In my 10+ years working in the ED, I’ve come across a few online FOAM resources (Free Open Access Meducation) that are essential to my practice. Inspired by ALiEM’s new How I Work Smarter series, I wanted to share these free tools in the hope that they may help you work smarter too, regardless of what your role is in the emergency management of patients.
This month marks our second ALiEM-Annals Resident’s Perspective discussion. Similar to the ALiEM-Annals Global EM Journal Club series and the first Resident’s Perspective piece on Multiple Mini Interviews, we will be discussing the most recent Annals of Emergency Medicine Resident’s Perspective piece on the Integration of Social Media in Emergency Medicine Residency Curriculum. We hope you will participate in an online discussion based on the paper summary and questions below from now through August 1, 2014. Respond by commenting below or tweeting using the hashtag #ALiEMRP.
As the Free Open Access Meducation (FOAM; #FOAMed) movement has continued to flourish over the past few years, Twitter has become a vital method for disseminating/discussing educational and clinical content. We thought it would be interesting to see who is being ‘followed’ on Twitter in the FOAM world. Certainly, the metric of Twitter followers does not necessarily correlate with quality. And, it misses newcomers to the FOAM scene and those with a more focused area of expertise/interest. We are more interested in understanding the landscape such as who is involved, geographic locations, areas of expertise, and association with blogs/podcasts.
Clinical Toxicology has published guidelines for out-of-hospital management of 16 distinct overdoses and their dose thresholds, above which, pediatric patients should be referred to the Emergency Department for evaluation. Clinical Toxicology is the official journal of the American Academy of Clinical Toxicology (AACT, @AACTinfo), the American Association of Poison Control Centers (AAPCC, @AAPCC), and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT). There are two caveats to be aware of regarding these guidelines.
- They were developed between 2005 and 2007. New medications have been approved since that time and there may be more recent data available.
- As with any poisoning, dose is only one factor when determining disposition. Consideration should also be given to intent, underlying medical conditions, co-ingestion of other medications, presence of symptoms, and drug formulation.
This PV Card summarizes the pediatric ingestion dose thresholds for referral to an ED.
Whether alteplase (tPA) is given for ischemic stroke, pulmonary embolism, or STEMI, there is an important practical issue to be aware of during administration. Dr. Charles Bruen (@resusreview) published a great step-by-step pictorial tPA Mixing Tutorial. Once the tPA is mixed, it will invariably be infused via a smart pump through its corresponding tubing. At my institution we use Alaris® CareFusion smart pumps, through the principle applies irrespective of which brand pump is used.
Rate control with IV medications is recommended for atrial fibrillation in the acute setting in patients without preexcitation. This was a Class 1 recommendation (Level of Evidence B) per the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation . What does the evidence say? Are calcium channel blockers or beta blockers better?
There are a few reasons why piperacillin/tazobactam (Zosyn) is not usually my first choice for a broad-spectrum gram-negative agent in the ED. First, at my institution, the Pseudomonas aeruginosa susceptibilities to pip-tazo are lower than that for cefepime. Second, pip-tazo does not have great CNS penetration, especially compared to ceftriaxone, cefepime, or even meropenem. Third, do we really need the anaerobic coverage that pip-tazo provides for every sick patient? Pip-tazo is great for empiric treatment of intra-abdominal and severe diabetic foot infections, but may not be needed for a hospital-acquired pneumonia. Fourth, with its frequent dosing (every 6 hours), too often the second dose is missed if the patient is still boarding in the ED.