Webucation 26/4/17

This edition of web wisdom hails from the realms of paeds and adult neurology with a smattering of tox and how to move patients. Credit to the original content creators.

• BMI in ED
• The ED transfer
• The 3 must read articles of 2016
• Paediatric cerebral venous thrombosis/
• Still 4 hrs for that level?
• Kicking against stroke thrombolysis

The last link makes you garner some perspectives. Would you really give snake venom to yourself or your loved ones? Know the whole argument prior to making your mind up.

Webucation 7/2/16

A Happy Lunar New Year to asian readers. Wisdom from the world this edition comes from specialities of trauma to tox and even some nerd evidence thrown in at the end. Do view and credit the original content creators.

• A metric not supported by evidence - Should you be judged by the hour?
• Ultrasoundoftheweek - Great point about lung point.
• Adult educational theories - Theories for everything.
• Necrotizing fasciitis pearls n pitfalls - Air in my flesh, it must be bacteria.
• Trauma for all ages - Any country left for old men?
• Single dose activated charcoal - Not all black and white it seems

• Alarm alarm! - Alarming stats with negligible impact

The last link is once again superb dogmalysis. Tech does not solve ALL our problems. Some we bring onto ourselves.

Webucation 13/12/15

This episode of web wisdom hails from the realms of almost all specialities. Make sure you visit the content on the sites and all credit to them.

• Information overload - Insights into Meducation

• Central line showdown - The Thunder Dome of lines!

• A FAST thoracotomy - Standstill is bad

• HD in Lithium OD - Just what can you do about it?

• Somethings amiss in this chest - What could it be?

• The bleeding edge - Teg-less but not

• Post intubation sedation for pregnant patients - Which is safe for your 2 patients?

The last link is a great resource for a population that goes under our radar. Good to know it is a safe, universal strategy nowadays to start analgesia first and then followed by sedation. 

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.

Webucation 26/5/15

We've been away but the FOAM world has not slept. Here's some gems from radiology as well as updates to kids, some cough mixture pearls and THAT video. Thanks to all the content providers.

• Imaging case of the week-137 - Emergucate's shocking CXR

• Vampires be gone - Don't be a serial chaser says the Pro

• OD optimal dosing  - How much fat is enough?

• New kids on the block - Got to know the little things. And updates too.

• Worms in my head? - Shot through the head? And you're to blame.

• Real surgical airway - How to do it in video. Controversy that follows is also interesting!

• How long DOES it last? - Wow. I bet you didn't know this!

A superb last link gives us the myth busting of our dreams. I am totally ashamed that I did not know this and have been telling most of my patients that it'll be over in a few days. Will change that now. 

Webucation 17/1/15

This edition of web wisdom brings you weird and wonderful and in rainbow colours as well. Be sure to credit the original content creators.

• Cough CXR? - Sometimes even bad things come in three's.
• That's a big tummy - Think you know your kid abdo xrays? Try this one.
• Ventilation in severe asthma - Can you get out of this difficult position in the future?
• Blue vomiting? - Cos who knows when this will show up...
• Dont i+d that paronychia - That's no moon, its a whitlow!
• Bronchiolitis 2015 - Finally a simplification we were all waiting for.
• Anti-CT top 10 - Ban pan scan man.

The last link provides yet another example of how the world is collectively wisening up to the dangers of irradiation and importance of wholistic care.

SEMS 2014: Yao Yi Ju - Novel recreational drugs you may see on your shift

Continuing our tox track videos: Dr Yao Yi Ju (PhD) is from the analytical side of things and this is her perspective of the novel recreational substances of abuse visible in today's EDs.

SEMS 2014: Chan Wui Ling - Recreational drugs

Dr Chan Wui Ling gives us the rundown on new "rec" drugs in the party scene these days and their impact.

SEMS 2014: Gene Ong on Paediatric Toxicology

Adj A/Prof Gene Ong from KKH Children's Emergency Dept gives us a quick rundown on common toxicological scenarios in modern city life. He gives this version of toxicology via the child's perspective - which is refreshing.

SEMS 2014: Updates in paeds toxicology from Rahul Goswami

Parachuting loaded mice

Now who would have thought that panadol could kill snakes!?! No need for bags of sulphur then... kidding.

Here's a fantastic story from the chaps at Poison Review:

Parachuting loaded mice!

The Line is Elegant, but NOT Fail Safe.

Assessing if a patient with acute paracetamol exposure with the Rumack-Matthew nomogram is probably one of the better prediction tool in medicine, but it is not fail safe. As this retrospective study remind us, it can sometime fail to predict late rise in serum paracetamol level crossing into toxic zone, especially when the paracetamol is in mixed formulation with other drugs. Even acute exposure to paracetamol alone sometimes show late rise.

So what are we to do??? Well, my best guess will be, if there is a large ingestion especially in mixed formulation, or when the serum level is really just below the line, we may want to check another level a few hours later.

As far as I know, there is no study to inform if this strategy will make a difference in patient outcome, so no one really knows. Maybe someone wiser have a better plan. Till we know, be mindful...

***
Dougherty PP, et al. Unexpected late rise in plasma acetaminophen concentrations with change in risk stratification in acute acetaminophen overdoses. J Emerg Med. 2012 Jul;43(1):58-63. Epub 2011 Jun 29.

http://www.ncbi.nlm.nih.gov/m/pubmed/21719230/

Mixology

Risks of mixing NRG drinks with ETOH

Original article