Focused FOAMed – The Learners Lens

24 Jan
January 24, 2019

Background: This is a guest post from two of our friends all the way in Italy.  They have actually sent several revisions of this post as a way to help learners focus on different aspects of FOAMed.  One of the major caveats the authors mentioned is that FOAM covers most of the coolest parts of EM, but there are other topics that are important as well.  The authors advocate for a compilation of resources into a simple syndication reader (i.e. Feedly) and podcast application (i.e. Downcast, Overcast, etc).  When searching for topics consider using FOAM search. Finally, study and focus on FOAM topics that you like and need:

  1. Like = your passions, what you’re best at
  2. Need = what you’re worst at or scared of

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Titles Don’t Make Leaders

23 Jan
January 23, 2019

When I was a kid, I used to play chess with my grandfather every day.  Each piece on the chess board had unique moves that could be made in order to help win and capture the other person’s king (i.e. checkmate).  I used to think the king was the most important piece when I was kid, but the truth is, the king, had some of the most limited moves. A more reasonable reality is that the strength of the king is enhanced by optimally orchestrating and enhancing each of the other piece’s abilities.  A team can either be successful or fail based on the management style of a leader.

Recently, I also read a book called Multipliers, by Liz Wiseman who does an absolutely amazing job talking about the attributes of successful leaders.  I began to think about the ideas in this book and the analogies that could be made to the pieces on a chess board.  From this combination, I developed a talk on leadership : “Titles Don’t Make Leaders.” Read more →

REBEL Core Cast 3.0 – Asthma, COPD + PNA

23 Jan
January 23, 2019

Take Home Points

  1. Single dose oral dexamethasone is an excellent choice for asthma exacerbations. It takes away the compliance issue for patients who have trouble getting medications or filling medications once they leave the ED.
  2. Antibiotics aren’t always indicated in COPD exacerbations, but are used much more frequently than in asthma exacerbations because the structural changes in the patient’s lung lead to increased bacterial colonization. In general, if the patient has increased cough or sputum production, they probably would benefit from a course of antibiotics
  3. In general, azithro alone is no longer a good choice as solo covereage for community acquired pneumonia.  Adding either amoxicillin or cefdinir to your azithromycin should get you good coverage of both strep pneumo and atypicals.

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The HOUR Trial: Clinical Decision Rule for Opioid Overdose Patients in the Emergency Department

21 Jan
January 21, 2019

Background Information: In 2017, more than two-thirds of the 70,000 drug overdose deaths in the United States involved an opioid.1 Many emergency departments are affected as opioid overdoses increased 30% from July 2016 through September 2017 in 52 areas in 45 states.2 With the half-life of naloxone being between 60-90 minutes the appropriate disposition and observation time of these patients following naloxone reversal continues to be debated in the literature.3,4, A study on heroin overdose patients treated and released by pre-hospital providers showed no deaths in the one-year period studied.5 While this only applies to isolated heroin use, other studies have shown no increased incidence of death within 48 hours of patients treated with naloxone for non-fentanyl opioid overdoses.6,7 Many of these studies, however, suffer from poor follow up which is unsurprising given the difficulty in tracking patients with opiate use disorders. It is important to note that the increased presence of synthetic and long-acting opioids further complicates this topic. A systematic review of a clinical prediction rule known as the St. Paul’s Early Discharge Rule, concluded that ambulatory patients with normal vital signs, and a Glasgow Coma Scale (GCS) of 15 only needed 1 hour of observation prior to discharge.8,9 The authors of this study sought to validate this single center derived rule and its six criteria. Read more →

IDSA Guideline on Seasonal Influenza Management 2018

14 Jan
January 14, 2019

Article: Uyeki TM et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza. Clin Infect Dis 2018. PMID: 30566567

Background: Influenza is an Emergency Department scourge that we deal with every year. The vast majority of patients recover from uncomplicated influenza without anything more than supportive care but, influenza can cause serious complications. Young children, older adults, pregnant and postpartum women, people with neurologic disorders and patients with certain chronic medical conditions (i.e. COPD, CAD, Diabetes, Immunocompromised states) are at increased risk for these complications. Annual vaccination is the best method to reduce the impact of influenza on morbidity and mortality. Though antiviral medications for influenza are far from perfect, the indications for their use must be understood. Read more →