Thursday, September 17, 2015

@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.

Maia (@maiadorsett)

Monday, September 14, 2015

@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

Wednesday, September 2, 2015

@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.

Maia (@maiadorsett)