Essential # management

Excellent self explanatory talk.
Essentials indeed.

Webucation 22/10/17

This edition of web wisdom encompasses mythbusting in trauma and radiology. Also a tour de force in dissections and finally a must hear podcast if you work in medicine at any level - all about UTIs. 

• Grow a spine... or don't
• The intoxicated C-Spine
• All about the aortic scourge
• Contrasting myths
• Do you really need to do a pelvic exam?
• But the angiogram was normal!

• You think you know UTIs?

The last podcast will stun you. not because its a sexy topic but maybe because it will make you remember the relevant issues in a most common presentation. Test yourself - do you know how to handle UTIs?

Ortho damage control

Nice vid on damage control surgery from the orthopaedic standpoint. Dr Ebraheim's other educational videos can be found here.

Webucation 24/7/16

This edition of webucation was slightly delayed due to holidays but we're back with pearls from surgical trauma, cardiology updates and even a funny xray of sorts... As always visit and support the content creators.

• Best site for a chest hole? - Location location location
• What aside from the STEMI? - Great learning points in the end
• A thorny issue - Desert hands
• CPR & amiodarone - Drug free CPR?
• Pelvic trauma -A great mini review
• Scan pan? - Saving lives for a living or something else?

• Top 10 errors of procedural sedation - The top 10 list of shame!

That last list is a solid reminder that although sedation is COMMON in EDs, it is far from safe. Buyer beware and make sure you got one of these before you start!

K-wire removal

Prof Larry Mellick describes and assists in removal of this infected wire. Remember that source control is a pillar of sepsis treatment and this is one of those cases.

For more of his videos, go to his youtube site.

Oh shoulder reduction...let me count the ways I love thee.

Shoulder reductions are one of my favourite procedures to do and we have seen it evolve from medieval "leg in the armpit" method to the "no drug" massage nowadays. How many ways can you recall? Here's a delightful compendium.



Get more of Prof Larry Mellick's videos here.

Webucation 22/9/15

This edition of webucation includes lots of orthopaedics with a smattering of cardiology and a fine trick for central lines. As always, credit to original content creators.

• Greek Drama - Is this a Parthenon fracture?
• What else do you see? - Definitely not something common but worth the know.
• Better way for CVCs? - A better way to guide the wire
• Practical guide to backslabs - These guys are drunk on ortho.
• I am number 4 - The 4 hour rule in panadol
• Expunging zero miss from chest pain - There is no such thing as Zero risk.

The last link is a good indicator of where risk stratification in ED is going. It will not be long where presentation troponins and 2 ECGs are all that is required once a good history is taken in low risk chest pain. Watch this space.

Gaining traction

Here's another of Prof Larry Mellick's great videos. Self explanatory with great x-rays and commentary. Love the ketamine adjustment!



For more of his videos, go here.

ACL exam - all you need to know.

Dr Nabil Ebraheim makes some fine videos and this is no exception. It demonstrates the Lachman and Pivot shift tests and explains the pathology, relevant investigations and follow up as well. I'm a biased ACL tear sufferer but this is a common injury and it pays to know the sensitive and specific tests.

Webucation 2/7/15

Web wisdom this edition comes from areas of urology, general surgery, trauma and paeds. As always, give credit to the content creators.

• Teaching practical skills - Can you set it up like this?
• St Emlyn's top 10 trauma papers 2014-2015 - Just like Letterman's, but in EM
• Is it peritonitis? - How good are your hands?
• Swan song for tamsulosin? - A rolling stone no more
• STEMI or not? Here I come... - One formula to rule them all
• Emergucate's imaging case - What are  the chances?
• Stop crying! - Is not the right thing to say in these circumstances

The last link is a gem in mnemonics. It also has a great Rule of 3's for infantile colic. Great site for paeds. Do visit it.

Webucation 14/4/15

The edition of web wisdom encompasses lots of radiology, a smattering od dogma-lysis and even some phramacology. Pls credit the original content creators.

• Bad things come in 3s - Superb xray and diagnoses to be gleaned.
• Bloody screwdriver - Newer but not necessarily better.
• There's bleeding! - Space is the final frontier.
• Cervical collars slashed - Abandonware or not?
• Emergucate's imaging case of the week - Sticks out like a sore thumb!
• Flash oedema - Conventional modern management all addressed here. Including good DL vs VL training point.

• Is 2 better than 1? - EM Nerd asks this exact question in prescribing terms?

The last link shows us the quality of critical appraising and high level analysis that is out there in the world of FOAM. Long may this continue.

Webucation 16/2/15

This edition of web wisdom comes from the domains not just land based radiology and paediatrics but also a gem of a myth-buster from the air. Soeaking of air, LITFL does quick work on something familiar. Pls credit the original content creators when able.

• Did you spot it before clicking ? - Be honest!

• Imaging case of the week - Think laterally man

• Algorithm for knee - Why not we say.

• PTX time for change? - All this tension over a cannula.

• Sports name - What eponymous sport is the answer?

• Paeds inguinal hernia - its not just the old men who get this.

Your lungs will no explode - Aeromed myth busting finally

The last link is another great piece of dogma lysing which is all too common these days with the advent of sensible, pragmatic studies which are permeating our profession. Long may it continue.

Webucation 1/9/14

Lots of cold things in the following musings from around the web. From the realms of trauma to radiology to EBM. As always credit to the original content providers.

• On your knees - Emergucate truly educates with this one. Am partial to this as I suffered from this one!
• Shoulder this burden - The much taught and rarely seen shoulder lesion.
• EBM - a movement in crisis? - A great read for enthusiasts and detractors of the current state of EBM.
• Is my hand broken? - If it is, can you tell clinically?
• Ice pack ahead - Does this simple humble intervention actually work?
• Boy its cold! - Larry Mellick provides a great view into the world of actual severe hypothermia.
• PR disaster - the trauma pro eulogizes the PR. We say RIP.

The last link gives another chance to chime in on our pet peeve. Rectal assault on conscious trauma patients with normal neurology is archaic practice. Dare you step into the 21st century? Or more importantly - will you allow your trainees to? 

Webucation 31/7/14

While part of this blog was on a sojourn to a faraway continent to relish the World Cup, we hope the videos from our recent major conference have kept you entertained.
Webucation makes a comeback and this time we have gems from genres of critical care to ortho to even pop culture television!

• A great job - Cliff Reid gives an inspiring talk on job selection, satisfaction and the meaning of life! 
• AKA what? - EM Ireland gives us a morsel of AKA ... also known as...
• Bleeders must die! - What bleeds more commonly - test your knowledge.
• Activation clause - To Activate or not, that is the question.
• Medical specialties in Westeros - For the Game of Thrones fans among you!
• Give it the knee. - What is up with that knee?
• Low protein shake - Another tasty paeds morsel on losing protein this time. Great refresher.

Apple off cup or cup off axis or ???

Prof Larry Mellick gives us a tour de force video on a reduction of a carpal bone dislocation. Much conjecture not just in the video but in reality on the floor in most departments as well.
Enjoy and spread the knowledge.

Webucation 4/1/14

Our 1st installment of Webucation this year contains a barrage of trauma, a smattering of cardiology and a torrent of critical care... pun intended.

• The logroll is dead... long live the log roll? - Could you be harming your patient by shifting him needlessly?
• Blocking rib #s - Chris gives us a superb technique for pain control with far less risk
• 3 for 2  - So you think you know knee #s, can you spot all three of them? 
• The value of a goodhistory - Salim the Rebel EM debunks some myths about chest pain history
• Activation stations - Is overactivation an issue, here's maybe why?
• AXR mythology - Does the abdo xray really change your management?

• IVC roundup - Think you've got a handle on preload? Watch the IVC debate rage on at EMCrit.

The last link demonstrates a few things. Firstly, certainly we don't know it all. Next, it is a fine testament to the state of affairs that so many people not only care deeply but are willing to enter the fray on the topic. Lastly, Viva la FOAM as they say!

Webucation 18/11/13

We took a break for some family vacations but are back with more web trails for you. Meducation continues with snippets from paeds, cardio, trauma and good old "robots replacing us" prophecies!

• When to image the aorta -The trauma pro suggests some reasonable mechanisms
• Using clot busting drugs to treat acute strokes? - Really good summary from my old bosses in WA.
• Delayed Dx of Kawasaki disease - Its not that rare and vigilance is key
• What-is-this-radiographic-sign-called? - Another quiz from the invaluable Radiopedia.org
• Thoracic x-ray - Emergucate gives us a nice case from thoracic trauma
• Replace us with computers - Forget the zombie apocalypse, Skynet is still a threat!
• Low yield cardiac stress testing ED patients - Its used in many places, but is this still a viable, cheap strategy?

• Stop shouting! - This last article is a great illustration that EDs, institutional practices and medical staff interaction are the same around the world. There's always comfort in the chaos if you keep the channels of communications open though. 

Webucation 23/10/13

Web wisdom this time encompasses the fields of paeds, surgery, orthopaedics and a whole lot of radiology. As always, support the original content providers.

• Cavity mnemonic - Radiopedia gives us a great memory aid for cavitating lung lesions
• Typhlitis - What?? That's what I said... Paeds EM Morsels talks about necrotising abdominal pathologies
• How to confirm ankle joint penetration - Interesting stuff... use the blue!
• MBA accident - Know your trauma c-spine films? Do this test then.
• How bent can we leave it? - Just how bendy can we leave paeds #s?
• The death of decorum - Greg Henry decries the death of decency
• Death from thousand clicks -  The time saving devices are a phenomenal waste of time

• 10 tips for approaching abdominal pain in the elderly - ALiEM puts this much discussed topic succinctly.

We here echo this last link as a great reminder to all trainees and professionals of the high morbidity and mortality of abdo pain in the elderly. Our guide can be found under "Useful guides" above and here is the direct link for your reference. Have a high threshold of suspicion always.

Webucation 29/9/13

Web musings this week come from the worlds of critical care, paediatrics, orthopaedics and even the dermatologists! A lot of the below has risk management and error reduction pearls included. So visit and support the content creators as always. 

• Pneumonia detection - difficult x-rays in children, but not impossible
• Splinting upper/lower - EM in 5 gives a great rundown about casting limbs
• Is it Nec Fasc? - ALiEM relate a fascinating case, with a bit of risk management thrown in
• Variability of different BVMs - this article was a surprise to me. Click to be surprised as well.
• Is this distracting? - Ryan Radecki breaks down another myth. This  time about c-spine clearance.
• What is a wide mediastinum? - The trauma pro answers this much asked question
• Vent settings in asthma - what to do AFTER the intubation

The last link is a good reminder to trainees and professionals alike on the subtler aspects of holistic critical care. Additionally we would like to remind our readers of an old adage: 

                            "If you are intubating an asthmatic, you have failed him/her medically"

It's not a judgement but rather to remind you that there are tons of things that you can do prior to mechanically ventilating an asthmatic (most of the time). So make sure you have thought of the following prior to attempting this very high risk procedure:

• Broncho-dilator maximisation 
• Continuous nebs
• Ipratropium
• IV infusions of beta agonists 
• Theophylline (old school I admit)
• Adrenaline 
• Magnesium
• Non invasive ventilation and nebs via that route (anecdotally works great in our XP)
• Steroids

Emcit has the best crashing asthmatic talk over here.

About time re: Sternal #s

Thanks to JournalWatch for this update: Isolated Sternal Fractures May Not Warrant Hospital Admission Richard D. Zane, MD, FAAEM Reviewing Odell DD et al., J Trauma Acute Care Surg 2013 Sep 75:448 Most patients can be safely discharged after emergency department evaluation.

Sternal fractures are usually associated with high-energy trauma. Conventional wisdom has been that patients with sternal fractures require hospitalization because of the injury mechanism (usually motor vehicle crash), potential for occult associated injury, and severity of pain. In this retrospective study of 1867 patients with sternal fracture who were admitted to Israeli trauma centers over a 12-year period, the authors compared in-hospital events between patients with isolated sternal fractures (26%) and those with sternal fractures associated with other injuries (polytrauma; 73%). Patient characteristics and mechanisms of injury (mostly motor vehicle collisions and falls from significant height) were similar in the two groups. Compared with patients with polytrauma, those with isolated sternal fractures less frequently exhibited tachycardia, hypotension, tachypnea, Glasgow Coma Scale score ≤14, and Revised Trauma Score ≤11. No patients with isolated sternal fracture required endotracheal intubation, chest tube, thoracoscopy, or resuscitative thoracotomy; these procedures were performed in 17% of patients with polytrauma. EDITOR DISCLOSURES AT TIME OF PUBLICATION Disclosures for Richard D. Zane, MD, FAAEM at time of publicationEditorial boardsPocket Emergency Medicine CITATION(S): Odell DD et al. Sternal fracture: Isolated lesion versus polytrauma from associated extrasternal injuries — Analysis of 1,867 cases. J Trauma Acute Care Surg 2013 Sep; 75:448. (http://dx.doi.org/10.1097/TA.0b013e31829e227e)