How to get FOAM to work for you

ED Rounds – Jan 2019

Dr. Kavish Chandra presents rounds on Free Open Access Medical Education (FOAM) and how to make it work for you

How to get FOAM to work for you

š“If you want to know how we practiced medicine 5 years ago, read a textbook. If you want to know how we practiced medicine 2 years ago, read a journal. If you want to know how we practice medicine now, go to a (good) conference. If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM. — from International EM Education Efforts & E-Learning by Joe Lex 2012

Definition

šFOAM (free open access medical education) is a collection of resources, a global community and an ethos for anyone, anywhere and anytime.
 
Globally, there has been an exponential increase in the number of active emergency medicine and critical care websites, blogs and podcasts.
Cadogan et al. (2014)

 

What are we doing at sjrhem.ca?

We also have our own online journal channel at Cureus.com. Articles are submitted by local as well as international authors, and reviewed by peers and finally approved by local channel editors

 

The practical guide (adapted from Thoma et al. (2014)

šStep 1 – Get an RSS aggregator
  1. Feedly
  2. Flipboard

Then within the program, search blogs and website by name or URL. The programs above generally search your created list and populate a “to read list” with direct links and the option to defer until you have more time

Examples of websites and blogs

4. Resus.Me http://resus.me
5. EM Literature of Note http://emlitofnote.com
7. Academic Life in EM http://academiclifeinem.com
8. Life in the Fast Lane http://lifeinthefastlane.com
9. St. Emlyn’s http://stemlynsblog.org
10. The SGEM http://thesgem.com
11. Pediatric EM Morsels http://pedemmorsels.com
12. Rebel EM http://rebelem.com
13. Don’t Forget the Bubbles http://dontforgetthebubbles.com
14. The Poison Review http://thepoisonreview.com
15. Trauma Pro’s Blog http://regionstraumapro.com

 

šStep 2 – connect with social media (SoMe)

Use SoMe to connect with the largest online medical community

Participate in post publication reviews

If anything, take away one of the many pearls

šSJRHEM @sjrhem
šECCU course @eccucourse
šKen Milne @TheSGEM
šThe Bottom Line  @WICSBottomLine
šSaint Emlyn’s @stemlyns
šAcademic Life in EM @ALIEMteam
šRob Bryant @robjbryant13
šTessa Davis  @TessaRDavis
šTeresa Chan  @TChanMD
šRob Rogers  @EM_Educator
šFOAM cast @FOAMpodcast
šFOAM Highlights @FOAM_Highlights
šAnand Swaminathan @EMSwami
šSalim R. Rezaie @srrezaie
šJavier Benitez  @jvrbntz
EM Res Podcast @BobStuntz
šRadiopaedia.org @Radiopaedia
šCasey Parker @broomedocs
šRyan Radecki @emlitofnote
šMinh Le Cong @ketaminh
šChris Nickson @precordialthump
šScott Weingart @emcrit
šMike Cadogan @sandnsurf
šMatta nd Mike @ultrasoundpod
šLeon Gussow @poisonreview
šBryan D. Hayes @pharmERToxguy
šSimon Carley @EMManchester
šSteve Carroll, DO @embasic
šHaney Mallemat @CriticalCareNow
šRob Cooney, MD, MEd @EMEducator
šMichelle Lin @M_Lin
šBrent Thoma @Brent_thoma
šBoring EM @BoringEM
šFOAM Starter @foamstarter

See the attached image for “How to Twitter”

 

 

Please find the entire rounds presentation below

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Managing Shocks – not shock…

ED Rounds – Jan 2019

Andrew Lohoar


Dr. Lohoar presents rounds on the topic of ‘Electrical Injuries’ including electrocution, lightening strike and Taser injuries.



X2 Darts have a double barb, X26 Darts come in extra long ‘winter coat’ and standard ‘summer’ varieties.



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The Febrile Infant

ED Rounds – Dec 2018

Dr. Robin Clouston


Objectives

  • Discuss the risk of serious bacterial infection (SBI) in the neonate or young infant (<90d) with fever
  • Review current suggestions for the work up, management, disposition, and follow up in the care of neonates and young infants with fever
  • Discuss the role of decision tools (ex: Rochester, Boston, Philadelphia) to aid in decision making for the well-appearing infant with fever

Introduction

  • •The febrile neonate (<28d) and young infant (<90d) are commonly encountered in the emergency dept.
  • Many will have a self limited, viral illness
  • A small but significant proportion (up to 15%1 in some series) will have a serious bacterial infection (SBI)
  • How to best assess and manage such infants has long been a matter of debate.

Definitions

  • Neonate: 0 to 28d
  • Young Infant <90d
  • Fever = rectal temp >/= 38.0C
  • Serious bacterial infections (SBI) include:
    • Bacterial meningitis, bacteremia, UTI, pneumonia
    • Some series: enteritis, cellulitis, abscess, osteomyelitis, septic joint
  • Invasive Bacterial Infect (IBI)
    • Bacterial meningitis and bacteremia

Common Pathogens

  • In neonates < 28d, most common pathogens are:
    • E. coli
    • Group B streptococcus
    • S. pnuemoniae
    • S. aureus
    • L. monocytogenes
    • Also:
      • Herpes simplex virus
      • Respiratory syncytial virus
      • Enterovirus

Click below for full presentation:

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ED Rounds – Competency By Design

ED Rounds – September 2018

Dr. Jo-Ann Talbot

 


 


Competency-based medical education (CBME) is an outcomes-based approach to the design, implementation, assessment, and evaluation of a medical education program using an organizing framework of competencies.

Competence by Design (CBD) is the Royal College’s version of CBME. It is a transformational change initiative designed to enhance CBME in residency training and specialty practice in Canada.

The first stage in residency is known as Transition to discipline. It emphasizes the orientation and assessment of new trainees. Foundations of discipline, the second stage, covers broad-based competencies that every trainee must acquire before moving on to the third stage, which is known as Core of discipline. The third stage covers more advanced, discipline-specific competencies. As part of CBD, the Royal College is also exploring moving the Royal College exam to the end of this stage.5 The fourth and final stage of residency education is known as Transition to practice. During this stage the trainee demonstrates readiness for autonomous practice

RCPSC 2016


 

Dr. Talbot’s Presentation

Competence by Design – Are You Ready?

Competency by Design Are You Ready? Dr. Jo-Ann Talbot – 2018

Click link above to view


Further Reading

CBD Cheatsheet

Download (PDF, 128KB)


Emergency Medicine – Entrustable Professional Activities 

Download (PDF, 71KB)


 

Entrustable Professional Activity Guide: Emergency Medicine

EPA-guide-emergency-medicine RCPSC 2018

Click link above to view


 

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ED Rounds – Oncologic Emergencies and Emerging Treatments

ED Rounds – May 2018

Dr. Paul Frankish

 

Take Home Points

  1. In patients on Immunotherapy for cancer beware of diarrhea or dyspnea, as it may represent an autoimmune side effect.

  2. LMWH is the treatment of choice for the duration of Malignancy associated PE.

  3. SVC obstruction is “sneaky” and new dyspnea is far more common than facial swelling.

 

Immunotherapy

 

 

 

 


Febrile Neutropenia

A single oral temperature >38.3 deg C

or

A sustained oral temperature >38 deg C

with

An absolute neutrophil count (ANC) less than 500 cells per microliter (0.5 x 109/L)

 

*Far and away one of the most common oncologic presentations to the ED

*70% hematologic and 30% solid organ malignancies

*Treatment Timelines (as per IDSA):

1.STAT CBC within 10 minutes

2.Broad empiric antibiotics within 60 minutes

 

History

1.Diagnosis

2.Date and type of last Chemo

3.Use of G-CSF

4.Use of antimicrobials

5.History of prior infection

6.PMH/surgical history

7.Medications/Allergies

 

Exam

1.Mental Status

2.Volume Status

3.Oral Mucosa

4.Skin/Catheter Sites

5.Respiratory

6.Cardiovascular

7.Abdomen

 

Treatment

*Imipenem 500 mg IV Q6H or

*Pip/Tazo 3.375 gram IV Q6H or

*Cipro 400 mg IV and Vanco 1 gram IV Q12H if penicillin allergic

*Consider adding Vanco to monotherapy if:

1.IV Catheter Infection

2.Gram positive organism not yet identified

3.MRSA Colonization

4.Hypotension/Shock

 


SVC Obstruction

*Subacute SVCO results in milder symptoms like facial swelling, cough, dyspnea, facial redness, dilated superficial veins.

*Acute SVCO is more severe and can result in altered LOC, increased ICP, airway obstruction.

*Test of choice is a contrast enhanced CT chest

 

 

Treatment

1.Elevate HOB

2.Dexamethasone 10 mg IV

3.Symptom control

4.Airway management if indicated

5.Urgent Radiation Oncology Consult

6.If known Small Cell Lung Cancer, then worth a call to Medical Oncology

 

 


 

Pulmonary Embolus

*New dyspnea of unknown etiology in patient with active malignancy is a PE until proven otherwise

*Alternate explanations for new dyspnea are pericardial effusion, SVCO, lung tumor burden, anemia.

*Preferred treatment is LMWH indefinitely

 

Investigation of choice is CTPA

 

ECG may show S1QT3 – But don’t rely on this sign

PoCUS may also be helpful for initial triage of acute dyspneic patient – look for dilated RV and IVC

 

Treatment

*Dalteparin 200 units/kg sc for 1 month

then

*Dalteparin 150 untis/kg sc thereafter

*Main evidence for LMWH over warfarin comes from CLOT trial

*50% reduction in recurrent VTE with LMWH vs. warfarin

*Presumed to be because of poor tolerance of PO meds in patients with cancer nauseated from chemo

*May not be relevant in era of modern anti-emetics and anticoagulants, data pending

 


 

Epidural Spinal Cord Compression

1.Back pain (90% of cases)

2.Motor weakness

3.Sensory impairment

4.Autonomic dysfunction

5.Perianal numbness

6.Conus medullaris syndrome

 

Investigations and Treatment

*Dexamethasone 10-20 mg IV immediately if SCC is suspected

*MRI is preferred (generally T/L spine)

*Radiation Oncology if previously diagnosed malignancy

*Neurosurgery if new diagnosis of malignancy

 


 

 

 


SJRH Oncology Services – On Call Consults

 

 

 


Full Presentation

 

Download (PDF, 43.05MB)

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ED Rounds – Epistaxis

ED Rounds – March 2018

Dr Christopher Chin MD FRCSC

Rhinology, Anterior Skull Base, Head and Neck Oncology

Otolaryngology- Head & Neck Surgery

Saint John Regional Hospital

 

Objectives

  • Cover basic and advanced techniques to obtain hemostasis in the ER
  • Review what options are available if that fails

Agenda

  • Review of anatomy
  • Management algorithm
  • What options are available when traditional packing fails
  • What’s new in epistaxis?
  • Special scenarios

 

Download (PPTX, 11.86MB)

 

Download (PDF, 16.26MB)

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ED Rounds – Sexual Assault and the SJRH SANE Program

Sexually Assault and the SJRH SANE Program

ED Rounds Presentation by Dr. Robin Clouston and Maureen Hanlon RN, SANE Co-ordinator


The Sexually Assaulted Patient – Evaluation & Management in the Emergency Department

Dr. Robin Clouston

Download (PPTX, 479KB)

 


The Saint John SANE Program

Maureen Hanlon RN, SANE Co-ordinator

Download (PPTX, 189KB)

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