Webucation 5/5/18

Web wisdom this round comes from gurus in EBM, critical care, trauma and even some philosophers on the state of affairs in medical education/administration. Credit as always to the original content providers.

• Breech delivery - info for when you need it!
• High flows you should know - all about BiPap and the new-ish HFNC
• The top 10 trauma papers - compiled by St Emlyn's
• Shrug it off - a novel technique for your subclavian needs
• The tPA drug war without end - controversial because science clashes with dollars
• UTI pearls and pitfalls - you'l be surprised at what you learn about "simple" things

• The trouble with mindfulness - one of the best articles I have read recently relating to error prevention and human behaviour. Well worth a read even if not in a "medical" mood.

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?

Webucation 29/5/17

This edition of web wisdom brings us trauma, ultrasound and radiology pearls as well as reminding us of our dark sides in medical over treatment. All credit to the original content creators.

• The what on ultrasound?

• Compare and contrast

• The trial of a woman?

• Top 10 trauma papers of 2016

• Think laterally

• Mythology and science of UTI

The last review is a must read if you work in an ED or even in an outpatient setting. It demonstrates the gross negligence we have been all guilty of. 

In essence - stop over-treating asymptomatic patients - be they elderly or catheterised or even pregnant. 

It is a clinical diagnosis most of the time.

When treating with antibx, keep it short and choose the safest drug.

Webucation 29/5/16

Webucation this month comes from the realms of paedatric surgery, urology and even on some tele-medicine. Remember to visit and credit the original posters.

• No place to be - Not what you'd expect a surgeon to say
• A fontanelle of youth - Battle the Bulge
• Torsion pearls and pitfalls - Its not just the guys, girls get it too.
• Reboa - Rreat talk about a great topic on new use of catheters!
• Calling for help - Phone etiquette for the busy physician
• Metaphysis this! - Vegetables are good for you says Radiopedia

• Sepsis-3 - This is need to know classification for all who deal with this disease

The last link is a must read for those in our speciality. For it is said many a time that the 2 things that we deal with mostly in our career are related to vascular problems and sepsis. So be good at them.

Webucation 3/11/15

Web wisdom this episode distills some thoughts about kidney stones, updates our facts in paeds and even challenges dogma about CTs in trauma - heavens no....
All credit to the original posters and do visit their sites for more content.

• The no CT in trauma experience - Blasphemy! Radiation-less trauma managment?
• Colchicine in acute gout - High or low? It's not poker.
• Stop throwing stones - Expulsion is the only option?
• The_Bottom_Line on analgesia - Special K vs the big M
• What classic sign is this? - Revenge of the Fallen
• Better less than more - Could it be that more research is good?

• Best topics in 2015 paediatrics  - A little knowledge about little ones

The last link is essential for anyone treating kids these days. Have to keep up to date as the parents surely are!

Outside the abdomen

Here's another great case from Prof Larry Mellick.
Reminding us that sometimes abdominal pain pathology is "outside the abdominal examination".
Also remember these other pathologies when formulating a differential:

• Inferior MI (adults)
• Lower lobe pneumonia
• Hernia

Webucation 12/9/13

Web wonders this time stretch from the world of paediatrics to geriatrics, from ECG to trauma and even some words of wisdom from an "old" ED hand. be sure to support the original content creators.

• 10 things i wish i had started doing the day i began practicing - the "Fickle Finger" gives us his laments, triumphs and ultimately much wisdom. Well worth a read.
• JHC ecg-of-week - excellent explanations now follow weekly ECGs at John Larkin's site
• Pain, honeymoon and torsion? - not the typical testicular test. another great example from Larry Mellick
• A time based approach to elderly patients with AMS - think geriatrics don't have time sensitive issues? Think again.
• Dissecting it in in 5 mins - the all knowing K. Wang sets the record straight on Aortic Dissections
• LFTs and liver lacerations - the Trauma Pro clears the air on investigating these
• Avoid oxygen desats - Paeds EM Morsels argues that there should never be desats in children either.

The last point echoes on from NODESAT policies from airway gurus around the world. We cannot but echo them further to all our readers. Prepare, prepare, prepare. The boy scout mentality staves off lots of trouble for your patient. Our ventilation guide is here.

Webucation 13/8/13

Web musings come from abundant surgical sources this time. Enjoy the readings and always support the original content providers.

• Always check what you ordered - the Trauma Pro reminds us that philosophy is similar in restaurants and hospitals
• Surgical or medical jaundice or something-else - another illuniating video by EM tutorials
• CT in stab wounds - do you really need to?
• Sciatica therapy - maybe a rethink what you thought is essential examination?
• Haematuria management - A brief rundown of bloody urine in the ED
• Fluid responsiveness - ED Lyceum gives us some collective knoweldge on this ongoing fluids debate
• Contrast induced nephropathy - EDTCC gives us a great run-down on this controversial topic. Certainly there has been a tendency to err on the side of caution by radiologists but is there any REAL evidence for what we do?

What we do in our practice is that we look into all the factors (some latent) when deciding who needs a scan with contrast:

1. Age
2. GFR - more so than creatinine
3. Pathology in question - can it be observed rather than immediate diagnosis now?
4. Renal disease?
5. Non contrast scan - you will be surprised at its utility

Feel free to comment or ask your friendly radiologists to if they have an opinion.

Strand and deliver

This was a standard KUB done for renal colic but there is something odd about it.

Normal patient haemodynamically and in all other ways.

Any guesses?