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?

Ortho damage control

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

Webucation 30/8/17

Webucation this time comes from subjects encompassing departmental ethos, paediatric and adult trauma, ECG dilemmas and even TED talk skills. As always credit to the original content creators. Do visit their sites.

• What really happens to a SAH?
• Pseudo lung point on U/S
• Bouncing kids and their injuries
• Don't kill your audience with bulletpoints
• STEMI or not STEMI... that is the question
• Is it ever too late to trauma activate?

• Nurse led codes
• What if your child had an arrest (this is a "must hear")

The last 2 links are worth the listen on your way home or on a jog. They describe and portend resuscitation at its best when elements align. Both talks show what can be if we get the heady mix of training, tech and guts right.

Webucation 30/6/17

Webucation this month comes from the realms of trauma, cardiology. paeds and tests our "mythos" on cardiac arrest management! All credit to the original content providers.

• Pressing those veins
• Is Amiodarone dead?
• Ultrasound in paediatric trauma
• Egg white for sepsis?
• REACTing to REACT2
• The bamboo flute chest drain technique

• Is "A" really top of the treatment list?

The last link should make you wonder - are you really doing the right thing? LMAs that are inserted by ambulance personnel in the Singapore system are more than adequate. 

So things to focus on include:

• High quality CPR
• Reducing the over-oxygenation
• Using ETCO2 and U/S to guide your resuscitation
• Engaging reperfusion strategies early
• Replacing the tube when pendulum of stability has swung your way.

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 28/2/17

This shot of Webucation includes sonography, pulmonary physiology, old school physics and even some etiquette advice. All credit to the original content providers.

• Hocus POCUS in cardiac arrest
• Things that scare me
• "Back to school" mathematics on closing velocity
• Impact of rudeness on medical teams
• Doctors better than Google?

• The truth about oximetry

The last link is extols a personal bug bear as well - why stab someone's artery to prove nothing? So in the future think twice before an ABG.

Webucation 8/11/16

Web wisdom this edition comes from the climes of mostly trauma this time but also from philosophers in our field from around the globe. 

• Amal Mattu to the graduating resident - Advice from a sage
• Liver lacs explained - Are you enzyme addicted?
• Motorbike accident with a rare complication - Pneumo - what?
• Out of Africa - Could you take one night in the Cape?
• 10 resus orders  - Fire fighting in EM

• Pressure in trauma? - Probably the best explanation in managing hypotense trauma patients

The last link and its sequel is a must hear audio cast. It is a simplistic yet deep dive into management of the critically injured trauma patient.

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!

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.

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.

Transport is TRICI

The recent SEMS 2016 conference in Singapore was well received by attendees and its myriad of workshops/courses and talks continues to grow. This year, Changi General Hospital added a one day workshop to highlight the troubles in transporting critically ill patients. It involved lectures, simulation, quizzes and demos and lots of food.

"Shoutout" goes to Changi Simulation Institute for once again hosting and moulaging our sims.

TRANSPORT In the Critically Ill 

(aka TRICI)

What its all about - TRICI

Demonstrating practically our retrieval bag and contents

Dr Joanne Ang debriefing after a multi-stage simulation

No gain without pain

The actual quiz - learning without the stress of marks

Dr Charles Chan-Johnson (centre) & SSN Himmah (extreme left) giving a synopsis of actual ambulance transport

Ambulance ride along with mannequin

Teaching faculty of Dr Naleen and SSN Irene "treating" a critical patient

A/Prof Loh Lik Eng giving a paediatric transport primer

Feedback was encouraging and we plan to have more of the above. If you would like to join/participate/know more do send us an email.

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 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!

Webucation 26/7/15

Web musings from around the globe this round include pointers on trauma, paeds, cardio and a good rundown on the ever challenging asthmatic.

• Choose life, choose minimal radiology - Gathering momentum to return to clinical judgement
• The crashing asthmatic - Avoid the crash for Dr your patients sake. Excellent talk
• Taking the lead - A great learning case from Steve Smith himself
• South of California? - Emergucate's imaging case of the week is a peninsula.
• Those little necks - ERCast discusses paediatric C-spine clearance

• Archaic trauma life support - Basic course indeed

The last link is a notion supported by our group as well. It is essential to know the basics of trauma resuscitation and how teams work in that arena. It just shouldn't be termed "Advanced" in this day and age.

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. 

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 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.