@WUSTL_EM #EMConf: #FOAMed Supplement No. 18 & 19

Conference October  21st [LJ]
1. Interesting Case Conference
Sometimes its important to know the atypical presentations of common diseases.  This week we discussed Kawasaki Shock syndrome.  emdocs discusses the reasons for delayed diagnosis in Kawaski disease. f you are having trouble remember all the diagnostic criteria, check out the ALiEM  card for Kawasaki's disease.

2. Abscess/Cellulitis and Antibiotics
- Dr. Willman gave a great presentation discussing the benefit of antibiotics in patients with abscess/cellulitis.
- EP Monthly promotes skipping the antibiotics unless systemic illness or severe immunosuppression is present.
- FOAMcast discusses the ISDA guidelines suggesting that Bactrim is probably sufficient as a single agent for MRSA and Strep Coverage.
- On a related topic, the SGEM discusses Clinda vs Bactrim for SSTI

3. EMS and the changing the healthcare landscape. 
Dr. Brent Myers discussed the coming tide of payment reform and its effect on EMS.  JEMS discusses EMS and bundled payments.

Conference October 27th [MD]
1. ECGs in PE
- We covered Amal Mattu's episode of ECG findings of PE.   Take home:  Inferior + Anteroseptal T waves inversions > think PE!
- Everyday EBM EKG Challenge No. 5 reviews an interesting case of  ST elevation in PE.
- Dr. Smith's ECG blog covers the ECG findings in PE

2. #RightCare in Emergency Medicine
- To Read More about the Lown Institute, check out their webpage or focus specifically on Right Care Action week here.
- If you did not get a chance to read the Wired article about David Newman, do so now and make sure to check out the NNT.com
- To read more about the silent epidemic of preference misdiagnosis check out these two blog posts at the BMJ: 1 and 2.
- Shared Decision Making is one technique to avoid Preference Misdiagnosis.  Read about Emergency Physicians Perceptions of Shared Decision Making in this article in Academic Emergency Medicine.
- Check out our own Hippocratic Medicine series about examples of the harms of overtesting or overuse, and stay tuned for an upcoming post on Lessons from #RightCare Week at the Barnes Jewish ED.

Enjoy,
Louis Jamtgaard (@Lgaard)
Maia Dorsett (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 17

1.  Core Content: Tick Born & Viral Illness
- emdocs covers Diagnosis and Treatment of Rocky Mountain Spotted Fever in the ED.
- What's the data surrounding tamiflu use for influenza?  EP Monthly reviewed it in this article and EM Lit of Note addressed here. The NNT.com also analyzed the numbers for treatment of influenza with tamiflu

2. Rural  & Farm Trauma
- Life in the Fast Lane discusses Trauma's Golden Hour.
- Here is a lecture from Free Emergency Medicine Talks about Farm Related Trauma.
- Refer to Life in the Fast Lane's post on management of open fractures to help with all those Auger-related injuries!

3. Difficult Case(s)
- Beware "unintentional blindness" - the "blocking" effect that occurs when you are performing a challenging task.  A great example is this NPR story on Why Even Radiologists Can Miss a Gorilla Hiding in Plain Sight.
- Radiopedia covers the LeFort Classification.
- The MayoClinic EM Blog covers management of Facial Trauma.
- Everyday EBM assesses the evidence surrounding antibiotics for mandibular fractures.
- EMCrit covers treatment of Aortic Dissection

4. Chest X-ray pathology - for a nice revew, work through this tutorial on Chest X-ray anatomy & pathology

5. Foot Problems
- Taming of the Sru covers the approach to the Foot X-ray.
- Use Northwestern's excellent Orthopedic Teaching site to cover Foot Cases.

Enjoy,
Maia  (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 16

1. Airway Cases - The Severe Asthmatic
- How to manage the ventilator once you've intubated: EMCrit on Ventilator Settings for the patient with obstructive airway disease. [MD]
- EM Rap covers Ventilator Basics in Ventilators 101  Part 1  and Part 2. [AR]
- Annals of Emergency Medicine covers whether Non-Invasive Positive-Pressure Ventilation Improve Outcomes in Severe Asthma Exacerbation? [MD]
- Annals of Emergency Medicine Systematic Review Snapshot covers whether IV Magnesium reduces hospital admission in patients with acute asthma. [MW]
- Our own blog covered the evidence regarding the use of ketamine in acute asthma exacerbation.

2. Termination of Resuscitation (in the Field)
- We recommend reading this retrospective study in JAMA regarding criteria for Prehospital Termination of Resuscitation for Cardiac Arrest.
- Journal of EMS covers Resuscitation past the 25 minute mark. [BS]
- This NPR story covers the post-resuscitation/death "Pause", making the ever-important case to stop what we are doing for a moment, not leave the room, and appreciate the person in the bed. [BF]

3. Emergency Deliveries
- Maternity Training International offers a wealth of educational resources (including instructional videos) to help you prepare for the emergency delivery. [MD]

4. C-spine Clearance
- A bit of an oldie for the FOAMed world, but here is a 2011 podcast from EMCrit on evaluation for C-spine injuries. [SM]
-(Free from EMRA members):  the July 2015 EM-RAP paperchase covers the most recent guidelines for C-spine clearance. [SM]
- Taming the Sru covers interpretation of C-spine CT. [SM]

Enjoy,
Maia Dorsett (PGY-4, @maiadorsett)
Sara Manning (PGY-4. @EM_SaraM)
Mike Willman (PGY-2)
Brendan Fitzpatrick (PGY-4)
Bridgette Svancarek  (EMS Faculty)
Adam Rieves (PGY-1)

@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.

Enjoy,
Maia (@maiadorsett)

@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
@Lgaard

@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.

Enjoy,
Maia (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 12

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. Evaluation of Pediatric Abdominal Pain
- Don't Forget the Bubbles had this post on the differential diagnosis for obstruction in the pediatric population.
- Our own EM Journal club covered non-operative management of pediatric appendicitis.
- St. Emlyn's covers the spectrum of pediatric emesis 
- FOAMcast covers pediatric GI emergencies.
- Test your pediatric X-ray prowess with this series of cases of obstruction vs. ileus.

2. Interesting Case Conference - Rocky Mountain Spotted Fever
- A good review on the Emergent Diagnosis of the Unknown Rash, including the deadly causes.
- Crashing Patient covers Tick-Born Illnesses

3. Neonatal Sepsis
- PEM blog reviews the evidence surrounding procalcitonin as a marker of serious bacterial infection in the febrile newborn and you can listen to a podcast about the febrile newborn.

4. Intraparenchymal Hemorrhage - EM Lyceum provides this comprehensive review on emergency management of ICH.

5. Pelvic Inflammatory Disease
- New England Journal of Medicine published this recent review on Pelvic Inflammatory Disease.
- EM Lyceum covers the history & physical exam findings, diagnostic workup & management of PID.

Enjoy,
Maia Dorsett (@maiadorsett)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 11

 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. Resilience - We had a great grand rounds by Brendan Fitzpatrick about resilience and its importance to a long, healthy career in emergency medicine.  The importance of this topic is highlighted by this article  discussing the need for resident education on factors contributing to physician burnout.

There are a large number of TEDx talks on the subject (honestly, just google "TED talk and resilience").  Here are links a couple:
    How to Cultivate Resilience by Greg Eells
   Paul Robertson on Crisis is inevitable, Failure does not have to be

The concept of mental toughness and the role of stress inoculation training was discussed several times on with Michael Lauria on both emcrit and iteachEM.  These are great podcasts if you're interested:
  - Enhancing Human Performance in Resuscitation: Going with the Flow
  - Mental toughness Part I.
  - a link to the emcrit book club for On Combat
 - Stress Innoculation training covered on iTeachEM

2. Complex Diagnosis -  We discussed how our cognitive wiring both helps and hurts us in emergency medicine.  Sometimes we have to react based on pattern recognition, but other times need to slow down and think a little more critically in order to prevent potential patient harms.
   - You can read a New York Time's Review of Daniel Kahneman's book Thinking Fast and Slow.
   - Here is a lecture Daniel Kahneman gave at the Woodrow Wilson school of public and international affairs if you prefer to listen instead of read.

With regard to specific learning points covered:
   - See this EKG challenge on Neurocardiogenic Injury which covers troponin elevations and EKG abnormalities with CNS pathology.
   - The NNT addresses the use for heparin for acute coronary syndromes.
   - The Journal Circulation had a three part series on the pathophysiology of adults with congenital heart disease:  Part 1, Part 2, Part 3.

3. C-spine Radiology
- BE SURE to review the latest recommendations from the Eastern Association for the Surgery of Trauma regarding cervical spine clearance in the obtunded trauma patient.
- University of Virginia has this educational tutorial on cervical spine imaging.

4. Urologic Emergencies  - Urology came and spoke with us about practical approaches to Urologic problems in the ED.  We'll just share some tweeted pearls & a few links to some #FOAMed below.

Don't forget the bubbles covers phimosis in this post on penile problems.
You tube has this video from University of Florida Dept. of Urology on troubleshooting urinary catheters.

Enjoy,
Maia (@maiadorsett) and Sam (@CSamSmithMD)

@WUSTL_EM #EMConf: #FOAMed Supplement No. 10

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. Headache Potpourri:  In this section, the 4th year residents taught the first years about some common and uncommon causes of headache in the ED.  The talks were short and sweet, here are some additional resources:

 - See this post on steroids for recurrent migraine headache from our own blog.
- The Ophtho book is a generally great resource for all eye related things.  Here is a link to the chapter on glaucoma  (including the acute angle closure variety).
- LITFL Covered Acute Angle Closure Glaucoma in this post
- See this article regarding the rate (of ~ 9%) of patients with presumed idiopathic intracranial hypertension (pseudotumor cerebri) who have sinus venous thrombosis.
- Bacterial vs. Viral Meningitis?  Review the low discriminatory value of classic signs & symptoms in this post by EMLyceum.
 - Make sure that you measure opening pressure correctly - go ahead and briefly review this resource for lumbar puncture from Emergency Medicine Australasia.

2. Alcohol Withdrawal
- Review the Signs & Symptoms of alcohol withdrawal with this LIFTL post.
- See "Beyond Benzos for Alcohol Withdrawal Syndrome" on this blog
- Listen to this EMCrit podcast on management of severe alcohol withdrawal and delirium tremens.
- Here is a link to the Bellevue paper on aggressive benzodiazepine/phenobarbital protocol for alcohol withdrawal discussed in conference
 - Review the evidence yourself about ketamine as an adjunctive treatment for alcohol withdrawal.

3. Are you LIV'N? Cardiac Ultrasound for the Hypotensive Patient

- EMCurious covered the basics of focused cardiac ultrasound (FOCUS) in this post.
- Go ahead and check out  this video from EMin5 on EPSS for estimation of LV function
- Our own blog covered Takatsubo's Cardiomyopathy as part of the EKG Challenge Series. 

4. Trauma Case Conference:  Crush & Burn
- emdocs covered management of minor burns in the ED
- FOAMcast covered burn management according to Rosenalli 
- The Maryland Critical Care Project covers Managing the Burn Patient in the ICU
- LIFTL reviewed the basics of Crush Syndrome Management
- This NEJM review article gives a nice overview of the pathophysiology and management of acute kidney injury due to rhabdomyolysis.

Enjoy,
@maiadorsett