![Room9er ["Room Niner"]:](https://room9er.com/wp-content/uploads/2020/03/cropped-Screen-Shot-2020-03-08-at-3.16.16-PM.png)
As mentioned in a few of the research projects, Dynamed could be a good source of information on the go. They also have an app.
Website / App
Reply
Monthly Archives: May 2014
Pretty Handy
Here is a practical YouTube video on performing physical examination of the hand. Courtesy of Dr Mallory.
Post-Publication Peer Review
For those who have not been introduced to this concept, here is a blog post from Dr Radecki who writes the EM Lit of Note.
Because blog posts are not “peer-reviewed” before they are posted, the quality of a given post could be low. But depending on how many people read the post, the discussion can be lively and constructive.
This is in contrast to formal journal publication, where the peer review is PRE-publication, and discussion may be minimal. We will see a comment or two in an issue a month or two later, sometimes an official comment in the same issue. But the volume and even quality of responses possible with blogs, twitter, etc may surpass that of the official, slow process in the journals.
Scientific American had a nice article about this PPPR concept. As FOAMed and social media continues to expand in medicine, and in other fields, I think we will see more respect for this type of peer-review.
Journal Club May 2014
Journal Club is this coming Thursday, May 22.
Where:
Kashmir Indian Restaurant (Patio!) (Beer + wine!) (I absolutely love this place.)
1285 Bardstown Road
(loads of parking across the street in the Mid City Mall)
When:
7 PM
Email or text me if you will be there.
Attached articles:
1. Hypnosis in the ED
2. Wound management myths
3. Is it actually a spider bite?
Routine Coags in Chest Pain
Thought this was a great little post regarding Coagulation studies in chest pain patients. Not sure how often its getting routinely obtained on our CP patients @ UofL but at Norton they get it on almost every chest pain patient that rolls through the door.
We’ve reduced the amount of coag studies we’re getting on our routine trauma patients, probably about time we make sure we’re doing the same in our low-risk chest pain patients.
Can they eat?
Thoughts from Dr Ruben Strayer (who provided a great deal of our PSA card information) on enforcing fasting in the ED prior to sedation. No benefit, maybe even some harm? Don’t tell the folks at Kosair.
The Big Fat Suprise
Cool new book arguing it is ok to eat bacon, eggs and butter. My copy is due to arrive in the mail today.
Even cooler are these old articles (below) about CAD and MI that another author posted on his website in a review of the Fat book. Check out the articles. And this one written a few years ago. You’ll be drinking guiltless Breve lattes in no time.
Best App since Spotify
Just like Spotify, the QX Read app seems too good to be true. And free. I’d pay $5 or $10 for this little guy. Thanks to Cunningham for letting me know about this one. There could be other similar apps but this one so far has no shortcomings.
The app lets you perform literature searches, follow journals, follow keywords, follow collections you or other users make. It checks for new articles using your keywords and specialty interests. Best feature is you can login with the UL Library Proxy and while you read the abstract of the article, the app is getting permission for the article and you can open the pdf in seconds. Then open the app in your cloud app to save.
I’m sure you all get as frustrated as I do trying to use your phones to search for and download articles through UL’s library website ; ).
Ultrasound lectures
These are some great ultrasound lectures w/ videos from the EM program at MUSC.
Ketamine’s Kryptonite
I witnessed the third patient to have apnea as a side effect of ketamine administration. As in the other two cases ketamine was infused as a push, rather than the slow administration. This was not the resident, but typically and to be by the book, MDs should be the ones pushing ketamine. SLOWLY.
In this case our resident did well managing the sedation. Hypoventilation was diagnosed well before desaturation. Painful stimuli did not induce respirations as the ketamine is too good of an analgesic. We began to BVM ventilate, placed nasal trumpet, sat was never lower than 85%. Took about 8 minutes to get spontaneous respirations. We gave narcan as the patient had fentanyl prior to ketamine. As in one other case of ketamine apnea the narcan did not help, but should be attempted.
So learning point. NEVER SLAM ketamine into the patient. Dilute the 1cc (50mg-100mg) of ketamine in 10cc of saline if it will help the temptation to push it.
Also follow the algorithm below for PSA intervention. We will have the sedation review sheet and reference card finished soon.
Public health for adrenaline junkies
Public health is associated with the least interesting courses of medical school (epidemiology and biostatistics). It has been linked to ED frequent flyers and psych hold patients (social and behavioral health). One might say it’s an integral part of vague clinical decision rules and flip-flopping society guidelines and Press-Ganey scores.
It’s also something us ED docs do every day, whether we want to or not. There’s no reason why we shouldn’t try to understand it and do it better.
Kiran and I have been developing a website dedicated to public health for ED personnel. It’s a FOAMed site. Our plan is to get it tied in with sites like EMCrit, ALiEM, LITFL, and the like. It’s still a very young project, but there’s a couple articles posted for you to glance at.
If anyone is interested in population health, there’s a ton of uncharted territory and we’d welcome the collaboration. Just let us know how you want to be involved. Also, tell your friends.
Special
Here is a very practical algorithm. I recommend using it every shift.
Source: life in the fast lane?