“We have defined “critical care medicine” as the triad of 1) resuscitation, 2) emergency care for life-threatening conditions, and 3) intensive care; including all components of the emergency and critical care medicine delivery system, prehospital and hospital.”

Critical care involves all those who look after the dying and the ‘at-risk-of-dying’ — wherever and whenever.

Yet it is one thing to know what critical care is, knowing what makes it what it is — what is at its core — is another. I asked Scott Weingart of EMCrit.org to tell us just what is the essence of critical care in the opening talk of SMACC.

Here is what he said:

http://www.youtube.com/watch?v=3QcGom3rslg

Safar P. Critical care medicine—quo vadis? Crit Care Med. 1974Jan-Feb;2(1):1-5. PubMed PMID: 4815738.

The post The Essence of Critical Care appeared first on Life in the Fast Lane medical education blog.

Adrian Bonsall is a Paediatric Emergency Fellow at Sydney Children’s Hospital.  Prior to studying medicine he worked as a computer programmer and systems analyst in the UK

When did you start becoming involved in health IT?

I’ve been programming since the first personal computers were available over 30 years ago.  Whilst a medical student I wrote programs that integrated a GP surgery’s software and developed revision aids.  Later I wrote a paediatric resuscitation scenario builder and a rostering software

What led to you start your rostering software? 

It began in 2001, when my then Emergency Department director was bemoaning the trials of devising a JMO roster which didn’t lead to a string of complaints about inequality, not meeting the current award or double-bookings.  I thought a simple 6-step process might be the way to lead even the least savvy computer user through to a better roster.  The Roster Wizard has been employed at about a dozen major hospitals, mainly in NSW, but also in Northern Territories, Queensland and the UK

Have you been involved in any other health IT projects?

A few.  I developed a Paediatric Resuscitation Calculator for drug doses & equipment sizes and it has been extensively used at Sydney Children’s Hospital and now further afield.  In 2011 I designed & built the Children’s Emergency Department website for the Mater Children’s Hospital in Brisbane and am now trying to revitalise the Sydney Children’s Emergency Department intranet site.  I have also ‘donated’ my revision notes (~350 topics) for the ACEM Part II exam, which I try to keep updated on my own embarrassingly under-constructed site (ambonsall.com).  I also write little web calculators for topics such as Burns fluids, Paediatric Growth centiles, and DKA fluids

Don’t you find implementing health IT in hospitals is a bureaucratic nightmare?

The three main issues I have encountered are: the meeting merrygoround that seems necessary to get anything approved; hospitals with their own IT departments can show some resentment and obstruction; and getting paid for professional work done whilst holding on to one’s intellectual property can be problematic

What do you enjoy most about health IT?

I really enjoy programming and breaking down the problem in a logical manner.  To me building my own software is a creative outlet, even if many other programmers have done it similarly in the past. 

What are you careers aims for the next 10 years?

I would like to have the time and resources to tackle another couple of large projects.  The current solutions to the Electronic Medical Record that I have used in emergency departments are slow, needlessly complicated, do not appear to save time for clinicians who have to input the data in real life practice, and have problems with integration with other hospital systems

What is the best piece of advice you’ve been given?

Don’t give interviews

The post TechTool Talk 004 appeared first on Life in the Fast Lane medical education blog.

The stage is set

In preparation for #IETMC13 the International Faculty Development teaching course – the #MeduBrawl has begun.

Traditional learning versus the flipped classroom, versus social media and FOAM. Gloves are off as we prepare to better understand the best teaching modality for medical education…

RIGHT...started a fight with @amalmattu after his statement.. "Those who CAN, teach. Those who CAN'T, tweet."

May 22, 2013 8:15 am via webReplyRetweetFavorite

@sandnsurf

Mike Cadogan

@sandnsurf The battle of wits has begun. And it ends when you decide and we both drink, and find out who is right and who is out of characte

May 22, 2013 8:20 am via webReplyRetweetFavorite

@amalmattu

Amal Mattu

@sandnsurf Definitely teaching=helping & vice versa. Will be fun debate, hi tech vs low tech, ipod vs 8-track, Wii vs. Atari... @IEMTC13

May 22, 2013 8:48 am via webReplyRetweetFavorite

@amalmattu

Amal Mattu

@medicalgraffiti @M_Lin @IEMTC13 @amalmattu @sandnsurf @EM_Educator oh, oh. We love to teach, fight, and tweet! Can we play? #medubrawl

May 22, 2013 10:31 am via TweetCaster for iOSReplyRetweetFavorite

@ultrasoundpod

Matt and Mike

@ultrasoundpod @M_Lin @IEMTC13 @amalmattu @sandnsurf @EM_Educator The #MeduBrawl is happening this Oct in Baltimore. Come on down!!

May 22, 2013 10:39 am via Twitter for iPhoneReplyRetweetFavorite

@medicalgraffiti

John Greenwood

@ultrasoundpod @medicalgraffiti @m_lin @iemtc13 @amalmattu @sandnsurf @em_educator "teach,fight &tweet..." twitter's own "eat, pray love"...

May 22, 2013 11:04 am via Twitter for iPhoneReplyRetweetFavorite

@bhanders

Neel Bhanderi

@IEMTC13 @amalmattu @sandnsurf I'm taking an initial duck&cover approach in this EduBrawl. Will strategically strike when u least expect it!

May 22, 2013 10:02 am via Twitter for iPhoneReplyRetweetFavorite

@M_Lin

Michelle Lin

The post Teach, fight, tweet… appeared first on Life in the Fast Lane medical education blog.

Welcome to the 104th 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 casts 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 to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.

The Most Fair Dinkum Ripper Beaut of the Week

Emergency Physicians Monthly

• Top spot goes to Emergency Physicians Monthly with a thought provoking and awe inspiring post on  Dying, Naturally, in the Emergency Department. How to walk a dying patient and their family through an unimpeded natural death in the emergency department. 
  

The LITFL Review Top Picks

Resus.ME

• RSI haemodynamics in the field - interesting study… How much harm could we be causing during intubation? 
• Cliff takes us through one of the holy grails of critical care in Predicting volume responsiveness.
• Difficult intubation on ICU - no wonder there having complications when capnography was only being used 46% of the time – doesn’t seem like the standard of care to me.
• Awake intubation - When one of the masters of EMCC education becomes a dummy! – Some tips on topicalise your awake intubation patient!

http://www.youtube.com/watch?v=SqkeRWwH760

The Poison Review

• Are vasopressors effective therapy in calcium channel blocker overdose? - The old school approach might be just as good as the new, just not as cool – interesting read!
  
• Metformin overdose and hypoglycemia - Be aware: metformin overdose can cause hypoglycemia in the absence of other glucose-lowering drugs, and blood glucose levels should be monitored closely.

StEmylns

• It’s Good to Talk – Debrief in the Emergency Department – brilliant summary of what debriefing is, and how to get the most out of it in the emergency department setting. 
• Is the picture starting to get clearer…. Cullen on high sensitivity Troponin.

 boringem

• Handheld Ultrasound - this really is taking the probe to the bedside, anywhere in any place!

Emergency Medicine Tutorials

• Toxicology for PGY1+2 - Nice intro summary on the basics of toxicology for the junior staff.
  

PHARM

• The airway masters Jim Ducanto handles a tonsillar bleed airway and shares some pearls along the way.
  
• Emergency Surgical Airway with Dr Keith Greenland as he shares his research focusing on the non-technical skills of the CICV scenario.

http://www.youtube.com/watch?v=5dRlApLVuDY

The Trauma Professional’s Blog

• Trauma Pearl: Unexpected Respiratory Failure After Blunt Trauma. Bottom line: Unexplained respiratory failure after blunt trauma, especially if no chest injury has occurred, is nearly always due to a missed abdominal injury.
  
• Don’t Ignore The Naughty Bits - Remember to take a look downstairs on your next trauma patient – you might be surprised by the injuries you find.

thebluntdissection

• a test of metal… all wrapped up in a toxicology conundrum. Nice review on recognising and managing chronic lithium toxicity.

Pediatric EM Morsels

• Kids are becoming more and more like “little adults” Are you prepared to manage Hypertensive Crisis in Kids?
  
• Diarrhea and Dehydration - Some great pearls here especially on how to communicate this issue to the family.

ETMCourse

• Life after death: the long term outcome of ED thoracotomy survivors - The results may surprise some of you!
  

Emergency Medicine News

• Emergentology: Your Emergency Family - or team. We all bring something to the family of the emergency department, and its generally something very special, and I love being part of that.
  

EM on the Edge

• Superb review on were we are at in the management of The Crush Syndrome…expect the unexpected….
  

EMCrit

• Janus General and Service Update - EMCrit creates his own virtual hospital to discuss and share cases, all in the process of maintaining confidentiality and providing some amazing FOAMed.
  
• Cyclic (Tricyclic) Antidepressant Overdose - There on the way back, and heading to an ED near you! Are you prepared to manage the dread TCA overdose?

empem.org

• Investigation of Pediatric Headaches - Not an easy task, but this podcast certainly puts you on the right track.
  

 Intensive Care Network

• Harris on Oxidative Stress - What is it? Why is it important? SMACC head honcho Roger Harris gives us the low down on it!
• Prevent trache deaths - Excellent podcast on dealing with issues and emergencies in patients with tracheostomies! Worth a listen!

 Resus Review

• DKA presenting as Wide Complex Tachcyardia - Start the insulin and check the K!
  

Dr Smith’s ECG Blog

• Atypical Chest Pain: Suspicious ECG, and a Left Main ACS is found in a 30-something-year-old!
  

EKG Videos

• Rodney Dangerfield revealed! Here’s the scoop on STE in aVR.
  

http://www.youtube.com/watch?v=fMvi_MnUqt0

The LITFL Review Shout Out of the Week

The SMACC2013 opening videos have been released and they are awesome. Check them out on YouTube SMACC Channel or listen to them on iTunes.

Check out:

Scott Weingart’s opening talk on “The Essence of Critical Care” sets the scene for the entire conference and captures the spirit of critical care.

http://www.youtube.com/watch?v=3QcGom3rslg

Also go to Resus.ME for the amazing Cliff Reid talk on: ‘Making things Happen” ( check out the slides and other supporting references, links and resources too) and ICN for the legendary John Myburgh’s evidence and opinion packed talk on ‘Catecholamines, Resuscitation and Resurrection’.

The GMEP Cases of the week

GMEP Video of the week

This weeks video is by Andy Neil from Emergency Medicine Ireland  with his video on social media he gave at the Workshop for EMS Gathering:

Twee Dee and Twitical Care

A motto to live by http://t.co/KJMr9AXufb

May 21, 2013 4:24 pm via EchofonReplyRetweetFavorite

@precordialthump

Chris Nickson

News from the Fastlane

• Want to search, find and look for everything FOAMed? Then check out - GoogleFOAM!
  
• Emergency Medicine Update May 2013 - Another awesome review of the literature.
• R&R In The FASTLANE 031 - with another great guide to papers that you should read, not just know about.

The Final Words

Stolen from CCM-L and modified. 3 things needed to be good ER doc. 1. Good sense of humor; 2. Poor sense of smell; 3. Mastery of ketamine

May 12, 2013 11:10 pm via webReplyRetweetFavorite

@JoeLex5

Joe Lex

LITFL Review EM/CC Educational Social Media Round Up

Show Reference list

The post The LITFL Review 104 appeared first on Life in the Fast Lane medical education blog.

Cliff Reid (@CliffReid) was without a doubt one of the superstars of SMACC. His talk ‘Making Things Happen’ is a lucid, practical and often times hilarious guide to the inner workings of a leading a great resus. The good news is that if you missed it you can now check it out on the SMACC podcast or watch the video on Resus.ME. Cliff’s ‘Making Things happen’ page on Resus.ME is a gold mine of references and resources supporting the talk.

Go on, check it out, make it happen!

The post Making Things Happen appeared first on Life in the Fast Lane medical education blog.

We are all at risk of missing the giant man in the gorilla suit every day in ED.

The Invisible Gorilla study is a classic –  watch the video.

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

The viewer is asked to count the number of times the people in white shirts pass the ball to each other.   At some point in the video a man in a giant gorilla suit walks slowly into the middle of the screen, beats his chest and then wanders off.  50% of people didn’t even notice him because they were so focused on counting the passes (that’s not to mention the other deliberate mistakes in the video).

Harvard researchers have now shown that even medics suffer from ‘Invisible Gorilla Syndrome’.

Although you might not think it, radiologists are just human and not superheroes who sit in a darkened room all day picking up every minor deviation from the norm.

Trafton Drew, a researcher at Harvard Medical School’s Visual Attention Lab, showed radiologists images like the one below and asked them to identify cancerous nodules…

Click to enlarge

The Results

So what’s the issue?  It’s called inattentional blindness – your brain is focusing on one specific issue and so all the other side issues are just phased out.

This is a problem we face every day in ED: recurrent abdo pain; drunk and disorderly; wheezy child; back pain.   The information we are given before we see the patient focuses our minds on particular areas and this can lead to us simply muting and ignoring the other potential problems.

Don’t ignore the gorilla.

References

• The Invisible Gorilla
• Radiologists can miss a Gorilla hiding in plain sight
• Drew, T., Vo, M. L. H., Wolfe, J. M. (in press). The invisible gorilla strikes again: Sustained inattentional blindness in expert observers. Psychological Science.

The post Inattentional blindness, unintentional consequences appeared first on Life in the Fast Lane medical education blog.

Now Sir Peter Wyllie goes one step further…heli jumping over Noonamah, NT

the quest for the ultimate LITFL photo continues….

The post LITFL Leap of Faith Noonamah NT appeared first on Life in the Fast Lane medical education blog.

Go to Chile instead!

My Santiago-based emergency physician buddy Pablo Aguilera is part of the crew putting together Urgencia UC: Conceptos 2013, an emergency medicine conference featuring luminaries like those named above as well as local speakers. It will be great if you’ve got some Spanish to work with but all the talks will be simultaneously translated into English/ Spanish (depending on what language the talk is in of course). It runs from August 29th to 30th 2013 (with an ECG workshop on the 28th) and you can register here.

Check out the website for Pablo’s EM program in Chile, the conference website, the conference Facebook page. Oh, they’re on Twitter too (@urgenciauc).

The post Urgencia UC: Conceptos 2013 appeared first on Life in the Fast Lane medical education blog.

You can subscribe to EMU directly via email by sending a message to:
jbleibmd AT yahoo.com

Also, remember to check out previous editions of EMU on LITFL here.

Emu May 2013

The post Emergency Medicine Update May 2013 appeared first on Life in the Fast Lane medical education blog.

Obviously this is a good thing.

But it can make it easier for us all to get lost and there is the danger of information overload — indeed, I’ve written a guide to (in)sanity in the age of FOAM that I continually update, the LITFL post on Information Overload. The FOAM world is now impossible to keep up with. We need to be able to find what we want when we need it, according to our knowledge needs.

One of the great developments for ‘just in time’ learning is the creation of GoogleFOAM by Vancouver-based EM Physician Todd Raine (@RaineDoc). It was known as emgoogle.com in it’s previous incarnation, but has now grown to be more inclusive.

This is what GoogleFOAM is all about:

• it is a search engine
• it allows a unified search of all the FOAM resources on the Web
• it is partly derived from the complete list of EM/CC Blogs is available at LITFL here, as well as the Podcasts available here.
• as GoogleFOAM develops it will allow search restrictions to separate realms, such as anaesthesia, general practice, ultrasound, etc.
• if you want to add a site to GoogleFOAM send Todd an email: taraine at hotmail dot com

GoogleFOAM is a work in progress, but is already a fabulous tool. It helps both learners and teachers find high quality free resources instantly.

GoogleFOAM is also particularly valuable for FOAM creators. Something that has been lost a little with the growth of FOAM has been the recognition that interconnectedness is everything to a blog. This how the first FOAM blogs and podcasts got their feet through the door in the first place — by building a network of relevant links that created a community. As more FOAM is created I liked to see more links to what has come before, so that users can see the incremental gain, so that connections are forged, relationships are created and conversations started. GoogleFOAM is ideal for this — search it before you blog or podcast and don’t be stingy when linking out

Vive la FOAM.

The post GoogleFOAM appeared first on Life in the Fast Lane medical education blog.