Tag Archives: Education

Death of CK-MB?

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Hey guys here is a relevant (albeit 7 years old) article supporting my abandonment of the CK-MB. I had heard Mattu talk about this on some podcasts but this article (along with some newer ones) is the evidence to support that practice. At Jewish I do not obtain a CKMB though when I want a total CK I now have to remember up front. On the POC machines at Jewish the Trop alone seems to error far less than when CKs are running with it. Still watch out for the Trop false positives.

Also I would plug Dr Mattu’s new ECG site. Now he charges a small fee (can pay weekly or monthly but I did the $27/year). Still video based (I prefer to just read a blog with pics) but top notch quality. There is a weekly case and a monthly lit review. The above article is in his Feb review. Might make a one month subscription part of the ECG month. ECGs of course are learned over years and decades, not in a month long elective.

The competition

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It turns out that the Mayo EM program has a little room9er of their own… except it’s public… and updated frequently… and has a fellow generating content for it. Truthfully, it’s a great site. Quite a few reviews on topics that don’t pop up on the other FOAMed sites (the killer rashes, retroperitoneal hematoma, tumor lysis syndrome). Worth a look if you’re stuck at Jewish South with a broken CT scanner).

Mayo EM.

 

How do they do it?

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Really cool article with commentary attempting to investigate how experienced docs walk into a room and smell the diagnosis and dispo in a few seconds. Looks like most of the “reasoning” is done before even seeing the patient. Read the RN notes!

As a resident I made a comment about Dr Mallory’s knowing the unteachable. I think this diagnostic skill is learnable but maybe not teachable. It can be called intuition. Pattern recognition. Etc.

FOAMed

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Nice little post from Lauren Westafer, who just finished medical school and is fairly well known amongst FOAMers (FOAMeders?). Reminds us to be tentative about accepting everything we read on the internet.

She apparently gave a SMACC talk which is a pretty big deal. I was linked to her post on the Life in the Fast Lane weekly review, which I consider pretty much the best roundup of FOAMed on the web.

Post-Publication Peer Review

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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.

Best App since Spotify

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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 ; ).

 

FOAMed and Social Media in Education

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At the CORD Academic Assembly there was a lot of talk about FOAMed and Social Media. I am on the social media committee with CORD and we have some informative projects on the horizon.

Here is a blog post detailing some of the FOAMed workshop with some How-To information.

Then Joe Lex and Nicholas Genes posted PRO and CON articles on the question “Is FOAMed essential to Emergency Medicine education.”

Not long articles, good to be at the forefront of these changes. And good discussion on the pluses and minuses of FOAMed

March EM:RAP Summary

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EMRAP_2014_03_March_3.1.14[1]

Hey Guys,
Just some things I learned on EM:RAP this month, and since I’m on admin thought I would post a few things.

The DRE (not the rapper Dr. Dre): from the Fingers & Foley’s section on EM:RAP; reviewed Esposito TJ et al. Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. J Trauma. 2005. They had 512 trauma patients at a Level I Trauma Center. “the negative predictive value of both the rectal exam and other clinical indicators was very high: 99%. However if the other clinical indicators missed the injury, so did the rectal exam. It didn’t add any information”
Basically showed added value of a rectal exam to be very minimal, and that ROUTINE RECTAL EXAM IS NOT RECOMMENDED. BTW, this is in the journal of trauma which is well-regarded amongst our surgery friends.

How to identify if patient’s contact lens is still in the eye (e.g. if patient has eye pain and feels like its still in there and can’t find it): Use Fluorescein much like you would for corneal abrasion as it will stain the contact lens as well, allowing you to find it (then you can evaluate for corneal abrasion at the same time). *keep in mind contact lens will be ruined*

Subarachnoid Hemorrhage: from an article in JAMA in Sept 2013 with 10 university affiliated Canadian EDs. Tried to come up with a decision rule for SAH and basically came up with:
The decision rule including any of age 40 years or older, neck pain or stiffness, witnessed loss of consciousness, or onset during exertion had 98.5% (95% CI, 94.6%-99.6%) sensitivity and 27.5% (95% CI, 25.6%-29.5%) specificity for SAH. Adding “thunderclap headache” (ie, instantly peaking pain) and “limited neck flexion on examination” resulted in the Ottawa SAH Rule, with 100% (95% CI, 97.2%-100.0%) sensitivity and 15.3% (95% CI, 13.8%-16.9%) specificity.
**Key points: this decision rule is more to identify high risk patients and the high risk symptoms. Sensitivity was very high, but specificity very low. Also keep in mind there are other important causes of headache to keep in mind**

Biphasic Reactions in Anaphylaxis: from Annals of Emergency Medicine in November 2013. A chart review was performed over 5 years and had ~500 pts with anaphylaxis, but also documented allergic reactions. Found biphasic reaction was extremely rare (2 cases while in the ED, and 3 out of the ED), with a rate of 0.4% while in the ED. 6% bouncebacks in the anaphylaxis group, none of which died and none of which came back in anaphylaxis. This study was limited in that it was retrospective, and there was variability in the outpatient management of these patients (unclear who was DC’d with what if any medications)
Rosen’s states corticosteroids can be helpful in reducing risks of protracted anaphylactic reaction and biphasic anaphylaxis (7-10 day course). H1 & H2 antihistamines are helpful in reducing some of the symptoms of anaphylaxis. 5-Minute Emerg Consult recommends Epi-Pen for those with anaphylaxis.
No Formal observation time has been established, though Rosen’s says 2-6 hours; with longer observation times/admission for those with prolonged reaction or requiring multiple dose epinephrine

Sorry this is so long, but I’m on Admin so thought I’d post something. Attached you’ll find the March Written Summary with all the articles they referenced. Hope this is helpful.