#FOAMed Digest No. 8: Thank You Sir, May I Have Another?

In the spirit of demonstrating how FOAM resources can reinforce resident curriculum, I thought for this installment of #FOAMed digest we would do something a little different and highlight FOAM resources that build on the topics and discussions from conference last week.  For those of you who didn't make it, the conference run down from last week:

             GI core content: esophagus and stomach
             Trauma Case Conference: Traumatic cardiac arrest in the blunt trauma patient 
                                                           Traumatic cerebrovascular injury
             Key papers in critical care
             Navigating the politics of innovation
                .... and a little on cognitive overload

For those of you who want to solidify and expand your knowledge,  you need not wait for tommorrow's review.  Here are some FOAM resources to help you do just that:

Disorders of the esophagus and stomach: Medical school taught you to memorize buzzwords and basics of management for disorders of the esophagus and stomach, but the FOAM world can expand

on this background and sometimes teach you to think critically about management decisions.  Here are some good FOAM resources on the Upper GI bleed:
              Who can I send home?  An oldie but goodie - a review from our own journal club on risk stratification for patients presenting with a GI bleed.
               Here is a critical review by EM Lyceum of upper GI bleed management including PPIs, octreotide in variceal bleeds, and conclusions from the good old NG lavage.  Some of things we do are really not that evidence-based.

Dr. Wessman's review of key article in critical care touched on GI also, recommending that we all read  this article published in NEJM, and reset our transfusion goal to 7 in the absence of massive hemorrhage.

And here is a link to the Scott Weingart video on Blakemore placement shown in conference. 

Traumatic Arrest:  Let's see if we can learn about things being done a little differently ... and prehospital -  Listen to this emcrit podcast  on management of a patient in traumatic arrest with Irish Road Racing doctor and RAGE team member, John Hinds.  Be sure to read the commentary, because there is an excellent discussion/debate bringing up important considerations for management of traumatic arrest.

Traumatic arrest patients usually do not need meds to facilitate intubation, but as an aside last week one of our trauma colleagues brought up whether we should be using ketamine instead of etomidate

Photo credit: http://inkrose98.deviantart.com/art/Car-Crash-2-254652116

when intubating trauma patients (especially hypotensive ones) in our ED.   I highly recommend this critical review posted last week by the SGEM about ketamine's undeserved bad reputation.  You might just make it your go-to in your next trauma patient even if you suspect intracranial pathology.

What blood products should we be giving to our patients?  A recent body of research from the THOR consortium (Traumatic Hemostasis and Oxygenation Research which includes St. Louis Children's Hospital PICU attending Phil Spinella), suggests whole blood.  Here is a link to the THOR website and articles of interest published by the consortium.

Last week during conference we asked the FOAMed world via twitter for input on CPR in traumatic arrest.  The response was largely negative.  Steve Carroll of @embasic mentioned potential use of REBOA.  For those of you unfamiliar with this device here is a description of the procedure and current evidence regarding its use from the Hennepin County site HQMeded.  If you are still interested, here is  an amazing story recounted on emcrit of prehospital REBOA use for a pelvic fracture. 

And finally... if you still have not watched Cliff Reid's talk on Making Things Happen on leading a resuscitation, do it now.  You will not regret it.

Traumatic vertebral artery injury: If you need a basic review of the talk given by our surgery colleagues, you can read the East Guidelines on Blunt Cerebrovascular Injury.  If you are wondering about the data on the sensitivity of CTA for detection of blunt cerebrovascular injury, you can listen to a podcast by the SGEM here.  Finally, our own blog took on the subject of whether vascular imaging is mandated in the presence of a cervical seatbelt sign, read what we had to say here.   

Navigating the politics of innovation: When I think about what I like about FOAMed, it is that it is a a bottom --> up innovation.  As we learned from Dr. Andrew Knight's talk last week, one of the barriers to dissemination of innovation is top-down decision making with the expectation of bottom-up use.  This is important when thinking about how to effect culture change, but also useful when thinking about managing patient expectations.  I think two good reads on how to talk to patients regarding management decisions are this article in Wired about David Newman and the NNT as a method for data translation, and the "Ed in the ED" blog as a discussion forum on difficult patient conversations.

Wild Style, the epitome of quick-thinking-calm-under-pressure

... and a little on Cognitive Overload : I highly recommend this lecture from Air Force pararescuer Mike Lauria on enhancing cognition and critical decision making in acute care that was shared on the emcrit blog.   Take a Deep Breath.


Enjoy,
Maia Dorsett (@maiadorsett), PGY-3