Ebola - All you need to know while at work

From the Office of the CEO:

Starting this week our Infection Prevention & Control team is providing on-site training sessions related to the use of personal protective equipment, with specific focus on donning and doffing procedures. Initially, this training will be targeted to staff in the emergency departments and ICUs.

While existing PPE supplies in the province provide a high degree of protection, please be aware that over the weekend PHAC will be reviewing PPE requirements and may make new recommendations to the provinces once this review is complete. The provincial task force will update these guidelines if necessary once these recommendations are made.

The PHC Ebola page is Here

The Latest CDC PPE Recommendations are Here

More info will be added, and updates provided, as they are available.

Weekly Reading List

The Weekly Reading List

... and we're back...

So, 2 months off for Summer, St Paul's Emergency Medicine Update, the birth of my second child.  Things have been quiet here, but not on the Webs.

At ICEM 2012, a group of EM and SoMe (Social Media) thought leaders put their heads together over a pint of Guiness (it was Dublin after all) to come up with the next step in Medical Education in the Wild West we call the Internet.  Thus was born FOAM (Free Open Access Meducation). This was 'shortened' to FOAMed. The goal was/is to provide a loose structure and enhanced usability to the array of EMCC (Emergency Medicine and Critical Care) blogs, podcasts, tools, and resources available on the Web, and to harness that bounty to improve Medical Education. Don't take my word for it, check out the originators:

The first 2 big tools to help harness all this are: - a Google Custom Search Engine (created by yours truly) that ONLY searches EMCC blogs, podcasts, tools and Journals. This is a good first filter, and if you don't find what you need, then you can resort to the full Google. - a realtime RSS feed of all the known EMCC blogs and podcasts.  You can visit the site to see the latest, or subscribe to their integrated, single stream RSS feed.

So, welcome to #FOAMed !

Okay, but what else happened?  Here is a smattering of other good stuff from the web:

Ultrasound for Subclavian Lines - you can do that?  Yes you can!

Dr Ves at CasesBlog points us to the new Guidelines for Management of Acute Bacterial Sinusitis (it's not sexy but it is important)

Does this overdose need dialysis? Review of Extracorporeal Removal Techniques for the Poisoned Patient

Urine Drug Screening - Useful? Part One focusses on Benzos, Part Two on Opiates.

Have you been given a Field Note by a FM resident? Want to know What's up?

Is that cut 'too old' to close? Are you sure? (Journal Link)

ENLS -Emergency Neurological Life Support (What to do in the first critical hour of a neurological emergency). This is a new 'Advanced Life Support' course, but the Protocols and the background info are FREE!  Yay FOAMed.

Erowid - more than anyone needs to know about Psychoactive substances... from a slightly different point of view.

Are you scared of CROCODILEs? A new approach to Pt Safety with Learners in the driver's seat.

Finally, this is just cool!

Enjoy the weekend.

Weekly Reading List


If I say 'it was another busy week on the Internet', will you get that it is ALWAYS a busy week on the Internet?  Let's get at it then.

First, a bit of a rant from Simon Carley at StEmlyn's about the generally poor state of teaching (and use) of Clinical Skills - Does anyone use Ophthalmoscopes anymore?

Staying with a theme, gives us a great synopsis of The Value of Symptoms and Signs in the Emergent Diagnosis of Acute Coronary Syndromes. [The original paper in Resuscitation (2010) is by Richard Body, Simon Carley et al of St Emlyn's - are we getting why this is called social NETWORKING?]

Since we seem to need a refresher on H&Ps and Clinical skills, I will bring the JAMA Rational Clinical Exam Series to your attention once again. [You can access it by using the Library VPNEMLitofNote highlights the latest in the Series When Do Patients Need Blood Cultures?

Here are a few more Skill/Tool related items:

Everything you wanted to know about Capnography (ETCO2 monitors) but were afraid to ask.

The Trauma Professional reminds you that not all pts need O2 - to treat the Pt not the numbers.

Femoral lines are Dirty... or are they?

Got no IV Access, a Central Line seems excessive, and the EX-IO is out of batteries?  Try the 'Peripheral IJ' (There is Gold in the Comments here, so read the whole thing)

Compartment Syndrome is Scary, but so is the Stryker.  The cure for Fear is Education.

Ventilator-Associated Pneumonia is an ICU problem... yer not off the hook just yet - Good Care Downstairs may mean No VAP Upstairs.

I mentioned the new Anticoagulation Guidelines in this weeks Journal Club, and now the fine folks at ALiEM have updated their Paucis Verbis Card for Overanticoagulation and Supratherapeutic INR. [You can get all the PV Cards Here.] St Emlyn's has a great post reminding us why this is important - You Snooze you Ooze.

A few more gems, then I am done:

ALiEM has a new blogger, Brian Hayes PharmD (an ED Pharmacist), and he starts by debunking the Cephalosporin/Penicillin cross-reactivity myths. reminds us that COPD exacerbations can impact more than the lungs.

The Poison Review reminds us that Tylenol is not just Acetaminophen anymore.

US Physics and Knobology made ridiculously easy... mostly.

Finally, if you simply have to have more to read this weekend, the latest R&R in the FastLane is out and full of researchy goodness.


I have more, but even I am going cross-eyed.  Watch for a Special post with a Philosphical bent next week.


Featured Resource

This week I feature 2 sites I find very useful for clinical decision making and teaching.

First is MDCalc, a great online medical calculator with a primary focus on Emergency Medicine and Critical Care.  You will find it featured prominently in this site's Clinical Links Rules/Resources section.

Second is the NNT.  the NNT turns a critical and analytic eye to landmark research, reviews and meta-analyses.  In a nutshell, they evaluate each paper and then calculate a Number Neede to Treat (or Harm) for the intervention.  The Traffic Light infographic at the top of each review gives you a Go/No Go/Caution advisory about the paper's findings.  Then there is a detailed explanation of how they reached their conclusions. See how they do it all here.

They have also begun to review Diagnostic Tests (Likelihood Ratios) and Risk Assessments.

The thread connecting the 2 sites is Graham Walker (@grahamwalker) an MD/geek extraordinaire, who created both sites.  He is worth a follow on Tumblr and Twitter.

Virtual Journal Club - Evidenced Based Management of Anticoagulation



Okay, so no big trials or local research this week.  Instead a recent Review of the management of Anticoagulation and it's attendant complications.  Published in the Chest supplement on Antithrombotic Therapy and Prevention of Thrombosis, this atricle provides an 'Evidence-Based' approach to the issue.  How well the authors do at presenting a balanced approach to the Evidence is something I hope we can discuss.  In any case it appears to be the most current and authoritative recommendations on Anticoagulation and Anticoagulation-related Emergencies.

Evidence-Based Management of Anticoagulant Therapy:  Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

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