Slow stuff and throwing stones?

Great ECG and discussion on top of that. All about bradycardia and something called "systole" arrest from Dr Amal Mattu.

I was also taught about calcium being lethal in Digoxin overdoses and its a hard dogma to ignore. Just remember that decision making in medicine is not just trials and evidence but a combination of patient preference, clinical course, physician experience and sometimes cost.

For more of his vids or older cases, go to www.ekg.umem.org

Cliff Reid on making things happen - SMACC 2013

Here's Cliff Reid's talk on the non medical aspects of running critical care crises. Highly recommended to all who work in an ED and kudos to the SMACC team for releasing this to the world for free.




For more vids from the great conference, go to their Youtube site.

What you need to know about your Eating Disorders Patients

Excellent article on eating disorders, applicable to other staved patients too.

1. Low blood pressure and bradycardia can be norm. Don't be too aggressive with fluids as you can tip them into heart failure. 

2. Watch for cardiac arrhythmias.

3. Osteoporotic fractures happens in these young people.

4. Refeeding syndrome and cardiovascular collapse can occur from aggressive refeeding - reverse slowly. 

5. Liver dysfunction - watch the serum glucose

6. Liver dysfunction - watch the coagulation

7. Bulimics - can have normal weight/appearance

8. Bulimics - hypokalaemia and metabolic alkalosis

9. Bulimics - GIT complication of purging

MascolonM, et. al. What the emergency department needs to know when caring for your patients with eating disorders. Int J Eat Disord. 2012 Dec;45(8):977-81. Epub 2012 Jun 18.

Here's the article link 

Webucation 19/5

Been away for a few weeks on a course. The web has been active though and here's more than a few good articles to ponder over.

• How-marriage-works-in-medicine - interesting read for those in and around wedlock and even more interesting for those not "locked"
• Ringer's ain't great...again. - not as much volume expansion as you once thought
• FOOSH again - excellent revision on a not so common wrist injury from Emergucate
• PTX aspiration - great video by NEJM on needle aspiration of pneumothorax of you have not seen one before.
• Don't ignore naughty parts! - the trauma pro talks about not ignoring stuff down below
• Macrolides and CCBs - do they interact and cause shock?
• LUL collapse - we agree that its probably the hardest collapse to see on CXR
• Microbiology pearls - truly one of the best write-ups we have seen recently. What every hospital doc should know about those pesky microbes and what really happens. We cannot recommend this link enough.

CDC field triage

The CDC has updated its field triage recommendations and they can be found here: Update article
A quick summary of recommendations is shown below for those interested in Disaster Med.

Not far enough - an airway video

Here is a a superb video by Dr Larry Mellick's team. It shows a not so frequent complication during an RSI procedure. It reminds us of the doctrine of check, recheck and check again after performing critical procedures. The patient was saved by constant monitoring and a high index of suspicion.



Be sure to follow more of Dr Mellick's videos here.

The back heart attack

Dr Amal Mattu gives us the down low on not just posterior MIs but a good dose of syncope as well.
This should be in the repertoire of all EM trainees and physicians.

For more of his vids or older cases, go to www.ekg.umem.org

Webucation 1/5/13

Here's more friendly pearls from the web. Mixture of surgery, radio and tons of paeds for good measure. 

The really interesting link is #5. I was taught impulse testing and other subtle tests to remember for detecting acute appendicitis but never subtle history taking!

• All about major burns - comprehensive run through from fluids to escharotomy
• The-winking-owl-sign - this spinal x-ray tute is a hoot
• Why people don't change their minds despite evidence - its not delusions but rather something else
• Headaches in kids - all about this little taught topic
• Road bumps and appendices? - will this be part of your alvarado?
• Paediatric-dermatology-challenge - really a great reminder of what's important and how to approach rashes in kids.

Remember to credit the content providers.