Wednesday, June 17, 2015

@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 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.


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