Sunday, October 5, 2014

#FOAMed Digest No. 6: Ain't Nobody Got Time For That

Welcome back, FOAMheads! My apologies for the delay this week. I ended up being a bit busier than I expected, which not coincidentally brings me to the theme for today's entry.

Sometimes you have a lot on your plate and may not be able to set aside a large chunk of time to watch/listen to a 30-minute-plus podcast. But that doesn't mean you don't have time to get your learn on! This time around, we'll highlight some of the best FOAMed sources of short-and-sweet educational pearls. Easily digestible for the highly-distractible mind of the EM trainee.

There is no moment like the present -- let's get started!




Three Stars:

1. The Glasgow Coma Scale was first introduced 40 years ago. It's past time we started assessing it properly. "GCS 12" doesn't cut it any more. What are the deficits? How do you score for eye-opening if the patient's eyes are swollen shut from trauma? What does "abnormal flexion" even mean, anyway? Ian Miller at TheNursePath provides us an excellent infographic-style breakdown of the "new" GCS.

2. The EMS 12-Lead blog, edited by EMT-P and prehospital resuscitationist extraordinaire Tom Bouthillet, is an excellent resource of EKG cases. This week's case provides an excellent example of why a resuscitationist must always treat the patient, not the monitor. Review the EKG and develop your interpretation first, then read the conclusion.

3. I don't know that a FOAMed segment has ever been more appropriately titled. "Positively Painful Private Parts" is a four-part series published by Brad Sobolewski on his PEM Blog, focusing on the evaluation of acute testicular and scrotal pain. There is a pediatric focus, not surprising given the nature of the blog, but Dr. Sobolewski does include information on "adult" diagnoses like epididymitis as well. Each part is succinct and high yield.
Part 1: Focused H&P
Part 2: Testicular torsion
Part 3: Pathology of the appendix testis
Part 4: Epididymitis

Oldie But Goodie:

An excellent case from The Blunt Dissection, in which Dr. Chris Partyka lays out everything you need to know when you must intubate a crashing neonate.

F(FN)OAMed:

Via your EMRA membership, you now have access to all of the resources from the EMedHome website. Go to the site and explore for yourself the wealth of resources available -- everything from taped lectures from prior EM conferences, the EMCast podcast hosted by Amal Mattu, weekly clinical and radiology pearls, and other vodcasts and presentations.

This week, check out the clinical pearl describing some of the changes in the new 2014 AHA/ACC guidelines for management of patients with NSTEMI.  Ryan Radecki at EM Lit of Note also published his take on the new guidelines this week; well worth the quick read.

(As always, if you need help getting access to any of these resources, please contact your friendly neighborhood Social Media Committee member.)

The Gunner Files:

1. Reinforce the take-home points from the EM Lyceum piece on DKA management with this bullet-pointed breakdown by Adaira Landry on emDocs.

2. In case you've been off the grid for the past week, ebola is here. Triage and isolation protocols are coming to an ED near you any day now. Luckily for all of us Daniel Cabrera at the Mayo EM Blog published for your review the CDC infographic Algorithm for Evaluation of the Returned Traveler.

3. So the latest installment of the Skeptic's Guide to Emergency Medicine will take you about half an hour to listen to, but it's well worth the time. Drs. Milne and Swaninathan analyze the Ottawa Aggressive Protocol for ED cardioversion and discharge of patients presenting with AFib.
This piece really highlights the interconnectedness of the FOAMed world, as it references back to last week's FOAMCast on AFib (as seen in FOAMed Digest #5), and a recently-published research letter (containing data from the largest-ever study on this topic) in JAMA calling into question the safety of cardioverting AFib patients presenting with >12 hours of symptoms.
This research letter was analyzed in depth by Rob Orman on the latest episode of his ERCast.
We're all in this together, folks.

4. I don't want to think too hard about having a cricket or other insect lodged in my ear canal, but it is probably in our best interest to know what to do if we're presented with it. Mitchell Li at ALiEM has us covered. (Great tip for getting out plastic beads, too!)

5. When you do get a little extra time, don't miss the September installment of the Annals of Emergency Medicine podcast. Covered topics include pigtail catheters for pneumothorax, acute stroke care, age-adjusted D-dimer cutoffs, and the HINTS exam (authored by our very own Dr. Brian Cohn!) You can download the podcast directly here.
(And be sure to check out Cohn's paper!)

Never stop learning,
Sam Smith, PGY-3

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