DRH-EM Education

#FOAMed Follow Up is back following the holiday hiatus. This past week was our quarterly tox rounds, and they focused primarily on cardiotoxicity.  A subset of EM FOAM has broken off into its own realm of FOAMTox, which has created numerous additional resources. Some popular sites to check out are The Poison Review and the toxicology library at Life in the Fast Lane.

• Dr. Hedge was tasked with covering the hypotensive and bradycardic patient, and he went over the presentation and treatment of the ABCDs mnemonic. The LIFTL EKG library crushes it per usual. Here’s beta/calcium channel blocker, digoxin effect, and digoxin toxicity. EMCrit has a breakdown of calcium channel blocker overdose treatment (with guest Leon Gussow of The Poison Review). LIFTL also has a short case of clonidine overdose. Recall that both clonidine and dexmetatomadine are both alpha-2 agonists.
• Dr. Nefcy ran through some cases, one of which was an OD on theophylline. Becoming more old school, but remains a drug that we need to know the side effects of. LIFTL has a short break down of it here.
• Dr. King covered Torsades de Pointe as well as some shakeweight gifs. Rob Orman of ERCast/EMRap interviewed ED ECMO’s Joe Bellezzo this past November regarding this very subject (sans shakeweight). There’s a great half hour podcast here. After listening, be sure to check out the write-up on the website of T de P by Dr. Weingart.
• Dr. Baltarowich discussed takotsubo. Sticking with a heavy LIFTL links this week, here’s an intro to takotsubo and a short case. Radiopaedia has some nice images as well.

That’s all for this week.

After a brief hiatus because of the Detroit Trauma Symposium, some oral board prep, and a Thanksgiving hibernation, FOAMed follow up is back to cover #EMConf. Here we go:

• Dr. Kennedy ran though some of his most difficult/fascinating cases from the previous year, one of which included a PEA arrest and another included cannabinoid induced psychosis.
  • PEA has been under increasing scrutiny in the FOAM community due to the lack of a provider’s reliability to palpate a peripheral pulse and the advent of ED ultrasound. The ED ECMO guys have a podcast discussing the demarcation of PEA hyperdynamic heart on echo and PEA with hypokinesis on echo. Interesting take on this subset of code management.
  • EMdocs has a short write u- of synthetic cannabinoids. For those of you more visually inclined , LITFL’s got a rather comical symptom card.

• Dr. Belen covered some of worrisome, unique presentations of patients with CA.
  • Here’s a Best Case Ever that will remind you to always keep obscure presentations on your differential.
  • Pediatric EM Morsels’ Sean Fox covers Typhilitis. Not every kid with n/v/d has gastro, be sure to have this seeded deep in your mind.
  • EMCrit has two notable podcasts on palliative care–one that Weingart did by himself, and another by Ashley Shreves of SmartEM who is palliative care fellowship trained.

• The better half of the Dr. Changs was kind enough to present on some emergency psychiatry.
  • ALiEM discusses re-initiation of atypical anti-psychotics in the ED.  They’ve also got a quick sheet on suicidal risk stratification.
  • Have an agitated patient who is not to keen on verbal de-escalation and potentially dangerous? Here’s a panel on ERCast on how they chemically restrain a patient.

• Dr. Cortis’ pediatric jeopardy reminded us all that kids are adorable until they are terrifying.
  • Emergency Medicine Cases has an example of pediatric cardiac arrest that does the same.
  • Simon Carley from St. Emlyn’s has a vodcast on pediatric sepsis.
  • Amal Mattu continues to exemplify his ECG wizardry with this pediatric ecg vodcast.

• Dr. Wollman ran through everything that is terrifyingly exciting in thoracic trauma. #FOAM is full of this and this will be nowhere near an exhaustive list, but here are a few links to get you started:
  • Andrew Sloas of PEM ED Podcast  guest stars on Emergency Medicine Cases and chats about one of his emergent pericardiocentesis. There’s a helpful US guided pericardiocentesis instructional video that follows.
  • Is there a reason to perform compressions in blunt traumatic arrest? Scott Weingart and Rob Orman go through their approaches and philosophies on Orman’s ERCast.
  • One of Weingart’s EMCrit podcast from a few years back covers aortic dissection. Always remember to treat the patient’s pain here. Ripping one’s aorta doesn’t seem to be too comfortable. Here are some examples of catching dissection on ultrasound from Ultrasoundcases.
  • Unsurprisingly, Life in the Fast Lane has a quality write-up on sternoclavicular joint dislocations.

Until next time.