to react based on pattern recognition, but other times need to slow down and think a little more critically in order to prevent potential patient harms.
   - You can read a New York Time's Review of Daniel Kahneman's book Thinking Fast and Slow.
   - Here is a lecture Daniel Kahneman gave at the Woodrow Wilson school of public and international affairs if you prefer to listen instead of read.

With regard to specific learning points covered:
   - See this EKG challenge on Neurocardiogenic Injury which covers troponin elevations and EKG abnormalities with CNS pathology.
   - The NNT addresses the use for heparin for acute coronary syndromes.
   - The Journal Circulation had a three part series on the pathophysiology of adults with congenital heart disease:  Part 1, Part 2, Part 3.

3. C-spine Radiology
- BE SURE to review the latest recommendations from the Eastern Association for the Surgery of Trauma regarding cervical spine clearance in the obtunded trauma patient.
- University of Virginia has this educational tutorial on cervical spine imaging.

4. Urologic Emergencies  - Urology came and spoke with us about practical approaches to Urologic problems in the ED.  We'll just share some tweeted pearls & a few links to some #FOAMed below.


Don't forget the bubbles covers phimosis in this post on penile problems.
You tube has this video from University of Florida Dept. of Urology on troubleshooting urinary catheters.

Enjoy,
Maia (@maiadorsett) and Sam (@CSamSmithMD)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 10


Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference. Please post additional resources as comments below or tweet to @WUSTL_EM.

1. Headache PotpourriIn this section, the 4th year residents taught the first years about some common and uncommon causes of headache in the ED.  The talks were short and sweet, here are some additional resources:

 - See this post on steroids for recurrent migraine headache from our own blog.
- The Ophtho book is a generally great resource for all eye related things.  Here is a link to the chapter on glaucoma  (including the acute angle closure variety).
- LITFL Covered Acute Angle Closure Glaucoma in this post
- See this article regarding the rate (of ~ 9%) of patients with presumed idiopathic intracranial hypertension (pseudotumor cerebri) who have sinus venous thrombosis.
- Bacterial vs. Viral Meningitis?  Review the low discriminatory value of classic signs & symptoms in this post by EMLyceum.
 - Make sure that you measure opening pressure correctly - go ahead and briefly review this resource for lumbar puncture from Emergency Medicine Australasia.

2. Alcohol Withdrawal
- Review the Signs & Symptoms of alcohol withdrawal with this LIFTL post.
- See "Beyond Benzos for Alcohol Withdrawal Syndrome" on this blog
- Listen to this EMCrit podcast on management of severe alcohol withdrawal and delirium tremens.
- Here is a link to the Bellevue paper on aggressive benzodiazepine/phenobarbital protocol for alcohol withdrawal discussed in conference
 - Review the evidence yourself about ketamine as an adjunctive treatment for alcohol withdrawal.

3. Are you LIV'N? Cardiac Ultrasound for the Hypotensive Patient

- EMCurious covered the basics of focused cardiac ultrasound (FOCUS) in this post.
- Go ahead and check out  this video from EMin5 on EPSS for estimation of LV function
- Our own blog covered Takatsubo's Cardiomyopathy as part of the EKG Challenge Series. 

4. Trauma Case Conference:  Crush & Burn
- emdocs covered management of minor burns in the ED
- FOAMcast covered burn management according to Rosenalli 
- The Maryland Critical Care Project covers Managing the Burn Patient in the ICU
- LIFTL reviewed the basics of Crush Syndrome Management
- This NEJM review article gives a nice overview of the pathophysiology and management of acute kidney injury due to rhabdomyolysis.

Enjoy,
@maiadorsett

@WUSTL_EM #EMConf: #FOAMed Supplement No. 9


Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference. Please post additional resources as comments below or tweet to @WUSTL_EM.

1. Trauma in Pregnancy by @rbavs
- Excellent run-down of the pearls & pitfalls of trauma resus in pregnancy by emDocs, including the precarious ventilatory status of pregnant patients at baseline and the general safety of trauma CT imaging as needed, as covered by Dr. Bavolek.
- Question-and-Answer based review of the challenges posed by physiologic changes of pregnancy when evaluating the pregnant trauma patient by @precordialthump at LifeInTheFastLane.
- And the follow up, monitoring & management of this patient – LifeInTheFastLane
- Review the EAST guidelines your trauma surgery colleagues will likely be following, from @cliffreid on Resus.me.
- Pro-tips for utilizing FAST exam in the pregnant trauma patient from the EDE Blog. Remember sensitivity is decreased in pregnancy, particularly in later term, and only a tiny amount of fluid posterior to the lower part of the uterus can be considered “physiologic.”

2. Pediatric Sexual Abuse by Dr. Jamie Kondis
- Excellent podcast from the PEM ED Podcast covering the cornerstone exam findings and red flags in pediatric abuse cases.
- High-yield discussion from January 2014 EM:RAP about the approach to the potential pediatric abuse patient.
- Pediatric EM Morsels with a brief piece on exam findings in pediatric abuse – remember there’s really no such thing as a “pathognomonic” bruise or fracture.

3. Morel Lavallée by Dr. Lucy Hormberg
- Learn more about the diagnosis and management of this uncommon but not unheard-of closed degloving injury from the sage minds at St. Emlyn’s.
- Review the ultrasound and MRI features of these lesions on Radiopaedia. 

4. The EKG in Acute ACS by Dr. Lucy Hormberg
- In an interview with @emcrit, @smithECGblog covers several difficult-to-diagnose ACS cases.
- Don’t miss a posterior MI. Review the EKG signs with this UMEM Educational Pearl. 
- Likewise, don’t miss an inferior MI. Review with LifeInTheFastLane. 
- Pericarditis can be difficult to distinguish from ACS. Let the guru of ED EKG himself, @amalmattu, talk you through it during this ECG Case of the Week.
- Another lecture from the great @amalmattu about the significance of changes in the Forgotten Lead, aVR. 

5. Door to Donut: ED Management of PE-likely Patients, by Drs. Gabe Gomez and Kevin Baumgartner
- Simple algorithm to review the workup of potential PE by @emcrit. Includes a link to a 2015 review article by the master of ED PE, @klinelab.
- Notes from an excellent lecture from the All NYC EM Conference covering the assessment of risk of PE in ED patients, posted at emDocs. 
- Applications and limitations of the PERC rule, also from emDocs. 
- Excellent summary of EKG changes seen in RV dysfunction due to PE from ALiEM – important to know as these patients have significantly higher mortality. 

6. Altered Mental Status in the Critically-Ill Patient, by Dr. Brian Wessman.
- Remember, what you start in the ED carries over to the ICU.
- The key to adequate sedation post-intubation is analgesia, as covered by @emcrit.  
- Use a scale to measure effect and titrate your sedation infusions. Again, analgesia first, with spot dosing of another agent (such as benzodiazepine) as needed. Check out this summary from emDocs. 



Never stop learning,
Sam (@CSamSmithMD) and Louis (@Lgaard)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 8


Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference.  Please post additional resources as comments below or tweet to @WUSTL_EM.
 
1. Things I Wish I'd Known as an Intern aka Approach to the patient by @CSamSmithMD
- I have shared the emdocs mindset multiple times on this #FOAMed supplement, and I must stress how good this series is.  It reinforces so much of what is wonderful about emergency medicine and is full of great advice about how to be a good (maybe even great?) emergency medicine physician.  Most recently,  I HIGHLY recommend this post by Larissa Velez which addresses a lot of the values discussed in Sam's talk.
- The power of the placebo effect is stressed in this EM Lit of Note post.

2. Trauma Resuscitation [thanks to Louis Jamtgaard (@Lgaard) for sending in most of these these links]
- * Every emergency medicine physician (especially our new third years moving into the role of the trauma senior) should watch Cliff Reid's video:  Making Things Happen
- In his lecture, Dr. Jamtgaard covered the unreliability of  blood pressure estimation based on pulse exam in trauma patients.  Rebel EM covered this data in this post.
- Want to read more about permissive hypotension? See these posts by LITFL and EMDocs on the subject.
- Assessment & management of extremity hemorrhage is covered in this post by LITFL.
- For more on tranfusion in trauma: see massive transfusion as covered by EMDocs and discussion of the PROPPR trial by EMCrit and EMNerd.
- The use of TXA in traumatic hemorrhage was critically appraised by our own journal club.  Read the results of the discussion and listen to the podcast.

3. C-spine Radiology - Taming of the Sru has this post with link to a video on interpretation of C-spine CT.

4. Joint Reductions in the Upper Extremities
- See this video  from Temple University on shoulder reduction using intra-articular injection and Cunningham technique shared with @WUSTL_EM via twitter by @ZackRepEM
- Mike Cadogan wrote this post on elbow dislocations for Life in the Fast Lane.
- Orthobullets has this post on management of MCP dislocations. Remember - flex that wrist!

Enjoy,
Maia (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 7

Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference.  Please e-mail wuemresidents@gmail.com to share additional resources (or just post them as comments below).

1.  Starting the year off with Approach to Chest Pain
- See this RebelEM post reviewing the HEART score to risk stratify chest pain patients in the ED.
- EM Literature of Note reviewed the HEART score in this post.
- Review Amal Mattu's approach to low risk chest pain in this excellent podcast by ERCAST
- For some primary literature, you can review Hess et. al. (2012) on employment of a Shared Decision Making Aid to reduce OBS admission for stress testing.
- Don't miss this  recent article by Weinstock et. al. on the low risk for cardiac events for patients admitted to the hospital with two negative troponins and non-concerning EKG changes.

2. Resuscitation Fluids: A Primer
- Didn't follow the Glycocalyx explanation on the first go around?  I don't think most people do.  Don't worry, Life in the Fast Lane has this explanation of the glycocalyx and its role in critical illness which you can access here.
- Our own Evan Schwarz reviews the importance of fluid choice in sepsis here.
- Dr. Wessman recommended several New England Journal of Medicine  articles during his talk, including this one on resuscitation fluids and this one on Albumin vs. Crystalloids.

3. EMS: Systems of Care
The PHARM blog did an excellent job compiling & summarizing the results of the best articles in prehospital medicine in 2014.  You can access this list here. Amongst these articles was this one on how Statewide Regionalization of Care can lead to improved outcome in Cardiac arrest patients.

Finally, please take the time and go here to sign a petition supporting an Air Ambulance for Northern Ireland in memory of the great Dr John Hinds, master of prehospital medicine, teacher of many and tireless advocate for improvement and support of prehospital care.

4. Ultrasound: eFAST
- check out this entertaining "clarification" of the eFAST by Cliff Reid and the Ultrasound podcast team.

5. Patient Satisfaction
- see Emergency Medicine Cases on Effective Patient Communication, Patient Centered Care and Patient Satisfaction.

Enjoy,
@maiadorsett

@WUSTL_EM #EMconf: #FOAMed Supplement No.6


Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference.  Please e-mail wuemresidents@gmail.com to share additional resources (or just post them as comments below).
 
Interesting Case Conference: Guillain- Barre Syndrome
- Life in the Fast Lane has this review of clinical presentation, complications of, diagnosis and management of Guillain-Barre syndrome.
- Our own Everyday EBM published this post on acute neuromuscular respiratory failure.

Pain Control in End-Stage Renal Disease
- We discussed the dangers of narcotic pain management (especially with morphine) in patients with ESRD due to decrease clearance of the metabolite (M6G) which leads to respiratory depression.  The renal fellow's network blog discusses the dangers of opiates in advance renal failure (as well as some suggestions) here.  

- We also  discussed trying techniques of regional anesthesia in end-stage renal disease which can lead to excellent pain control without systemic effects such as respiratory depression. Some of these techniques include femoral nerve and intercostal nerve blocks (you tube videos below).

Femoral Nerve Block for Hip Fractures (Larry Mellick):
  

Ultrasound-Guided Intercostal Nerve Block for rib fractures:



Peds Endocrine
- We discussed the differential diagnosis and management of pediatric hypoglycemia.  Natalie May wrote this practically-minded post and ED management & disposition decisions in hypoglycemic pediatric patients for the St. Emlyn's Blog.
- Life in the Fast Lane published this post on clinical presentation, diagnosis and management of adrenal insufficiency in kids.
- Emergency Medicine Cases published this post reviewing the TREKK (Translating Emergency Knowledge for Kids) consortium recommendations for treatment of pediatric DKA.

ED "Follow-up" Conference - Cellulitis 
- FOAMcast did this Podcast on Skin and Skin Structure Infections
- The Short Coat addresses antibiotic indications, duration and choice for cellulitis in this post.
- Here is a link to the Volz et. al. article on predicting which ED patients will "fail" observation status and require inpatient admission for their cellulitis.
- UMEM has this educational pearl reviewing predictors of failure for outpatient antibiotics in ED cellulitis patients.

Enjoy, 
@maiadorsett

@WUSTL_EM #EMConf: #FOAMed Supplement No. 5

Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference.  Please e-mail wuemresidents@gmail.com to share additional resources (or just post them as comments below).
  
1. Pediatric Cases:  Neonatal HSV
- You can read a brief review of epidemiology & presentation Neonatal HSV from Peds EM Morsels.
- You can review the "normal" levels of CSF pleocytosis as they vary by age here.
- Free Emergency Medicine Talks reviews a case and Management of Pediatric Status Epilepticus in the Seizing Infant.

2. Evaluation of the Pacemaker in the ED
- Connect to the Jacob et. al. (2011) paper describing radiographic identification of pacemakers/AICD via this emcrit post.
- Life in the Fast Lane covers Pacemaker malfunction here.
- Amal Mattu discusses Can you read ischemia with a pacemaker? and Can a pacemaker treat syphilis?

3. Difficult Diagnosis - Pre-eclampsia
-EMCurious provides a very nice review of the symptoms, workup and management of preeclampsia.

4. Musculoskeletal Cases - We reviewed some interesting cases and musculoskeletal anatomy.  Emergency Medicine Ireland has these resources for emergency medicine anatomy, which include some excellent reviews regarding cervical spine injury.   If you are interested in use of musculoskeletal ultrasound for the emergency physician, you can read Sonoguide's introduction to musculoskeletal ultrasound here.

Enjoy,
@maiadorsett

@WUSTL_EM #EMConf #FOAMed Supplement No.4




Welcome to @WUSTL_EM #EMConf, the #FOAMed Edition. The purpose of this weekly column is to identify #FOAMed resources that reinforce and expand on the concepts/facts discussed during weekly conference.  Please e-mail wuemresidents@gmail.com to share additional resources (or just post them as comments below).

1. Lightning Injuries 
Today as a combination of part of core content series, Dr. Noelker talked about the rare, but important presentations & management of lightning injuries.  
- For interesting videos on how lightning works, check out this video out:
 
On the medical side,
 - Life In the Fast Lane had this summary of Lightning Injuries
- The Adventure Medicine blog presents these guidelines on treatment & prevention of Lightning Injuries.
- For some cool teaching videos, see the national weather service site on Lightning Safety.

2. CPC/Interesting Case: Psoas Abscess
- Life in the Fast Lane has this summary of Psoas Abscess presentation & workup

- Apart from details of the diagnosis & management of a psoas abscess, this case reinforced the idea that we should reconsider the possibility of a missed diagnosis for patients who return to the emergency department multiple times.  I love the emdocs, "EM Mindset" series, and this week's post by Deborah Diercks touches on this essential learning point:

"With imperturbability and objectivity the EP will make more accurate diagnoses and will not overlook the subtle clues of serious underlying illness. This requires clinical skill, insight, poise, caring, and experience."

3. Updates to Stroke Care at WashUEM - We learned about the current state of stroke care at our institution (hint: very fast) as well as situations where hyperacute MRI may or may not have a role (such as suspected stroke mimic).

For those who want to read a little bit more on "DWI" MRI for diagnosis of acute ischemic stroke, radiopaedia.org has this article.

.... and keep your eyes & twitter feed open to catch the next WashU EM J Club Podcast on Endovascular therapy for ischemic stroke.

4. Joint Surgery & EM Trauma Case Conference: Airway Management in Trauma
Today in joint case conference, we had an interactive discussion of how complicated airway in management in trauma can actually be.  This is an area where there are lots  of FOAMed resources, so it was a bit hard to take a pick.  To list a few:
- EM Crit's Laryngoscope as a Murder Weapon series discusses Hemodynamic Kills.
- The Skeptics Guide to Emergency Medicine addresses the use of ketamine in TBI
- emdocs argues that our go-to drugs should be ketamine & rocuronium instead of etomidate & Sux in this post.
- Here is a link to the technique for Bougie-aided Cric on the EMCrit website

Enjoy, @maiadorsett

@WUSTL_EM #EMConf: #FOAMed Supplement No. 3


This week we had a combined conference with our neighboring residency at St. Louis University to discuss the important topic of wellness in emergency medicine.  The line-up included talks on sleep,  physician burnout, the impaired physician, second-victim syndrome, and a board panel of attendings to discuss their own "tricks of the trade".  Unlike sexier topics such as critical care, I was able to find a lot less on these topics in the FOAMed world.  While "wellness" may be more nebulous, it remains extremely important not only to our quality of life as physicians, but also to the quality of care we provide to our patients.

1. The Importance of Sleep.
The TED series has a number of talks on sleep.   Russell Foster, a neuroscientist, gave this talk on Why do we sleep?

2. Physican Burnout & The Impaired Physician.
There has been a fair amount of attention to the risk of suicide amongst physician in the public media. The article, Why Do Doctors Commit Suicide?  published in the NY Times draws attention to importance of peer support in physician coping.

For EM-specific resources, emdocs produces the EM Mindset series, which is written by EM physicians and describes our specific practice of medicine.  It has a lot to offer the young EM physician. Some posts in this series touch directly on mechanisms for resilience, including:
            James Adams:  Frameworks & Habits of an EP
            Rob Orman :  The Successful EM Mindset
            Steve Carroll: Masters of the Undifferentiated Patient
           
Finally, you can also read this article that was discussed during today's lecture on factors contributing to "burnout" during EM residency.

3. The Second Victim: The TED series has a number of talks that focus on humanizing the physician and discussing medical errors.  Brian Goldman's talk, entitled Doctors Make Mistakes, Can we Talk about that? is particularly well done.

4. Advice from Others:  Check out the How I Work Smarter series from ALiEM.
My particular favorite?  Rob Rogers' post,  because of this great advice which I have taken to heart:

                    ' Someday when you are sitting on your front porch in a rocking chair
                      thinking about the “good ole days” you aren’t going to have thoughts
                      of “I wish I had written one more paper or traveled for one more lecture."'

Enjoy ... or maybe take a nap instead. #ChooseWellness

 Maia
@maiadorsett