Thursday, July 23, 2015

@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
- 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)

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