This week’s dose of funtabulous frivolity combines a drop of seminal fluid, pacemakers and mobile phones, a town in Australia, coprolalia and a bleeding varicose vein.

Do you think you’ve got what it takes?

Let’s find out.

Question 1

A forensic pathologist examines the body of a recently deceased man. The pathologist notes a drop of seminal fluid at the tip of the dead man’s penis. Does this indicate that the man was engaged in sexual activity just before death?

Reveal the funtabulous answer!

Question 2

Are patients with pacemakers allowed to use mobile phones?

Reveal the funtabulous answer!

Question 3

Which Australian town with a population of about 27,000 has over 40,000 emergency department presentations per year?

Reveal the funtabulous answer!

• Alice Springs, in the very center of Australia.
  
• Do the math — this suggests that every person in Alice Springs has an average of 1.5 presentations to the ED every year!
• Possible reasons for this include:

• social deprivation of the local indigenous population contributes to greater prevalence and severity of a wide range of medical illnesses.
• high rates of violence, particularly related to alcohol.
• a large catchment area with presentations from out of town – Alice Springs Hospital has 189 beds servicing an area of 1.6 million square kilometres.

Click to enlarge (Source: Wikipedia)

Question 4

What is coprolalia?

Reveal the funtabulous answer!

Question 5

An elderly patient awoke in the middle of the night and noted brisk bleeding from a varicose vein on his shin. Why should you carefully examine the patient’s feet?

Reveal the funtabulous answer!

Want An Easy Way To Score Higher On The FFFF?

It’s easy — write the questions yourself!
You can submit a question to the FFFF using this form.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The tenth edition of our weekly series of eminence-based evidence:

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 11 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer

• Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med. 2010 Oct;56(4):392-401.e1. PMID: 20868907.

The DORM study is an important step towards rehabilitating the reputation of droperidol in the sedation of agitated patients. Droperidol is an (almost) essential emergency drug that we should not be afraid to use when required.

Recommended by Chris Nickson

• Solomon RC. Coffers brimming, ethically bankrupt. Ann Emerg Med. 2012 Feb;59(2):101-2. Epub 2011 Nov 10. PMID: 22078890.

A brilliantly written piece outlining our culpability as physicians and our responsibility to make a stand and pay the moral and financial cost of our involvement with big pharma.

Recommended by Andy Neill

This week’s R&R recommendations

Critical Care

Emergency Medicine

Quirky, Weird and Wonderful

Toxicology

Trauma

Ultrasound and Imaging

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Books on how to give a great talk are dime a dozen. But how do you give a talk that will be impossible for your audience to forget?

Rather than accept throw away epithets and sanctimonious dogma, I prefer to look for empirical evidence. This search led me to a talk given at the Urodynamics Society meeting in Las Vegas in 1983. Say what you will about the methods used, the talk given by British physiologist Professor G. S. Brindley at that conference will never be forgotten by those in attendance. Brindley later received a knighthood for his bioengineering research.

What follows is based on account of this lecture by Laurence Klotz, who attended the meeting as senior resident hungry for knowledge. Klotz went to every lecture he could and, on the face of it, there seemed nothing special about Brindley’s scheduled lecture on vaso-active therapy for erectile dysfunction.

Klotz relates the following from the morning of the lecture:

“About 15 min before the lecture I took the elevator to go to the lecture hall, and on the next floor a slight, elderly looking and bespectacled man, wearing a blue track suit and carrying a small cigar box, entered the elevator. He appeared quite nervous, and shuffled back and forth. He opened the box in the elevator, which became crowded, and started examining and ruffling through the 35 mm slides of micrographs inside. I was standing next to him, and could vaguely make out the content of the slides, which appeared to be a series of pictures of penile erection. I concluded that this was, indeed, Professor Brindley on his way to the lecture, although his dress seemed inappropriately casual.”

Once in the lecture hall, Klotz took his seat in the third row and noted that before him sat a number of middle-aged urologists with their partners in “full evening regalia”.

Brindley took to the podium, still in his tracksuit. He related his hypothesis that the injection of vasoactive agents into the copora of the penis might initiate an erection. The next sign that things might take a turn for the peculiar was when Brindley explained that, in the absence of any suitable animal models, he had elected to use himself as a guinea pig to test his hypothesis.

Klotz recalls:

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The ninth edition of our weekly series of eminence-based evidence:

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 8 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer

• Batchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace. 2007 Nov;9(11):1081-90. Epub 2007 Oct 10. Review. PMID: 17932025.

This paper is a thing of beauty for the ECG nerd – all the ways incorrect lead placement can play havoc with an ECG.

Recommended by Chris Nickson
Fulltext

This week’s R&R recommendations

Critical Care

• Batchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace. 2007 Nov;9(11):1081-90. Epub 2007 Oct 10. Review. PMID: 17932025.

This paper is a thing of beauty for the ECG nerd – all the ways incorrect lead placement can play havoc with an ECG.

Recommended by Chris Nickson
Fulltext

• Beck LH. Should the actual or the corrected serum sodium be used to calculate the anion gap in diabetic ketoacidosis? Cleve Clin J Med. 2001 Aug;68(8):673-4. PMID: 11510523.

If only I had a dollar for every time someone has asked me the question this little paper succinctly answers…

Recommended by Chris Nickson
Fulltext

International and Tropical Medicine

Pediatrics

Quirky, Weird and Wonderful

Toxicology

Trauma

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

What do you get when you combine salted pork, a full moon, William the Conqueror, Stendhal and a swollen labia majora?

The 74th edition of the FFFF of course!

Question 1

What underlying condition might make you want to treat a patient’s nose bleed by inserting nasal tampons made of salted pork?

From Humphreys et al (2011)

Reveal the funtabulous answer!

Question 2

Is a full moon associated with increased behavioural disturbance in emergency departments?

Reveal the funtabulous answer!

Question 3

What is the key component of the ‘William the Conqueror’ diet?

Reveal the funtabulous answer!

Question 4

What is Stendhal syndrome?

Reveal the funtabulous answer!

Question 5

A competitive athlete asks for your advice about an embarrassing medical problem she has developed… a unilaterally swollen labia majora. What sport does she most likely compete in?

Reveal the funtabulous answer!

Want An Easy Way To Score Higher On The FFFF?

It’s easy — write the questions yourself!
You can submit a question to the FFFF using this form.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The eighth edition of our weekly series of eminence-based evidence:

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 14 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famers’

• Abd-el-Maeboud KH, el-Naggar T, el-Hawi EM, Mahmoud SA, Abd-el-Hay S. Rectal suppository: commonsense and mode of insertion. Lancet. 1991 Sep 28;338(8770):798-800. PMID: 1681170

Recommended by Rob Orman
Learn more: ERCAST – The Suppository Conundrum

• Hudson ML, Moore GP. Defenses to Malpractice: What Every Emergency Physician Should Know. J Emerg Med 2011;41:598-606. PMID: 21094012

Recommended by Leon Gussow

This week’s R&R recommendations

Airway

Critical care

Emergency medicine

Pediatrics

Quirky, weird and wonderful

Retrieval, prehospital and disaster

Toxicology

Trauma

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

aka Postcards from the Edge 004

This ‘postcard from the edge’ is by Swedish Emergency doctor Katrin Hruska (@akutdoktorn), who writes a predominantly Swedish language blog called akutdoktorn.

I am a born optimist, which is why I have taken on the struggle to establish emergency medicine as a specialty in Sweden. Since EM is a supraspecialty I had to take the long way through an internal medicine residency, but now I am at least seeing the end of my EM training. I am also mildly adventurous. Not in the crazy, head-first, emergency physician way, but in a safe, Swedish way. Somehow I managed to convince my program director that a rotation abroad would make a great contribution to my education, so me and my family moved to Botswana in southern Africa for four months.

I came to Botswana for an ED rotation, hoping to do some good and learn something from it. Four months later I am ready to leave and I look back at my experience with a sense of relief. At least I didn’t kill anybody. I think.

Primum non nocere. First, do no harm. A principle that, hopefully, is more sacred to us doctors than the traditional medicine men here, whose remedies worsen the metabolic acidosis of babies with diarrhea and cause hematuria and acute renal failure in adults. Of course we know better than those quacks. We are highly educated medical doctors who practice evidenced-based medicine. Right?

Only I have learned evidenced-based in a kind of EM rule-in/rule out or good/bad way. Intubation for traumatic brain injury with GCS less than 8 is good. Intubation without proper skills and equipment is bad. But what do you do when that is all you have to work with? What is the threshold for intubation if your only airway adjunct is an ET tube size 7,5 or 9 and there is no endtidal CO2? And you are out of oral airways, except the infant sized? And there is only one ventilator, which does not work with assist-control settings, so you have to sedate the patient. And getting blood gases is a hassle since you have to rely on the benevolence of the ICU staff to analyze them? And you are lucky to even get the help of inexperienced A&E nurses?

I have no idea if intubating these patients saves more brain than it kills. And four months of experience in this setting has not made it any clearer to me. It has just made me care less. Because even if I try me very best to minimize the risks and optimize the care for a patient, I will later find them alone in the resuscitate room, with no one there to hear the alarms, while waiting for paperwork to be filled out, transport to arrive or just other doctors to make up their minds. That is when I start to blame the system. And when the system is at fault, you sort of resign from responsibility. Irresponsible doctors are lousy caregivers, so I struggle to feel responsible for every single one of my patients. I never thought it would be so hard and I doubt that I could do it for much longer.

I must admit that I had a somewhat naive perception of doctors in resource limited settings before coming to Botswana. I had heard stories about great clinicians who made accurate diagnoses based on clinical findings, auscultating and percussing the patients all over. But the only ones I see assessing chest expansion and vocal fremitus are the medical students. The medical officers have all trained abroad in hospitals with better resources, where you just order a chest x-ray. They are well trained with the same theoretical education as myself. When it comes to experience they are in some ways way ahead of me. After a year of internship they are supposed to work independently and with the patient clientele here, they quickly learn procedures and gain experience of treating very sick patients. They learn and seem to accept that they have to work with what they have got. And since x-rays are readily avalable, they are ordered in the same just-in-case fashion as back home. It is as if whatever resources are available are not limited. Another example of this is the iv fluids. During my stay we were sometimes out of normal saline and sometimes out of Ringers lactate and a few times we were out of both. You can be an expert on fluid resuscitation, but if their are no other fluids available than Dextrose when you are treating a severely dehydrated, septic child you are just as helpless as everybody else. It is an awful experience.

But when the next load of fluids arrives everything is back to normal. Almost anyone who hits the door gets an infusion. If it is there, it will be used until it runs out. In fact the iv fluids are used to clean wounds, since it is the only sterile solution available. If fluids were truly a limited resource and you knew that you only got a certain supply per month, it would not be hard to rationalize their use. The problem is not that fluids and other basic supplies are unaffordable, but that the stocks are not replenished on a regular basis and that running out of fluids, gloves or other necessities is somehow acceptable and seen as something uncontrollable. The most limited resource is structure.

CT scans, on the other hand, are indeed limited. The CT scanner in the hospital cannot do contrast enhanced exams, which means that abdominal and thoracic scans have to be ordered from outside. It is still financed by the government but the costs are much higher and the use is restricted, which means that those scans are hardly ever ordered from the emergency department. We mainly use the CT for brain scans. By some order, the cervical spine cannot be included in such a scan, even if there is a clear clinical indication and the result might actually influence the outcome. At the same time, surgery can demand a CT brain for a patient slightly confused patient with GCS 15 who needs admission for observation after a road traffic accident and refuse to admit without it. We see 85 year olds with hemiparesis, who are transferred from other hospitals for CT scans, only to confirm their strokes. This practice seems reasonable in the rich world, but if resources are limited, is this really where you want to spend your money?

To prioritize is ethically challenging and I don’t think that I, as a visiting doctor and a foreigner in this cultural context, is the right person to tell the local doctors how to use their resources, just because I have been trained to know what is possible in my own setting. And by bringing our way of practicing here, we are indeed prioritizing emergency care over other aspects of health care. If we are guided by patient-oriented outcomes, such as mortality and morbidity, we are probably doing good. But if we use surrogate markers, such as adherence to what is regarded as evidenced-based principles in the rich world, we are diverting resources away from other areas, without knowing with reasonable certainty that we are saving lives. If we successfully resuscitate a patient in cardiac arrest, that patient will need one of the very scarce ICU beds. The return of spontaneous circulation might seem like a victory, but considering how few people actually leave the hospital neurologically intact even with high quality intensive care, we have to ask ourselves if we don’t have more to gain from preventing cardiac arrest than treating it once it has occurred.

The unique dimension of Emergency medicine is time. Sometimes seconds matter and sometimes even days don’t count. Our job is to see the difference. But it is also to plan ahead and lead a team. When you are working in a well organized ED, you don’t realize how much work is done by others than yourself. You just expect carts and trays to be complete and the medicine cabinet to contain the same things today that you used yesterday. You certainly don’t expect the bag-valve mask to be assembled in a way that can give your younger patients bilateral pneumothoraces. Knowing how to work all the equipment yourself is important everywhere, but here it is indispensable.

In some ways emergency medicine here is similar to what I learned as a medical student in the mid-nineties. A myocardial infarction is chest pain with ECG-changes and STEMIs are treated with streptokinase, unless there is a contraindication. A few patients can be admitted or referred to cardiology, but that is more an exception than a rule. What happens with all the MIs that are missed this way? I have no idea. I do know, however, that the step to the current practice, where every tiny increase in troponins is an NSTEMI, is huge. Should the development here follow the same path or is it acceptable to keep missing those MIs, because other areas are more important to improve on first? What about pulmonary embolism? If we did get a CT scanner that could scan for PE, who should we scan? And what would we do with the results? There is not great evidence for anticoagulation to begin with. Who do you start on warfarin if INR monitoring is only done at the main hospital, if you cannot get even plasma to reverse the effect and to get packed red cells for a transfusion can take four hours. If more patients bleed to death, than are saved from dying of PE, we are no better than the traditional medicine men, harming people with toxic remedies.

I am convinced that a well functioning emergency department saves lives. But I think that development has to focus on getting the basics right and minimizing the adverse effects of our interventions. To secure impeccable hygiene and barrier care limits the spread of nosocomial infections at a low cost. To organize the ED in a way that allows good monitoring and an overview of all patients makes it possible to intervene before the patient deteriorates. Excellent on the floor management that stresses team work and communication reduces the unnecessary errors and speeds up processes. Documentation that makes it possible to measure quality and follow-up can help us identify problem areas. It also tells us how our patient population compares to study populations and if the evidence that is available is at all applicable in our setting. Because to use even excellent evidence from a completely different setting is not to practice evidenced-based medicine. If there is no evidence you just have to rely on your clinical judgement and common sense. And keep doing your absolute best for every single patient. In a dysfunctional organization that feels like banging your head against the wall, again and again.

But what else can you do?

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The seventh edition of our weekly series of eminence-based evidence (back after the festive season hiatus):

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 18 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer’

• Croskerry P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Academic Medicine 2003;78:775-780. PMID: 12915363.

You won’t be able to avoid cognitive errors such as anchoring, confirmation bias, psych-out error, and Yin-Yang out unless you’re aware of them. Pat Croskerry gives suggestions on tuning up your medical decision-making.

Recommended by Leon Gussow

This week’s R&R recommendations

Critical Care

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

If you were to ask me:

‘How do I find out about web 2.0 and social media education resources for emergency medicine and critical care?”

I’d reply:

“Easy, spend 10 minutes checking out The LITFL Review.”

Just over a year ago it became clear to me that keeping track of all the fantastic free education resources in our field was becoming near impossible for even the most assiduous insomniacal social media savvy technophilic medicos among us. Recognition of this need led to the creation of The LITFL Review – a ‘one stop shop’ that brings together a week’s worth of new educational material from the very best blogs, podcasts, tweets and online multimedia from around the world.

Kane Guthrie has been the furnace in the engine room of The LITFL Review, and we can all be thankful for his weekly Herculean efforts in bringing this all together. Great work, Kane!

Now that a year has passed, it’s time to reflect on just how incredible the free resources that are being shared in the social mediasphere actually are. In doing so, we give you our twenty favourite ‘Most Fair Dinkum Ripper Beauts!’ from the first 52 editions of The LITFL Review:

20. Big Transfusion, Little Hospital = Big Trouble

Casey Parker is one of those MacGyvers of medicine we prosaically call ‘GP Proceduralists’. His enthralling blog, Broome Docs, has rapidly become a staple of The LITFL Review. In this post he highlights the issues facing a small remote centre when facing patients with massive haemorrhage. The post must be read with its follow up: ‘Managing Traumatic bleeding: how can we apply the evidence in smaller hospitals?’.

• The LITFL Review 041
• Big Transfusion, Little Hospital = Big Trouble
• Managing Traumatic Managing traumatic bleeding: how can we apply the evidence in smaller hospitals?

19. Meningococcal Disease: Pearls and Pitfalls

I was lucky enough to work with Colin Parker in 2010 and picked up plenty of paediatric pearls along the way. Even luckier, his EMPEM podcast keeps getting better and the pearls keep on coming. Colin and team recruited Paediatric Infectious Disease specialist Chris Blythe for this succinct and informative review of the menace of meningococcal disease.

• The LITFL Review 047
• Meningococcal disease: Pearls and Pitfalls

18. The First Resus.ME! Podcast

Cliff Reid’s first podcast is a tantalising taste of what he can do. His insights into resuscitation education and practice are always on the money. Fingers crossed we hear more audio offerings from this great educator in the future.

• The LITFL Review 018
• First Resus.ME! Podcast

17. Podcasting in Emergency Medicine

Rob Rogers is the man when it comes to the practicalities of how to educate in emergency medicine. For this episode of EMRAP: Educator’s Edition he brought together two of the shining lights of EM/CC social media learning, Rob Orman and Scott Weingart. What follows is an entertaining nuts-and-bolts discussion of how to make a podcast… which is also, indirectly, a call to educators everywhere to join the social media revolution.

• The LITFL Review 049
• Podcasting in Emergency Medicine

16. Distracting injury in c-spine injuries?

Michelle Lin is to blogging what Rob Rogers is to podcasting. She is an emergency physician with a passion for education and has a social media presence dedicated to the academic aspects of emergency medicine. Her blog, Academic Life in Emergency Medicine, has two core offerings: the Tricks of the Trade and the Paucis Verbis cards. This post is an example of the latter – all you need to know about a topic to make clinical decisions is presented on a card that can be printed out or stored electronically for instant access.

• The LITFL Review 035
• Distracting injury in c-spine injuries?

15. IV Spike Cric

CLIC-EM is fairly recent edition to the emergency medicine blogging scene, coming out of Chicago. The blog focuses on brief reviews of interesting and important papers from the emergency medicine literature. We liked this practical do-it-yourself approach to an emergency cric… Handy if you find yourself without your standard kit.

• The LITFL Review 042
• IV Spike Cric

14. Weaning from Mechanical Ventilation

Serious conflict of interest with this one – Oliver Flower is one of my best friends in intensive care and is a LITFL contributor. His ICU Podcasts feature on the Intensive Care Network, a free to registrar social network for anyone interested in intensive care. Oli gives an intensivist’s perspective on how to liberate a patient from the machine.

• The LITFL Review 020
• Weaning from Mechanical Ventilation

13. Instinct versus Expertise

I consider Movin’ Meat, along with GruntDoc and Blogborygmi, to be the foundation stones upon which the emergency medicine social media colossus of today is built. Even before LITFL, these guys were bringing emergency medicine to the blogosphere. Movin’ Meat is not strictly an educational resource – though there have been some great educational posts over the years – yet, anyone who consults specialists from the ‘pit’ will learn from this post based on real life experience.

• The LITFL Review 037
• Instinct versus Experience

12. Patrick Croskerry: Clinical Decision Making in Emergency Medicine

Free Emergency Medicine Talks is one of the great treasures of the Internet Age for anyone interested in emergency medicine and critical care. Which is no surprise, as it is, in turn, the website of one of emergency medicine’s great treasures, Joe Lex. My eyes lit up when I saw this listed as Joe’s pick of the week… Both myself and EMCrit’s Scott Weingart (and I’d suspect TPR’s Leon Gussow is in the same boat) are starstruck cheerleaders for the work of Patrick Croskerry in bringing insights from cognitive psychology to the ‘perfect storm’ of emergency medicine decision making. Thanks to social media you get hear the gospel from the man himself.

• The LITFL Review 014
• Patrick Croskerry: Clinical Decision Making in Emergency Medicine

11. ‘Peer Review is dead, long live Peer Review!’

Graham Walker epitomises the tech savvy emergency physician of tomorrow… or perhaps the day after tomorrow. Everyone should know him from MDCalc and his work on TheNNT.com, but he also writes elsewhere, including The Central Line. This post – the oldest entry to make the Top 20 – looks into the future of peer review, a subject close to our LITFL hearts.

• The LITFL Review 002
• ‘ Peer Review is dead, long live Peer Review!’

10. Venlafaxine bezoar causing intestinal necrosis

The Poison Review is, in my opinion, the most under-rated medical blog out there. It’s author, Leon Gussow, has the perfect mix of intelligence, experience and diverse interests to make this the perfect poisons blog… after all, everything is poison… it just depends on the dose. Blogs tend to lack the high impact bedazzlement of a slickly produced podcast or vodcast, but the best blogs are unrivalled in their scope, detail and collation of useful resources – TPR does this well. The staple of TPR is telling us why we should, or (usually) should not, believe the new additions to the tox literature. Leon scores them with his notorious ‘skull and cross bones’ rating system. This post is just an example of the consistently top notch work Leon produces week in, week out.

• The LITFL Review 010
• Venlafaxine bezoar causing intestinal necrosis

9. Dr. Rivers on Severe Sepsis – Part I

Imagine if you could create a podcast that feature the likes of Emmanuel Rivers (that’s right, of ‘Early Goal Directed Therapy’ fame) talking about the latest developments in the assessment and management of severe sepsis. In other words, imagine you’re EMCrit’s Scott Weingart… Few could do what he does and then give it away for free. By the way, there’s also Parts II and III…

• The LITFL Review 034
• Dr. Rivers on Severe Sepsis – Part I

8. Chest Pain Risk

The SMARTEM podcast is mind blowing. David Newman and Ashley Shreeves get together on a monthly basis to dissect out the whys and wherefores that underlie what we do. Let’s not kid ourselves, listening to each podcast is an exercise in mental stamina – David and Ashley even advise taking it in bite-sized parcels. Yet the listener’s efforts are invariably rewarded, and there are often big surprises in store. My favourites so far have been the Subarachnoid Hemorrhage and Pediatric UTI podcasts, but neither of those were “Most Fair Dinkum Ripper Beauts”… In this one David tells us how he assesses the risk of badness happening to emergency patients presenting with chest pain.

• The LITFL Review 014
• Chest Pain Risk

7. Anatomy for Emergency Medicine video series – #1 Cervical Spine

Andy Neill is a LITFL reader from way back, and has gone on to create his own blog called ‘Emergency Medicine Ireland‘. Andy is a bit of an evidence boffin and likes to give his take on recent papers from the EM literature, but he has also started putting his skills as an anatomy tutor extraordinaire to use for ER docs. This is his first video on applied clinical anatomy for emergency medicine.

• The LITFL Review 049
• Anatomy for Emergency Medicine video series – #1 Cervical Spine

6. Atrial Fibrillation

If anyone was ever meant to podcast, it was Rob Orman. I may be misremembering, but I think Rob Rogers once likened him to the Barry White of EM podcasting. His curbside consult audio episodes have a captivating conversational style that allows him to really get into the ‘nitty gritty’ with an expert from another specialty. This one gets into the ins-and-outs of AF management with a likeable and knowledgeable electrophysiologist. Its worth listening to for the description of Rob’s first ‘hands on’ cardioversion if nothing else…

• The LITFL Review 011
• Atrial Fibrillation

5. Haemostatic Resuscitation

This video lecture by Richard Dutton, who we first met on a previous EMCrit podcast on resuscitation of the haemorrhagic shock patient, is one of the best lectures I’ve seen. Dutton really knows his stuff, and is actually one of the pioneers of the modern haemostatic resuscitation approach. What’s more, we get a few glimpses of Baltimore’s Shock trauma Center, which looks like one heck of a place to do medicine. Actually, this lecture shared the top spot of the 23rd LITFL Review with Scott Weingart’s take on The Mind of the Resus Doc: Logistics over Strategy… So check that out too.

• The LITFL Review 023
• Hemostatic Resuscitation

4. Bum crack fluid pump

After TPR, Resus.ME is the next most under-rated blog on the planet. Cliff Reid is a reliable source of new ideas and cutting edge insights in resuscitation. As for this post, how could you go past it with a title like that? Need to give fluids fast in a pre-hospital environment, but don’t have a pump? Here’s what to do.

• The LITFL Review 007
• Bum crack fluid pump

3. Paediatric airway for emergency physicians who are not also paediatricians

One thing I’ve learnt from the past few years of trawling through educational social media, is that if EMUpdates‘ Reuben Strayer makes a screencast you are being irresponsible if you don’t check it out immediately. In this one Reuben tackles the paediatric airway… the words “who are not also paediatricians’ shouldn’t be there – paediatricians will want to check this out too.

• The LITFL Review 021
• Paediatric airway for emergency physicians who are not also paediatricians

2. ERCAST Rant-Off

This episode of ERCast is a classic. Rob invited the world to send him their best rants on an emergency medicine topic. Put together, this makes for riotous listening. For me, Cliff Reid’s effort ensures him a place in the ranter’s Valhalla. Can’t wait for the next ERCast rant off…

• The LITFL Review 030
• ERCAST Rant-Off

1. Delayed sequence intubation

Perhaps more so than anyone, Scott Weingart sets the standard for what can be achieved with educational social media in emergency medicine and critical care. I’ve listened to Scott’s work from its inception, and later discovered that I was already a fan of his thanks to his book on emergency medicine decision making. Make no mistake, if you work in the emergency medicine and critical care fields you need to listen to every single one of the EMCrit podcasts – IT REALLY IS THAT GOOD. Scott’s post on delayed sequence intubation inspired me to adopt this approach in my own practice, and the outcomes have been near magical so far.

• The LITFL Review 005
• Delayed sequence intubation

I’m sure you’ll agree, that’s a pretty amazing selection of free educational offerings.
But it is only the tip of the iceberg, check out The LITFL Review each week to make sure you don’t miss anything…

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Followers of R&R in the FASTLANE will have noted in the third edition that Joe Lex recommended reading Danzl’s quirky, weird and wonderful  1992 masterwork on ‘flatology’:

“A classic paper on an unpleasant subject – farts.  Danzl approaches this sticky subject with tongue firmly planted in cheek, but he’s done his homework well.  This remains the classic article on this unmentionable topic.”

This week’s FFFF is dedicated to the science of flatology, and doubles as a study guide for Danzl’s exposition. Assiduous FFFFers will also recall a question regarding ‘son et lumiere’ sign from the 71st FFFF, which is also of great import to this topic.

Without further ado, here is this weeks funtabulously frivolous flatological friday five!

Danzl DF. Flatology. J Emerg Med. 1992 Jan-Feb;10(1):79-88. Review. PMID: 1629596.

Question 1

What did the Roman Emperor Constantine outlaw in 315 AD?

Reveal the funtabulous answer!

Life in the Fast Lane Medical Blog - Emergency Medicine education blog