Life in the Fast Lane Medical Blog » Education http://lifeinthefastlane.com Emergency Medicine education blog Thu, 24 May 2012 10:28:35 +0000 en hourly 1 http://wordpress.org/?v=3.3.2 Contextual learninghttp://lifeinthefastlane.com/2012/05/academics-without-titles/ http://lifeinthefastlane.com/2012/05/academics-without-titles/#comments Thu, 24 May 2012 07:22:36 +0000 Mike Cadogan http://lifeinthefastlane.com/?p=54531

Life in the Fast Lane Medical Blog Contextual learning

We are seeing an increased number of engaged, interested readers who are enjoying learning for the sake of learning. It has led to the development of 'anyone-anywhere-anytime-anything' learning

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]]> Life in the Fast Lane Medical Blog Contextual learning

The Internet is a powerful tool.

It has provided us with myriad opportunities to review the way we look at education. Social media and web 2.0 has increased the level of engagement at a global level and allowed high quality information to be written, read, heard, seen and shared. This sense of global community education is the very essence of the modern day version of asynchronous learning.

Asynchronous learning is a student-centered teaching method that uses online learning resources to facilitate information sharing outside the constraints of time and place among a network of people. Asynchronous learning is based on constructivist theory, a student-centered approach that emphasizes the importance of peer-to-peer interactions

We are seeing an increased number of engaged, interested readers who are enjoying learning for the sake of learning. It has led to the development of ‘anyone-anywhere-anytime-anything‘ learning …picking apart the standard educational models

Working online, and without a syllabus has allowed us to provide a complimentary strategy to solution driven problems (Problem Based Learning) and physical scientific constructivism (contextual learning) and be a little more creative in our educational approach. We have the opportunity to go beyond conventional classroom learning and develop a community based teaching model based on asynchronous contextual online learning. This will allow more time for reflection on complex ideas, which is great for continuous professional development.

With this is mind, we have a number of new projects underway at LITFL…

Finally the iMac box structure is being built…slowly

Asynchronous contextual learning

 

References:

  • According to Hull’s (1993) definition of contextual learning, learning occurs only when learners connect information to their own frame of reference
  • Karweit (1993) defines contextual learning as learning that is designed so that students can carry out activities and solve problems in a way that reflects the nature of such tasks in the real world. Research supports the effectiveness of learning in meaningful contexts (Carraher, Carraher & Schleimer, 1985; Lave, Smith & Butler, 1988).
  • Resnick (1987) points out that schools emphasize symbol manipulation and abstraction instead of the contextualized learning that is used in the world outside of school. She says the problem is that the symbols are detached from their real-world referents. Because they are decontextualized, they have no meaning for students.
  • Design for Contextual Learning: Web-based Environments that Engage Diverse Learners
  • Critical investigation of the problems with PBL [PDF]
  • Definitions of contextual learning
  • Asynchronous and Synchronous eLearning [PDF]

 

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

]]> http://lifeinthefastlane.com/2012/05/academics-without-titles/feed/ 3 Physiology Philes 001http://lifeinthefastlane.com/2012/05/physiology-philes-001/ http://lifeinthefastlane.com/2012/05/physiology-philes-001/#comments Thu, 24 May 2012 06:44:47 +0000 Michelle Johnston http://lifeinthefastlane.com/?p=54789

Life in the Fast Lane Medical Blog Physiology Philes 001

Welcome to the first in the Physiology Philes series, part of the basic science in clinical context project on LITFL. First up is the Valsalva Manoeuvre

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

]]> Life in the Fast Lane Medical Blog Physiology Philes 001

Welcome to the first in the Physiology Philes series, part of the basic science in clinical context project on LITFL. First up is the Valsalva Manoeuvre

The Valsalva Manoeuvre is an example of a tactic that demonstrates a basic cardiovascular physiologic feedback loop.  The purpose of it is to induce vagal firing from the cardiovascular control centre in the medulla, in order to slow the heart rate, and interrupt the rapid ventricular rate in a supraventricular tachycardia.

The video takes us through the manoeuvre – we start with an increase in transmural pressure in the aorta, and the initial baroreceptor reflex causing an initial slowing of the heart, through afferents to the medulla and a reduction in sympathetic outflow and increased vagal firing. We then follow the fall in venous return and thus cardiac output as a result of the sustained intrathoracic pressure increase, which stimulates a reverse and increase in sympathetic outflow. When the manoeuvre finishes, after about 10 seconds,  and blood rushes back into the great vessels, with added sympathetic peripheral vasoconstriction, the sudden increase in stretch at the aortic arch and carotid sinus again caused profound vagal outflow, at this point hopefully slowing down the AV node conduction enough to stop the SVT.

We then look at the best way of performing this in the clinical setting…

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

]]> http://lifeinthefastlane.com/2012/05/physiology-philes-001/feed/ 0 R&R in the FASTLANE 019http://lifeinthefastlane.com/2012/05/rr-fastlane-019/ http://lifeinthefastlane.com/2012/05/rr-fastlane-019/#comments Thu, 24 May 2012 00:00:08 +0000 Chris Nickson http://lifeinthefastlane.com/?p=54488

Life in the Fast Lane Medical Blog R&R in the FASTLANE 019

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 in the 19th edition of R&R in the FASTLANE.

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

]]> Life in the Fast Lane Medical Blog R&R in the FASTLANE 019

The 19th edition of our series of eminence-based evidence:

R&R in the FASTLANE 010 RR IN THE FASTLANE LOGO 21 590x213

A free 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 Famers’

  • Kelly LE, Rieder M, van den Anker J. More codeine fatalities after tonsillectomy in north american children. Pediatrics. 2012 May;129(5):e1343-7. Epub 2012 Apr 9. Pubmed PMID: 22492761
R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Hall of fame 64 You may have used codeine safely so far – but it’s a flawed medication and should be replaced in your practice.

Recommended by Ryan Radecki
Learn more: EM Literature of Note — Codeine, Potentially Unpredictably Lethal

This week’s R&R recommendations

  • Paul AM, Young NH, Price GC. Emergency tracheal intubation without drugs: outcome and one-year survival of medical patients not in cardiac arrest. Scott Med J. 2012 May;57(2):84-7. PubMed PMID: 22555228
R&R in the FASTLANE 009 RR GameChanger 64 More evidence that if the patient you’re intubating has a pulse, you want to paralyze them. The crash airway for the nearly-dead had longer intubation times and more first-pass failures. (n.b. my library doesn’t have access to the Scottish Medical Journal so I’ve only seen the abstract)

Recommended by Seth Trueger

  • Suzuki H, Nakajima W, Aoyagi M, Takahashi M, Kuzuta T, Osaki M. [A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient]. Masui. 2012 Apr;61(4):384-6. Japanese. PubMed PMID: 22590940.
R&R in the FASTLANE 009 RR WTF 64 Why restrict intubation to supine, semifowler’s, or tomahawk, when you can make the face-plane parallel to the floor? n=1 study of patient intubated while prone in the OR. Abstract-only – my library doesn’t have access to Masui (Japanese for Anesthesia) and I can’t read Japanese regardless.

Recommended by Seth Trueger

  • Venezia D, Wackett A, Remedios A, Tarsia V. Comparison of Sitting Face-to-Face Intubation (Two-Person Technique) with Standard Oral-tracheal Intubation in Novices: A Mannequin Study. J Emerg Med. 2012 May 3. [Epub ahead of print] PubMed PMID: 22560270
R&R in the FASTLANE 009 RR GameChanger 64 We should all know the limitations of airway studies simulation (e.g. Airtraq is great on models, terrible in the field; see this Resus.ME post) but this is a good proof-of-concept paper that shows laryngoscopists can be reasonably trained to perform face-to-face tomahawk intubations. I’ve only done this on models and people/patients without passing a tube, but it’s always good to have an extra arrow in the quiver.

Recommended by Seth Trueger

  • Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: a variation on a theme. Acad Emerg Med. 2008 Jul;15(7):683-7. PubMed PMID: 18691216.
R&R in the FASTLANE 009 RR Mona Lisa 64 R&R in the FASTLANE 009 RR Eureka 64 How to teach medical students in the ED to concisely present a patient.

Recommended by Chris Nickson
Learn more: LITFL — ED Case Presentation for Medical Students
Fulltext

  • Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as First-line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice. World J Surg. 2012 May 9. [Epub ahead of print] PubMed PMID: 22569747.
R&R in the FASTLANE 009 RR GameChanger 64 This is a real world study that shows that antibiotics first is a viable option for the treatment of appendicitis, confirming previous RCTs. Complications were less for those receiving primary antibiotics compared to those receiving primary surgery. A difficulty is that not all cases were ‘confirmed appendicitis’ – ‘early appendicitis’ can be hard to confirm.

Recommended by Chris Curry

  • Rossen R, Kabat H, Anderson J. P. Acute arrest of cerebral circulation in man. Arch Neurol Psychiat; 1943(50): 510-28
R&R in the FASTLANE 009 RR WTF 64 The Rossen study is shocking in its design, literally eye-popping in its technique and with consequently remarkable findings that obviously will never be duplicated in humans. The commentary by Smith (2007) is well worth reading.

Recommended by Reuben Strayer
Fulltext and Commentary

  • Panesar NS, Graham CA. Does the death rate of Hong Kong Chinese change during the lunar ghost month? Emerg Med J. 2012 Apr;29(4):319-21. Epub 2011 Dec 28. PubMed PMID: 22205780.
R&R in the FASTLANE 009 RR WTF 64 Emergency Physcians examine death rates in Hong Knog. How about their awesome conclusion:”To protect their family, the Chinese women postpone death until after the hungry ghosts have been fed and hopefully banished forever.”

Recommended by Cliff Reid

  • Mc Laughlin P, Neill SO, Fanning N, Mc Garrigle AM, Connor OJ, Wyse G, Maher MM. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad. Emerg Radiol. 2012 Apr;19(2):127-33. Epub 2011 Dec 16. PubMed PMID: 22173819.
R&R in the FASTLANE 009 RR WTF 64 Radiologists have been tele-reading for a while and this is a little study from Cork examining how well the iPad did for reading CT Heads. Bottom line – it did OK. This was with the original iPad and I imagine the newer one might pull it off even better.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — iPad for radiology reads. WARNING – NO FREE IPAD/VIRUS WITH THIS LINK….!

  • Kelly LE, Rieder M, van den Anker J. More codeine fatalities after tonsillectomy in north american children. Pediatrics. 2012 May;129(5):e1343-7. Epub 2012 Apr 9. Pubmed PMID: 22492761
R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Hall of fame 64 You may have used codeine safely so far – but it’s a flawed medication and should be replaced in your practice.

Recommended by Ryan Radecki
Learn more: EM Literature of Note — Codeine, Potentially Unpredictably Lethal

  • Korniyenko A et al. Visceral angioedema due to angiotensin-converting enzyme inhibitor therapy. Cleve Clin J Med 2011 May;78(5):297-304. Pubmed PMID: 21536824
R&R in the FASTLANE 009 RR Eureka 64 Visceral angioedema caused by ACE inhibitors in another obscure, easily missed toxicologic cause of cryptic abdominal pain and vomiting, to be considered along with narcotic bowel syndrome and cannabinoid hyperemesis.

Recommended by Leon Gussow
Learn more: The Poison Review — Puzzling abdominal pain and vomiting? Consider ACE inhibitor-induced visceral angioedema
Fulltext

The R&R iconoclastic sneak peek icon key

R&R in the FASTLANE 009 RR Authors 64 The list of contributorsR&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE 009 RR Hall of fame 64 R&R Hall of fame
You simply MUST READ this!		R&R in the FASTLANE 009 RR Hot Stuff 64 R&R Hot stuff!
Everyone ‘s going to be talking about this
R&R in the FASTLANE 009 RR Landmark 64 R&R Landmark paper
A paper that made a difference		R&R in the FASTLANE 009 RR GameChanger 64 R&R Game Changer?
Might change your clinical practice
R&R in the FASTLANE 009 RR Eureka 64 R&R Eureka!
Revolutionary idea or concept		R&R in the FASTLANE 009 RR WTF 64 R&R WTF!
Weird, transcendent or funtabulous!
R&R in the FASTLANE 009 RR Boffin 64 R&R Boffintastic
High quality research		R&R in the FASTLANE 009 RR Trash 64 R&R Trash
Must read, because it is so wrong!
R&R in the FASTLANE 009 RR Mona Lisa 64 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

]]> http://lifeinthefastlane.com/2012/05/rr-fastlane-019/feed/ 0 The LITFL Review 064http://lifeinthefastlane.com/2012/05/litfl-review-064/ http://lifeinthefastlane.com/2012/05/litfl-review-064/#comments Mon, 21 May 2012 22:11:32 +0000 Kane Guthrie http://lifeinthefastlane.com/?p=54423

Life in the Fast Lane Medical Blog The LITFL Review 064

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care

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

]]> Life in the Fast Lane Medical Blog The LITFL Review 064

Welcome to the superb 64th edition!

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.

The Most Fair Dinkum Ripper Beaut of the Week

Free Emergency Medicine Talks

  • Haney Mallemat not only receives Joe’s pick of the week – but he also get ours with his talk on Who needs a Central Line? This talk is packed full on all the pearls and pitfalls you need to know about resuscitating the hypotensive septic patient in the ED- and is a must listen to for all ED docs and nurses.

The LITFL Review Top 20 of the Week

Emergency Physicians Monthly.

  • Bypass the OR: ECMO in the ED - awesome case presented here on the use of ECMO in a patient with out of hospital cardiac arrest – ground breaking stuff and its were the future of resuscitation is heading.
  • New LBBB after Cardiac Arrest - What was the cause the hyperkalaemia or the adrenaline that caused the ST -elevation? Learning point:  Post cardiac arrest, the ECG may have transient ST abnormalities.

Emergency Medicine Literature of Note

  • Reducing ED Overcrowding Reduces Mortality - Highlights some of the work being done to improve access block and improve the flow and journey of patients through the ED, with a bonus positive effect on mortality and morbidity!
  • Skull fractures in severe TBI - Often seams insignificant when compared to the brain injury, but this study showed having a skull fracture increased mortality by 30% in severe TBI – a fact worth knowing!
  • Andy gives us a look at Steroids for Kawasaki disease. Remember: think Kawasaki in pre-school child with prolonged fever, funny rash, funnytongue, lymph nodes and conjunctivitis. It’s important cause it causes coronary artery aneurysms 
  • Although Roc -Rocks it sucks when you don’t provide effective post intubation care with adequate sedation and analgesia. Scott has a good rant about this in Pain and Terror as Effective Pressors.
  • A case of drowning in ‘Blue-lights and Sirens…’  highlight’s the epidemiology of this issue, the pathophysiology and some management pearls on the drowning victim.
  • Azithromycin – Not Guilty of Murder - Ryan takes a hammer to another controversial  NEJM study. Sums it up well with: There are lots of reasons not to prescribe azithromycin, but this study isn’t the one that should change your practice.
  • ICU guru Mathew Mac Partlin shares with us a case and provides us with and evidence based thought provoking discussion on neuroprognostication post cardiac arrest in ICN Hot Case #8.

The LITFL Review Shout Out of the Week

The Short Coat

Being a medical student these day’s is a tough few years, but is it easier these days with the amount of blogs and online resources these students have available to them? This weeks shout out goes to The Short Coat a blog by  who is a medical student’s attempting to integrate clinical tidbits and cases from the wards and literature, with an emphasis on Emergency Medicine, and she also seems to be a big fan of LITFL.

Check out some of her post below:

 Twee-D and Twitical Care

"If you need surgical airway, you have to do it before the patient is dead" Jim Ducanto via PHARM @
May 20, 2012 2:06 am via Twitter for iPadReplyRetweetFavorite
@MDaware
Seth Trueger

News from the Fastlane

The Final Words

  • “Stay Hungry – Stay Foolish”

-Steve Jobs

  • “Being the richest man in the cemetery doesn’t matter to me. Going to bed at night saying we’ve done something wonderful, that what matters to me.”

-Steve Jobs

That’s it for now…

Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps you to deal with anyone, anything, anywhere at anytime for at least another week! If you’d like to suggest something for inclusion in the next edition of The LITFL Review, email our roving reporter: kane AT lifeinthefastlane.com

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

]]> http://lifeinthefastlane.com/2012/05/litfl-review-064/feed/ 0 ED Ultrasound Simulatorhttp://lifeinthefastlane.com/2012/05/ed-ultrasound-simulator/ http://lifeinthefastlane.com/2012/05/ed-ultrasound-simulator/#comments Mon, 21 May 2012 00:00:45 +0000 Chris Nickson http://lifeinthefastlane.com/?p=54549

Life in the Fast Lane Medical Blog ED Ultrasound Simulator

Another great video from SAEM12 - The creators of the EDUS2 project tell us about their ED ultrasound simulator.

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

]]> Life in the Fast Lane Medical Blog ED Ultrasound Simulator

This a very cool project. How to make an ultrasound simulator on the cheap for use in training scenarios. We’ve already featured the first Australian implentation of this project (The Australian EDUS2 Project) in the 63rd LITFL Review. In yet another great video from SAEM2012, Paul Kulyk and Paul Olszynski the originators of this project tell the world what it’s all about:

Check out the EDUS2 website, where you can access the code, videos and design plans for free — all you need is to provide the hardware.

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

]]> http://lifeinthefastlane.com/2012/05/ed-ultrasound-simulator/feed/ 0 Emergency Medicine Mobile App Competitionhttp://lifeinthefastlane.com/2012/05/emdm-mobile-app/ http://lifeinthefastlane.com/2012/05/emdm-mobile-app/#comments Sun, 20 May 2012 14:50:00 +0000 Mike Cadogan http://lifeinthefastlane.com/?p=54732

Life in the Fast Lane Medical Blog Emergency Medicine Mobile App Competition

Emergency Medicine Diagnosis and Management 6e is now an eBook on SkyScape Medical resources and we are giving one licence away FREE...

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

]]> Life in the Fast Lane Medical Blog Emergency Medicine Mobile App Competition

Emergency Medicine Diagnosis and Management 6e has been turned into an eBook on SkyScape Medical resources and will be available on

  • Android OS >1.5
  • BlackBerry® OS >4.1
  • iPhone/iPod Touch  >2.0 and iPad

…so time for another simple and straight forward competition

 In 100 words or less tell us WHICH social media tools are most useful in delivering/discussing/disseminating health and medical education on the web and WHY

The lucky winner will be chosen by the least social media savvy of our guest contributors and receive a free

 

 

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

]]> http://lifeinthefastlane.com/2012/05/emdm-mobile-app/feed/ 13 Emergency Medicine Australasiahttp://lifeinthefastlane.com/2012/05/emergency-medicine-australasia/ http://lifeinthefastlane.com/2012/05/emergency-medicine-australasia/#comments Sun, 20 May 2012 00:00:05 +0000 Mike Cadogan http://lifeinthefastlane.com/?p=54693

Life in the Fast Lane Medical Blog Emergency Medicine Australasia

New Series: Short editorial reviews from Emergency Medicine Australasia which publishes peer-reviewed articles, reports, reviews and opinions

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

]]> Life in the Fast Lane Medical Blog Emergency Medicine Australasia

Life in the Fast Lane has it’s roots firmly in Australia – despite having a Welshman and a Kiwi at the helm!

As such…this year we have been collating short editorial reviews from our local journal – Emergency Medicine Australasia which publishes peer-reviewed articles, reports, reviews and opinions on the research and clinical practice of emergency care.

Emergency Medicine Australasia, with its strong interest in the effectiveness of emergency diagnostic and therapeutic techniques, is the journal of choice for anyone concerned with improving patient care in the pre-hospital and hospital emergency settings. As the leading journal in the specialty of emergency medicine in the Asia Pacific region, Emergency Medicine Australasia is committed to the furthering of scientific research, the support of educational objectives, and the dissemination of information to the emergency medicine community.

We will be hosting short editorial comments on the key papers from each issue of the journal – and encouraging the publishers to allow us access to the full-text version online of these articles. Each issue will be hosted on LITFL (e.g. the resuscitation guidelines, Vol. 24, Issue 1 and Issue 2) will will then be collated on the EMA Journal page on LITFL.

Hopefully these will provide insight into some of the great academic work being performed in the Southern Hemisphere.

Emergency Medicine Australasia

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

]]> http://lifeinthefastlane.com/2012/05/emergency-medicine-australasia/feed/ 0 Funtabulously Frivolous Friday Five 089http://lifeinthefastlane.com/2012/05/funtabulously-frivolous-friday-five-089/ http://lifeinthefastlane.com/2012/05/funtabulously-frivolous-friday-five-089/#comments Fri, 18 May 2012 00:00:37 +0000 Chris Nickson http://lifeinthefastlane.com/?p=53799

Life in the Fast Lane Medical Blog Funtabulously Frivolous Friday Five 089

In the 89th FFFF we find out how the Spanish health service intends to save 2 billion euros a year, what condition accounts for over 10 million courses of antibiotics each year in the US, as well as learn about a clever Dutch physiologist, ego bias and micromorts.

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

]]> Life in the Fast Lane Medical Blog Funtabulously Frivolous Friday Five 089

Relax it’s Friday!

Oh, you work shifts… never mind, another FFFF is here!

This week we find out how the Spanish health service intends to save 2 billion euros a year, what condition accounts for over 10 million courses of antibiotics each year in the US, and we learn about a clever Dutch physiologist, ego bias and micromorts.

Let’s dive on in…

Question 1

What new law was introduced in Spain in 2011, and is expected to save the Spanish health service over 2 billion euros a year?

  • Doctors were required to prescribe generic drugs whenever possible.
  • According to GaBI:

“The new law means that Spanish doctors will now have to complete prescriptions giving only the details of the active ingredients of the medicine, along with the dose and format. The pharmacist is then obliged to provide the cheapest available medicine, which will often be a generic drug rather than the more well-known brand-named version.”

  • Worth thinking about next time you write a prescription…

—

Question 2

According to the CDC, each year in the United States over 10 million courses of antibiotics are prescribed for what condition?

  • Upper respiratory tract infection (such as the common cold) caused by viruses
  • It goes without saying that these prescriptions are a waste of time for viral illnesses, which do not respond to antibiotics. But there is also the unnecessary cost, growing antibiotic resistance among bioflora and the exposure of patients to potentially life-threatening adverse effects.
  • This statistic was even worse before the CDC’s Get Smart campaign.

—

Question 3

What is ego bias?

  •  Ego bias is defined as systematic overestimation of the prognosis of one’s own patients compared with the expected outcome of a population of similar patients.
  • More senior physicians tend to be less optimistic and more reliable about patient’s prognosis, possibly reflecting reverse ego bias.

Poses RM, McClish DK, Bekes C, Scott WE, Morley JN. Ego bias, reverse egobias, and physicians’ prognostic. Crit Care Med. 1991 Dec;19(12):1533-9. PubMed PMID: 1959374.

—

Question 4

In 1903, which Dutch doctor-physiologist developed a string galvanometer to graphically record the changes in electrical potential during contractions of the heart?

  • Willem Einthoven (1860–1927)
  • Einthoven coined the term electrokardiogram (EKG) for his invention, which won him the Nobel Prize in 1924. His assignment of the letters P, Q, R, S and T to the various deflections is still used.
  • He is also known for these eponyms:

Einthoven’s law – In the ECG at any given instant the potential of any wave in lead 2 is equal to the sum of the potentials in lead I and III.

Einthoven’s triangle – an imaginary equilateral triangle with the heart at its centre, its equal sided representing the three standard limb leads of the electrocardiogram.

  • This is a quotation attributed to Einthoven:

“We should first endeavour to better understand the working of the heart in all its details, and the cause of a large variety of abnormalities. This will enable us, in a possibly still-distant future and based upon a clear insight and improved knowledge, to give relief to the suffering of our patients.”

—

Question 5

What is a micromort?

  •  A micromort is the risk out of a million of dying from a particular event.
  • As discussed in a great post on ScanCrit, they’re a useful way of quatifying the risk of different activities.
  • For instance:

Risk of a 50 year old dying from external cuases in normal daily living = 1 micromort
Scuba diving = 8 micromorts
100km motorcycle ride = 10 micromorts
Skydiving = 10 micromorts
Risk of of death from anesthesia during emergency surgery = 10 micromorts
Base jumping from Kjerag outside Stavanger in Norway = 430 micromorts
Climbing Everest = 12,000 micromorts per climb!

—

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.

Last week we defined funtabulous, this week — as gripping as this avalanche survival story is — we define ‘NOT funtabulous”:

http://www.youtube.com/watch?v=0pSBUXFJXiY

Hat tip to the fantastic blog ScanCrit which featured this video in a must read post on Avalanche Survival.

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

]]> http://lifeinthefastlane.com/2012/05/funtabulously-frivolous-friday-five-089/feed/ 1 Become a Meducation Master! Reduxhttp://lifeinthefastlane.com/2012/05/become-a-meducation-master-redux/ http://lifeinthefastlane.com/2012/05/become-a-meducation-master-redux/#comments Thu, 17 May 2012 14:13:22 +0000 Chris Nickson http://lifeinthefastlane.com/?p=54524

Life in the Fast Lane Medical Blog Become a Meducation Master! Redux

Rob Rogers' has a great little video explaining exactly what is going down in Baltimore this November on the IEM Faculty Development and Teaching Course.

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

]]> Life in the Fast Lane Medical Blog Become a Meducation Master! Redux

In Become a Meducation Master! I told you about an exciting new course being held in Baltimore from November 11th to 16th 2012:

The International Emergency Medicine Faculty Development and Teaching Course, presented by the University of Maryland Department of Emergency Medicine.

Rob Rogers (@EMRAP_EE) has now produced this little video showing exactly what this course has to offer:

http://www.youtube.com/watch?v=NdVHjQHGCSw

Check out the course homepage at teach.umem.org for new details as they are confirmed, in addition to information about course costs and accommodation options.

 

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

]]> http://lifeinthefastlane.com/2012/05/become-a-meducation-master-redux/feed/ 0 R&R in the FASTLANE 018http://lifeinthefastlane.com/2012/05/rr-in-the-fastlane-018/ http://lifeinthefastlane.com/2012/05/rr-in-the-fastlane-018/#comments Thu, 17 May 2012 00:00:14 +0000 Chris Nickson http://lifeinthefastlane.com/?p=54029

Life in the Fast Lane Medical Blog R&R in the FASTLANE 018

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 in the 18th edition of R&R in the FASTLANE.

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

]]> Life in the Fast Lane Medical Blog R&R in the FASTLANE 018

The 18th edition of our series of eminence-based evidence:

R&R in the FASTLANE 010 RR IN THE FASTLANE LOGO 21 590x213

A free 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 Famers’

  • Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. Epub 2010 Jul 31. Review. PubMed PMID: 20674088
R&R in the FASTLANE 009 RR Eureka 64 R&R in the FASTLANE 009 RR Hall of fame 64 Levitan et al get into some great technical aspects of video and alternative devices for laryngoscopy. The point here is that while VL may make laryngoscopy easier, tube delivery and placement may paradoxically become more difficult, primarily because of the sharper angle between the blade and the trachea. Porn for airway enthusiasts.

Recommended by Seth Trueger

This week’s R&R recommendations

  • Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. Epub 2010 Jul 31. Review. PubMed PMID: 20674088
R&R in the FASTLANE 009 RR Eureka 64 R&R in the FASTLANE 009 RR Hall of fame 64 Levitan et al get into some great technical aspects of video and alternative devices for laryngoscopy. The point here is that while VL may make laryngoscopy easier, tube delivery and placement may paradoxically become more difficult, primarily because of the sharper angle between the blade and the trachea. Porn for airway enthusiasts.

Recommended by Seth Trueger

  • Segal N, Yannopoulos D, Mahoney BD, Frascone RJ, Matsuura T, Cowles CG, McKnite SH, Chase DG. Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation. 2012 Mar 28. [Epub ahead of print] PubMed PMID: 22465807.
R&R in the FASTLANE 009 RR Hot Stuff 64 Supraglottic devices (SGDs) have been all the rage in emergency settings lately. For lots of good reasons. But this tiny study questions the use of SGDs in cardiac arrest. Without any blood pressure, SGDs compress the carotids and restrict cerebral blood flow. And the flow measurements are convincing. But – it’s on pigs. Still, this will be talked about.

Recommended by Thomas Dolven
Learn more: ScanCrit.com — Supraglottic airway devices in the critically ill

  • Green RS Reflections from a Canadian visiting South Africa: Advancing sepsis care in Africa with the development of local sepsis guidelines. African Journal of Emergency Medicine (2012), http://dx.doi.org/10.1016/j.afjem.2012.03.004
R&R in the FASTLANE 009 RR Eureka 64 R&R in the FASTLANE 009 RR Landmark 64 Sepsis is a killer worldwide… but needs champions to pioneer it’s death. An excellent overview from Dr Green who is a world Guru on the topic.

Recommended by Sa’ad Lahri
Fulltext

  • Homma S, et al; the WARCEF Investigators. Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm. N Engl J Med. 2012 May 2. [Epub ahead of print] PubMed PMID: 22551105.
R&R in the FASTLANE 009 RR Boffin 64 WARCEF trial – For patients with severe heart failure (LVEF < 25%), Warfarin was no better than Aspirin for the combined outcome of any stroke or death. There was a significant reduction in the incidence of ischaemic stroke, but at the expense of major haemorrhage. Patients with pre-existing AF were excluded.

Recommended by Matthew Mac Partlin
Fulltext

  • Matthaiou DK, Ntani G, Kontogiorgi M, Poulakou G, Armaganidis A, Dimopoulos G. An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med. 2012 Apr 27. [Epub ahead of print] PubMed PMID: 22538461.
R&R in the FASTLANE 009 RR Boffin 64 Procalcitonin levels – not much good for diagnosing bacterial sepsis, but handy for shortening duration of therapy without increasing 28-day negative outcome rates.

Recommended by Matthew Mac Partlin
Fulltext

  • Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, Desai SV, Shanholtz C, Brower RG, Pronovost PJ. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012 Apr 5;344:e2124. doi: 10.1136/bmj.e2124. PubMed PMID: 22491953; PubMed Central PMCID: PMC3320566.
R&R in the FASTLANE 009 RR Hot Stuff 64 Our ARDS-Net guided lung-protective ventilation strategy seems to work long term as well. ARDS-Net demonstrated a short term mortality benefit. This US 4 academic centre (13 ICUs – medical, surgical, trauma) prospective observational trial demonstrated an absolute 4% and 8% drop in 2 year mortality with adherence to one or both of the ARDS-Net lung-protective ventilation parameters respectively, compared to no adherence at all. No report on morbidity outcomes though.

Recommended by Matthew Mac Partlin
Fulltext

  • Nomura, Jason T, Genes N, Bollinger HR, Bollinger M, and  Reed JF. “Twitter Use During Emergency Medicine Conferences.” The American Journal of Emergency Medicine (March 16, 2012). PMID 22424992
R&R in the FASTLANE 009 RR Hot Stuff 64 I’ve always been jealous watching my timeline on twitter fill with hashtags from folk at big conferences. @takeokun pulled the tweets from one conference to get an idea of what people were saying. I look forward to filling your timeline when I’m at ICEM2012!

Recommended by Andy Neill

  • Ranchord AM, Argyle R, Beynon R, Perrin K, Sharma V, Weatherall M, Simmonds M, Heatlie G, Brooks N, Beasley R. High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: a pilot randomized controlled trial. Am Heart J. 2012 Feb;163(2):168-75.
R&R in the FASTLANE 009 RR Hot Stuff 64 No difference in this pilot study of titrated oxygen therapy for STEMIs – but wide confidence intervals… more studies needed.

Recommended by Andy Brainard

  • Smith SW, Khalil A, Henry TD, Rosas M, Chang RJ, Heller K, Scharrer E, Ghorashi M, Pearce LA. Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction. Ann Emerg Med. 2012 Apr 18. [Epub ahead of print] PubMed PMID: 22520989.
R&R in the FASTLANE 009 RR Landmark 64 R&R in the FASTLANE 009 RR Eureka 64 This is Steve Smith’s (yes that guy) big idea about distinguishing BER from STEMI on ECG criteria. This type of thing is really important as the classic STEMI criteria just aren’t cutting the mustard. It’s a dense enough paper to follow and even if you don’t understand the calculation the concept is priceless.

Recommended by Andy Neill

  • Chiang HK, Zhou Q, Mandell MS, Tsou MY, Lin SP, Shung KK, Ting CK. Eyes in the needle: novel epidural needle with embedded high-frequency ultrasound transducer–epidural access in porcine model. Anesthesiology. 2011 Jun;114(6):1320-4. PubMed PMID: 21519228; PubMed Central PMCID: PMC3104409.
R&R in the FASTLANE 009 RR Trash 64 Tech porn. One-crystal ultrasound transducer placed on the tip of a stylette that fits in the lumbar needle! Never miss an epidural again. And when they get smaller, they will fit in a spinal needle. Maybe.

Recommended by Thomas Dolven

  • Walter S, Kostopoulos P, Haass A, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012 May;11(5):397-404. Epub 2012 Apr 11. PubMed PMID: 22497929
R&R in the FASTLANE 009 RR Trash 64 Taking the crazy on the road – mobile stroke response units with an MD and a scanner in order to save a few minutes for TPA administration. Not sure this is the best resource outlay….

Recommended by Ryan Radecki
Learn more: EM Literature of Note — Mobile Stroke units – Probably Not Helpful

The R&R iconoclastic sneak peek icon key

R&R in the FASTLANE 009 RR Authors 64 The list of contributorsR&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE 009 RR Hall of fame 64 R&R Hall of fame
You simply MUST READ this!		R&R in the FASTLANE 009 RR Hot Stuff 64 R&R Hot stuff!
Everyone ‘s going to be talking about this
R&R in the FASTLANE 009 RR Landmark 64 R&R Landmark paper
A paper that made a difference		R&R in the FASTLANE 009 RR GameChanger 64 R&R Game Changer?
Might change your clinical practice
R&R in the FASTLANE 009 RR Eureka 64 R&R Eureka!
Revolutionary idea or concept		R&R in the FASTLANE 009 RR WTF 64 R&R WTF!
Weird, transcendent or funtabulous!
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High quality research		R&R in the FASTLANE 009 RR Trash 64 R&R Trash
Must read, because it is so wrong!
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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

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