We are excited and proud to introduce a new series as part of the recently announced ALiEMU: Capsules: Practical Pharmacology for the EM Practitioner.
The Capsules series’ primary focus is bringing Emergency Medicine pharmacology education to the bedside. Our expert team distills complex pharmacology principles into easy-to-apply concepts. It’s our version of what-you-need-to-know as an EM practitioner. We hope you enjoy it.
One of my favorite images of medical education is the renowned Eakin’s painting, The Agnew Clinic. It depicts a gilded age operating theater filled with eager pupils looking on as Dr. Agnew prepares to preform a partial mastectomy. Despite being a cross-section of medical training from the late 1880s, any medical trainee today will experience an unspoken bond with those students dutifully taking notes in the tiers of Dr. Agnew’s operating theater. And there is a certain beauty to this lineage of physicians: all of us familiar with the same rite of passage into medicine but separated by a century’s worth of advances in science and society. (more…)
Everyone has a slightly different relationship with technology. For me, it has always been a tool for creativity. Whether working on video, music, or photography – I have spent more hours in front of a computer than I care to admit. I always dreamed about somehow using my experience with media development in a productive way for the medical field, but judging by the doctors who I knew in high school/college (including my parents), my impression was that physicians and the world of the internet would remain forever apart.
I was recently the author of a PV card for management of Salicylate Toxicity, which had some discrepancy with expert opinion. The point of contention was in regards to measurement of urine pH vs serum pH for alkalinization. In preparing the first version of the card, I began with notes from a recent toxicology rotation, and expanded by examining textbooks and review articles. Although there was mention of serum pH measurement, numerous sources emphasized urine alkalinization as the primary endpoint for the treatment of aspirin toxicity. Therefore I choose to include this on the size-limited PV card.
Despite review by numerous peers and colleagues, not long after publication we were met with concern from prominent toxicologists regarding an oversight in mentioning serum alkalinization. Utilizing the strengths of our blog and social media we were immediately able to initiate a discussion with experts on the topic.
Dr. Lewis Nelson of NYU was able to clarify that by prioritizing serum alkalinization, we will avoid the cerebral toxicity that is the primary etiology of mortality. Serum alkalinization should also facilitate urine alkalinization as well as allow time to arrange for hemodialysis. Dr. Bram Dolcourt from Detroit expanded that serum alkalinization and normokalemia alone do not guarantee an optimal urine pH and suggest measurement of both urine and serum. From Twitter, Dr. David Juurlink from Toronto also recommended measurement of both, stating his forthcoming publication will expand on the topic. Our own ALiEM clinical pharmacist Dr. Bryan Hayes also assisted with expert insight as I was revising the PV card.
As the ALiEM-CORD virtual fellow, I have had the challenging task of collaborating with experts in my field, while still very much in a learner role myself. I was fortunate enough to have been featured on a site that has a robust commenting system and pride in peer review, even if it is post-publication. There is certainly content on the web that may be inaccurate or ‘less-accurate’, and consumers of both FOAM and conventional publications, as always, should remain critical and review multiple sources. There is a broad range in teaching and practice based on region, and when we work together we can identify what is truly best practice. Hopefully this conversation and the forthcoming publication on the topic will translate into changes in practice and in the textbooks in the coming years. Luckily, utilizing the strengths of our medium, we are able to publish these corrections today.
For those curious, here was the original version 1.
“Math is like an atomic powered prosthesis that you attach to your common sense, vastly multiplying its reach and strength.” – Jordan Ellenberg
“If you don’t get elementary probability in your repertoire, you’re like a one-legged man in an ass-kicking contest.” – Charlie Munger
When your grade school teachers told you that you’d be doing math every day of your life, you scoffed. In adulthood, you likely took perverse pride in noting their predictions to be wrong. Enter Jordan Ellenberg (@JSEllenberg) to show you that math is nothing less than a method of thinking and reasoning, and it pervades your everyday decisions. While it can be ignored or avoided, you do so at your own peril.
The Case of the Flirtatious Patient has been sparse in volume of comments but we’ve still had a really interesting set of comments over the past week. We are now happy to present to you the Curated Community Commentary and our two expert opinions. Thank-you again to all our experts and participants for contributing again this week to the ALiEM MEdIC series.
For all you medical education folks out there, you will know that learner assessment is a really hot topic these days. Competency-based medical education (CBME), entrustable professional activities (EPAs), milestones… These are all the fancy new terms that are floating out of most residency educator’s mouths. Herein we present our McMaster Modular Assessment Program (McMAP) in e-book form, courtesy of ALiEM Press.