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!

The eyes have it

Prof Larry Mellick posts great medical vids on his Youtube channel. Here's his recent posts on opthalmological emergencies. 
Great tips include:

• Grading and complications of hyphema
• Pathophysiology of corneal ulcers
• Distinction of periorbital and orbital cellulitis

This is modern learning at its finest and make a point to "like" and subscribe to his channel.

TXA denial SMACC-down

SMACC 2015 videos will be coming fast and enlightening as they continue their valuable trend in post conference broadcasting. Long may it continue.
Prof Karim Brohi enthralled at our local conference a few years ago and he is at his whimsical best here. He lays the "SMACCdown" on deniers of a novel therapy using science.
SPOILER ALERT - be prepared for a heavy dose of sarcasm.

Prof Brohi's other talks in 2014 are here and here.

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 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. 

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 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.

Trauma resuscitation - Myths and Realities

Prof Karim Brohi of Trauma.org attended and lectured at one of the trauma grand rounds just before SEMS ASM 2014. This is a recording of that talk and the Q&A session that follows. Lots of myths dispelled and important priorities brought into focus.

SEMS 2014: Prof Karim Brohi - Major Haemorrhage and Trauma Induced Coagulopathy

We have come to the end our run of selected videos from the SEMS Annual Scientific Meeting 2014 and it has been our pleasure to bring you this series. Hopefully this ushers in a new era of FOAM video and audiocasts of South East Asian Conferences.

We leave you with a detailed analysis on bleeding and coagulopathy in major trauma from the trauma guru himself. Prof Karim Brohi gave a series of talks in Singapore (not just the conference) and this one is essential for any level of medical personnel who deals with major trauma.



Slides are here:

Prof Karim Brohi Major haemorrhage & Coagulopathy from Rahul Goswami

CEM (UK) on traumatic arrests

The UK College is now active in the FOAM world and here's a good example of modern trauma information being disseminated to the general population.

SEMS 2014 - Ng Kee Chong: What is permissible in a critically injured child?

A/Prof Ng Kee Chong is the esteemed head of the only tertiary paediatric emergency department in Singapore. He discusses the modern techniques of adult trauma resuscitation and then gives an in-depth analysis of which of those principles can be realistically applied to the critically injured child.




His slides are below:

A/Prof Ng Kee Chong - What is permissible in paediatric trauma from Rahul Goswami

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 29/3/14

We're happy to be back and we bring you some tasty bits of med-ed from the realms of paeds, ob/gyn, surgery and even some philosophy. Credit as always to the content creators.

• Shock in early pregnancy - Chris Cresswell's excellent pathway/guide for bleeding in early pregnancy
• Neonatal analgesia - Should children really be deprived of this based on whim?
• Abc easy as 123? - Ryan Radecki asks is ABCD3 is what you need
• Is it just culture? - Do we really need to keep doing this for everyone? ... Bug bear of mine.
• A what lesion? - The Trauma Pro shows us a lesser known disease. 
• Under the dome - Why is the dome gone?
• More TPA debate - great debate on stroke lysis. Pros and cons all laid out for you.
• Dogmalysis - Cliff Reid's homage to myth busting.

The last link is close to our hearts. We deal with such "traditions" day in/day out. We thank such innovators in bringing to light the remedies in such scientific form.

Ear emergency!

Here's a nice vid on an ear heaematoma by Prof. Larry Mellick.
Rare but crucial diagnosis and treatment. Also great anatomy revision thrown in.



See more of his videos here.

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 4/12/13

Web learning this time comes form the depths of "bloody" trauma but also from the murky realm of crystalloids.... pun intended. We also get a dose of gynae and neonatology - perennial blind spots for some. 

• Fitz-hugh-curtis syndrome  - EM Tutorials gives us a nice reminder of the pathology, Dx and treatment options for this "blind spot"
• Neonatal CXR - Emergucate brings us a good revision on another rare image
• Collared you say? - The trauma pro brreaks down different types of collaring
• CCF guidelines - Resus.me points us towards the new cross continental CCF guide
• What you though about fluids - Game changing evidence from ICN about fluids
• The trauma arrest - Rob Orman and Scott Weingart discuss trauma arrests

• Watch and wait instead of scan??? - What manner of witchcraft is this?

The last link we truly echo. Clinical examination has taken a back seat to volume-necessitated pathways and unfortunately rampant, random irradiation. The backlash may be coming. It's time to do some doctoring again folks.

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.

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.