Beyond the Abstract: Systematic Online Academic Resource Review #2: Endocrine, Metabolic and Nutritional Disorders
Planning to write the next great FOAM post on hyperkalemia, but not sure what’s already been done? Or maybe a less popular topic, that you hope has minimal coverage? Or are you a resident, medical student, or even a curious attending searching for the latest, best FOAM regarding a specific topic?
If so, then we have great news for these answers are here in the recently published second Systematic Online Academic Resource (SOAR) Topic Review.1 This series aims to identify and evaluate online education resources by topic. The inaugural entry has already revealed the FOAM landscape related to the renal and genitourinary organ system.2 We can now share results for endocrine, metabolic and nutritional disorders.
We developed search terms specific to endocrine, metabolic and nutritional Disorders from the American Board of Emergency Medicine’s Model of the Clinical Practice of Emergency Medicine (MPCEM). We then performed a systematic search of both FOAMSearch as well as each site within the social media index top 50.3,4 We then assessed the quality of those resources using the revised METRIQ score and designated learner levels for each resource.5
The search yielded 36,346 resources, of which 756 met the criteria for quality assessment. Table 1 displays the 121 posts identified as high quality (rMETRIQ ≥ 16). Overall, the most covered subtopic was potassium disorders, representing 15% of all posts. Subtopics that did not have a high-quality resource identified include metabolic alkalosis, respiratory alkalosis, fluid overload, phosphorus metabolism, hyperglycemia, malabsorption, malnutrition and thyroiditis. Table 2 graphically describes the number of high-quality posts by subtopic coverage and recommended target audience. Of note, resources that were better categorized under a different MCPEM category were generally not included. For example, fluid overload content specific to heart failure was not included.
We hope that educators and learners can use this information to find relevant educational resources, and that FOAM content creators can use this information to help identify topics to produce new content.
| Subtopic | Name of First Author | Name of Blog Post | Level of Trainee Recommendation |
| Metabolic Acidosis | Farkas, Josh | PulmCrit: pH-guided fluid resuscitation & BICAR-ICU | Intern, Junior, Senior, Attending |
| Metabolic Acidosis | Farkas, Josh | Is correcting hyperchloremic acidosis beneficial? | Intern, Junior, Senior, Attending |
| Metabolic Acidosis | Rusyniak, Dan | Tox & Hound – aka AKA | Intern, Junior, Senior, Attending |
| Metabolic Acidosis | Multiple | Alcoholic ketoacidosis – WikEM | Clerk, Intern, Junior, Senior |
| Metabolic Acidosis | Spiegel, Rory | CC Nerd-The Case of the Neutral Documents | Clerk, Intern, Junior, Senior, Attending |
| Respiratory Acidosis | Chan, Wendy | VBG vs ABG in Hypercarbia | Clerk, Intern, Junior, Senior |
| Acid Base (Mixed) | Farkas, Josh | Fluid selection using pH-guided resuscitation | Intern, Junior, Senior, Attending |
| Acid Base (Mixed) | Weingart, Scott | Acid Base in the Critically Ill – Part V – Enough with the Bicarb Already | Intern, Junior, Senior, Attending |
| Corticoadrenal Insufficiency | Long, Brit | Mimics of Sepsis: What do ED Physicians Need to Know? | Intern, Junior, Senior |
| Corticoadrenal Insufficiency | Farkas, Josh | Adrenal crisis – EMCrit Project | Intern, Junior, Senior, Attending |
| Corticoadrenal Insufficiency | Gaillard, Frank | Adrenal hemorrhage | Radiology Reference Article | Radiopaedia.org | Intern, Junior, Senior, Attending |
| Cushing’s Syndrome | Multiple | Cushing syndrome | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Calcium | Long, Brit | Oncologic Emergencies Part I: Pearls and Pitfalls | Intern, Junior, Senior, Attending |
| Calcium | Swaminathan, Anand | Hypercalcemia | Intern, Junior, Senior, Attending |
| Calcium | Multiple | Hypocalcemia – WikEM | Intern, Junior, Senior, Attending |
| Calcium | Taliaferro, Dustin | EM@3AM: Hyper- and HypoCa | Intern, Junior, Senior, Attending |
| Hypovolemia | Astin, Matt | The SPLIT Trial: Saline vs Plasma-Lyte Fluid Therapy | Intern, Junior, Senior, Attending |
| Hypovolemia | Rezaie, Salim | SMART Trial Part 2: Secondary Analysis of Balanced Crystalloids vs Saline in Sepsis | Clerk, Intern, Junior, Senior |
| Hypovolemia | Rezaie, Salim | Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over? | Clerk, Intern, Junior, Senior |
| Hypovolemia | Rezaie, Salim | Does Lactated Ringers (LR) Raise Serum Lactate? | Clerk, Intern, Junior, Senior |
| Hypovolemia | Farkas, Josh | PulmCrit- Get SMART: Nine reasons to quit using normal saline for … | Intern, Junior, Senior, Attending |
| Hypovolemia | Farkas, Josh | IBCC chapter & cast – Fluid selection & pH-guided fluid resuscitation | Intern, Junior, Senior, Attending |
| Hypovolemia | Farkas, Josh | The SPLIT trial: Internal vs. external validity | Intern, Junior, Senior, Attending |
| Hypovolemia | Rezaie, Salim | Balanced vs Unbalanced Fluids in Pediatric Severe Sepsis | Clerk, Intern, Junior, Senior |
| Hypovolemia | Multiple | Fluid Choice in Sepsis: Does it matter? | Clerk, Intern, Junior, Senior, Attending |
| Hypovolemia | Kenny, Jon-Emile | Are balanced crystalloids better than saline? SMART Talk with Dr … | Intern, Junior, Senior, Attending |
| Hypovolemia | Farkas, Josh | PulmCrit- Overcoming occult diuretic resistance: Achieving diuresis … | Attending |
| Hypovolemia | Multiple | CT hypoperfusion complex | Radiology Reference Article … | Clerk, Intern, Junior, Senior, Attending |
| Hypovolemia | Multiple | Dehydration (peds) – WikEM | Clerk, Intern, Junior, Senior, Attending |
| Hypovolemia | Rezaie, Salim | The Great Debate Between Balanced and Unbalanced Crystalloids Continues | Junior, Senior, Attending |
| Hypovolemia | Morgenstern, Justin | IV fluid choice part 1: The SPLIT trial | Clerk, Intern, Junior, Senior, Attending |
| Hypovolemia | Drenzla, Adam | SALT OF THE EARTH (PART 1) | Clerk, Intern, Junior, Senior |
| Potassium | Meyers, Pendell | Critical Hyperkalemia by H. Pendell Meyers, EMCrit Intern – EMCrit | Junior, Senior, Attending |
| Potassium | Farkas, Josh | Hyperkalemia – EMCrit Project | Clerk, Intern, Junior, Senior |
| Potassium | Farkas, Josh | Management of severe hyperkalemia in the post-Kayexalate era | Intern, Junior, Senior, Attending |
| Potassium | Swaminathan, Anand | Is Kayexalate Useful in the Treatment of Hyperkalemia in the … | Clerk, Intern, Junior, Senior |
| Potassium | Singh, Manpreet | Hyperkalemia – The Great Imitator | Clerk, Intern, Junior, Senior |
| Potassium | Multiple | Tumor Lysis Syndrome – Diagnosis and Treatment | Clerk, Intern, Junior |
| Potassium | Multiple | Management of the Sick Dialysis/ESRD Patient | clerk, intern, Junior, senior |
| Potassium | Meyers, Pendell | A young man with back spasms | Intern, Junior, Senior |
| Potassium | Helman, Anton | Emergency Management of Hyperkalemia | EM Cases Podcast | Junior, Senior, Attending |
| Potassium | Long, Brit | Updates in Management of Hyperkalemia | Clerk, Intern, Junior, Senior |
| Potassium | Weingart, Scott | Treatment of hyperkalemia in the ED | Clerk, Intern, Junior, Senior |
| Potassium | Farkas, Josh | PulmCrit- BRASH syndrome: Bradycardia, Renal failure, Av blocker … | intern, Junior, senior, attending |
| Potassium | Farkas, Josh | Myth-busting: Lactated Ringers is safe in hyperkalemia, and is … | Junior, Senior, Attending |
| Potassium | Multiple | Insulin Dosing in Hyperkalemia | Intern, Junior, Senior, Attending |
| Potassium | Rezaie, Salim | ECG Changes of Hyperkalemia | Clerk, Intern, Junior, Senior |
| Potassium | Santistevan, Jamie | emDOCs.net – Emergency Medicine EducationSubtle ECG findings … | Clerk, Intern, Junior, Senior, Attending |
| Potassium | Morton, A. Ross | Management of Hyperkalemia with ECG Changes | clerk, intern, Junior, senior |
| Potassium | Awad, Nadia | Thyroid Storm: Treatment Strategies | Intern, Junior, Senior, Attending |
| Potassium | Grock, Andrew | Bicarbonate: Completely Useless? | Junior, Senior, Attending |
| Potassium | Hayes, Bryan D | Hyperkalemia Management: Preventing Hypoglycemia From Insulin | Senior, Attending |
| Sodium | Smarandache, Andrei | When and how to treat hyponatremia in the ED | Intern, Junior, Senior |
| Sodium | Farkas, Josh | Hypernatremia & dehydration in the ICU – EMCrit Project | Senior, Attending |
| Sodium | Farkas, Josh | Emergent treatment of hyponatremia or elevated ICP with bicarb … | intern, Junior, senior, attending |
| Sodium | Farkas, Josh | Taking control of severe hyponatremia with DDAVP | Attending |
| Sodium | Helman, Anton | Emergency Management of Hyponatremia | EM Cases | intern, Junior, senior, attending |
| Sodium | Farkas, Josh | Unconventional therapies for hyponatremia: Thinking outside the … | intern, Junior, senior, attending |
| Sodium | Farkas, Josh | PulmCrit- Controlled aquaresis: Management of hypervolemic or euvolemic hyponatremia with oral urea | Junior, senior, attending |
| Magnesium | Morgenstern, Justin | Torsades de Pointes: Approach to resuscitation | intern, Junior, senior |
| Magnesium | Multiple | Hypermagnesemia – WikEM | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Lodeserto, Frank | Pediatric DKA: Do Fluids Really Matter? – REBEL EM – Emergency … | Clerk, Intern, Junior, Senior |
| Diabetic Ketoacidosis | Morgenstern, Justin | IV fluids do not cause cerebral edema in pediatric DKA – First10EM | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Farkas, Josh | Blood gas measurements in DKA: Are we searching for a unicorn? | Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Farkas, Josh | Anatomy of a DKA resuscitation – EMCrit Project | Clerk, Intern, Junior, Senior |
| Diabetic Ketoacidosis | Hughes, Darrel | Is There Any Benefit to an Initial Insulin Bolus in Diabetic … | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Abela, Nikki | Fluid Type and Infusion Rate in Paediatric DKA | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Multiple | Cerebral edema in DKA – WikEM | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Lubberdink, Ashley | TREKK Series | Diabetic Ketoacidosis | Clerk, Intern, Junior |
| Diabetic Ketoacidosis | Farkas, Josh | PulmCrit- Dominating the acidosis in DKA | Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Farkas, Josh | PulmCrit – Four DKA Pearls | Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Multiple | emDOCs.net – Emergency Medicine Education Diabetic … | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Multiple | Diabetic ketoacidosis | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Diabetic Ketoacidosis | Multiple | PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method | Junior, Senior, Attending |
| Diabetic Ketoacidosis | Monette, Derek | PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA | Junior, Senior, Attending |
| Hyperosmolar Hyperglycemic State | Multiple | Hyperosmolar hyperglycemic state – WikEM | Clerk, Intern, Junior, Senior, Attending |
| Hyperosmolar Hyperglycemic State | Multiple | Hyperosmolar hyperglycemic state | Radiology Reference Article … | Clerk, Intern, Junior, Senior, Attending |
| Hyperosmolar Hyperglycemic State | Multiple | Non-ketotic hyperglycaemic seizure | Radiology Reference Article … | Clerk, Intern, Junior, Senior, Attending |
| Hypoglycemia | Multiple | Hypoglycemic encephalopathy | Radiology Reference Article … | Clerk, Intern, Junior, Senior, Attending |
| Insulin Pump | Multiple | Insulin Pumps: Complications and Emergency Department Presentations | Intern, Junior, Senior, Attending |
| Insulin Pump | Weingart, Scott | Podcast 198 – Insulin Pumps and Such with Josh Miller, MD | Clerk, Intern, Junior, Senior, Attending |
| Insulin Pump | Rezaie, Salim | Diabetic Gastroparesis Needs HUGS | Intern, Junior, Senior, Attending |
| Nutritional Disorders | Multiple | Osteoporosis | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Nutritional Disorders | Long, Brit | Protein Shakes and Dietary Supplements: What are their ingredients and how much is too much? | Senior, Attending |
| Vitamin Deficiencies | Multiple | Rickets | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Vitamin Deficiencies | Groth, Meghan | Mythbusting the Banana Bag | Intern, Junior, Senior, Attending |
| Wernicke-Korsakoff | Multiple | Thiamine Deficiency | Intern, Junior, Senior, Attending |
| Wernicke-Korsakoff | Pescatore, Rick | Should You Prescribe Oral Thiamine for Chronic Alcoholics … | Senior, Attending |
| Wernicke-Korsakoff | Multiple | Wernicke-Korsakoff syndrome – WikEM | Clerk, Intern, Junior, Senior, Attending |
| Wernicke-Korsakoff | Multiple | Wernicke encephalopathy | Radiology Reference Article … | Clerk, Intern, Junior, Senior, Attending |
| Wernicke-Korsakoff | Swaminathan, Anand | Wernicke’s Encephalopathy Archives – REBEL EM – Emergency … | Junior, Senior, Attending |
| Parathyroid Disease | Multiple | Parathyroid hormone | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Parathyroid Disease | Multiple | Parathyroid glands | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Parathyroid Disease | Newman, Samantha | PTH versus PTHrP — Small Differences, Big Implications – Clinical … | Intern, Junior, Senior |
| Pituitary Disorders | Multiple | Sheehan syndrome | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Pituitary Disorders | Multiple | emDOCs.net – Emergency Medicine EducationThunderclap … | Intern, Junior, Senior |
| Pituitary Disorders | Multiple | Pituitary gland | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Pituitary Disorders | Multiple | Optic pathway glioma | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Pituitary Disorders | Multiple | Pituitary apoplexy | Radiology Reference Article | Radiopaedia.org | Intern, Junior, Senior, Attending |
| Pituitary Disorders | Multiple | Empty sella | Radiology Reference Article | Radiopaedia.org | Intern, Junior, Senior, Attending |
| Pituitary Disorders | Multiple | Elevated prolactin (differential) | Radiology Reference Article … | Clerk, Intern, Junior, Senior, Attending |
| Hyperthyroid | Multiple | Thyroid storm – WikEM | Intern, Junior, Senior, Attending |
| Hyperthyroid | Lipp, Chris | CRACKCast E128 – Thyroid and Adrenal Disorders | Intern, Junior, Senior, Attending |
| Hyperthyroid | Multiple | Hyperthyroidism – WikEM | Clerk, Intern, Junior, Senior |
| Hyperthyroid | Multiple | Thyroid Storm and Aortoiliac Occlusive Disease | Intern, Junior, Senior, Attending |
| Hyperthyroid | Multiple | Bedside Rounds Series: Goiter – Clinical Correlations | Clerk, Intern, Junior, Senior |
| Hyperthyroid | Lee, Terrance | Diagnosing hyperthyroidism: Answers to 7 common questions | Clerk, Intern, Junior, Senior |
| Hypothyroid | Fox, Sean | Hypothyroidism and Myxedema Coma — Pediatric EM Morsels | Intern, Junior, Senior, Attending |
| Hypothyroid | Multiple | Myxedema coma – WikEM | Intern, Junior, Senior, Attending |
| Hypothyroid | Zhao, Leah | Spot the Diagnosis! The case of the Pale Woman | Intern, Junior, Senior |
| Tumors Of Endocrine Glands | Multiple | Parathyroid adenoma | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Tumors Of Endocrine Glands | Multiple | Central nervous system germinoma | Radiology Reference Article … | Intern, Junior, Senior, Attending |
| Tumors Of Endocrine Glands | Multiple | Craniopharyngioma | Radiology Reference Article | Radiopaedia.org | Junior, Senior, Attending |
| Tumors Of Endocrine Glands | Multiple | Carcinoid tumor | Radiology Reference Article | Radiopaedia.org | Intern, Junior, Senior, Attending |
| Adrenal Tumor | Multiple | Pheochromocytoma | Radiology Reference Article | Radiopaedia.org | Intern, Junior, Senior, Attending |
| Adrenal Tumor | Multiple | Adrenal adenoma | Radiology Reference Article | Radiopaedia.org | Intern, Junior, Senior, Attending |
| Adrenal Tumor | Multiple | Adrenal cortical carcinoma | Radiology Reference Article … | Intern, Junior, Senior, Attending |
| Pituitary Tumor | Multiple | Acromegaly | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Pituitary Tumor | Multiple | Pituitary adenoma | Radiology Reference Article | Radiopaedia.org | Clerk, Intern, Junior, Senior, Attending |
| Thyroid Tumor | Multiple | Medullary thyroid carcinoma | Radiology Reference Article … | Clerk, Intern, Junior, Senior |
| Thyroid Tumor | Multiple | Anaplastic thyroid carcinoma | Radiology Reference Article … | Intern, Junior, Senior, Attending |
References:
Special thanks to SOAR co-authors Ryan Pedigo, Lisa Zhao, JooYeon Jung, Shirley W Bae, Teresa Chan, and Andrew Grock.
- Hsiao, JJ, Pedigo, R, Bae, SW, et al. Systematic online academic resource (SOAR) review: Endocrine, metabolic, and nutritional disorders. AEM Educ Train. 2021; 5:e10716. doi:1002/aet2.10716
- Grock A, Bhalerao A, Chan T, Thoma B, Wescott A, Trueger N. Systematic Online Academic Resource (SOAR) Review: Renal and Genitourinary. AEM Educ Train. 2019;3(4):375-386. doi:10.1002/aet2.10351
- Raine T, Thoma B, Chan T, Lin M. FOAMSearch.net: A custom search engine for emergency medicine and critical care. Emerg Med Australas. 2015;27(4):363-365. doi:10.1111/1742-6723.12404
- Thoma B, Sanders J, Lin M, Paterson Q, Steeg J, Chan T. The social media index: measuring the impact of emergency medicine and critical care websites. West J Emerg Med. 2015;16(2):242-249. doi:10.5811/westjem.2015.1.24860
- Colmers-Gray I, Krishnan K, Chan T, et al. The Revised METRIQ Score: A Quality Evaluation Tool for Online Educational Resources. AEM Educ Train. 2019;3(4):387-392. doi:10.1002/aet2.10376
A patient presents to your ED with an all too common complaint – chest pain. After a focused history and physical exam, you have an extremely low clinical suspicion for thoracic aortic dissection, pulmonary embolism, pneumonia, pneumothorax, pericarditis/myocarditis, and Boerhaave’s syndrome. When the labs (including a troponin), an ECG, and chest x-ray yield normal results, questions often arise. Can you discharge her with a single troponin if she is low risk? How do you define low risk? And lastly, does she need urgent provocative testing after discharge?