The Free Open Access Medical Education movement (#FOAMed) often focuses its attention around the hottest topics in emergency medicine. Would you use a bougie when performing a cricothyrotomy or not? What is your preferred ratio of blood products for massive blood transfusion in trauma? How do you assess response to resuscitation in septic patients? These debates rage on in the Twitterverse, and if you want in on those conversations, I heartily recommend following the Twitter feed of PHARM (Prehospital & Retrieval Medicine) podcast creator and host Minh Le Cong, MBBS (@rfdsdoc). RFDS, as all Aussies but few Americans know, stands for Royal Flying Doctor Service. Dr. Le Cong seems to run a small ICU from his plane as he covers vast swaths of the Australian bush. While passing the time on long flights, he enjoys serving as a lightening rod in the #FOAMed conversation on Twitter, bringing his extensive knowledge and experience to these debates, along with his tenacity and good humor. From high-yield pearls to frequent links to new papers, his feed is certainly a busy one. So beware: following Dr. Le Cong is akin to drinking the Twitter Kool-Aid. You will learn a lot, but once you’ve followed him, there’s no turning back.
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ACEP Now: Vol 33 – No 06 – June 2014Increasingly, emergency medicine providers are using Twitter as a tool to disseminate more traditional bread-and-butter medical knowledge, the information found in those bounded collections of pages held together with glue and thread. Ah, yes…books.
This month, there were a number of tweets that referenced “traditional” medical education that caught my eye. The first came from the feed @Master_USMLE. This account is devoted to board-review pearls found in various review books and has amassed more than 53,000 followers—many being medical students and residents. The feed mainly consists of mnemonics that you may not remember and probably don’t need to. However, you might like the occasional EM-relevant entry. One recent standout: “Vertigo differential: VOMITS: Vestibulitis, Ototoxic drugs, Ménière’s disease, Injury, Tumor, Spin (benign positional vertigo).” Not bad, but this tweet was missing something—the one cause of vertigo you simply can’t afford to miss, cerebellar stroke! I applaud using VOMITS as a mnemonic for the differential diagnosis of vertigo but made this glaring omission known in my tweeted response. Mnemonics seem to work best when the acronym of the mnemonic is in some way associated with the medical problem it is used for. Vertigo tends to causes emesis, so you’re more likely to remember it and use it. But the real reason to follow @Master_USMLE is that your medical students probably read it, and no one wants to be pimped by their students!
Rule of 50s to correct sugar: % dextrose x cc/kg=50. Adult gets D50 at 1cc/kg. Kid gets D25 at 2cc/kg. Infant gets D10 at 5cc/kg.
More Twitter-based PR for old-fashioned book learning came from Michael Stone, MD, emergency ultrasound fellowship director at Brigham & Women’s Hospital in Boston (@bedsidesono). Last month, Dr. Stone was busy tweeting a slew of high-yield pearls from his own boss, Ron Walls, MD, author of the Manual of Emergency Airway Management and chair of EM at “the Brig.” Dr. Walls’ checklist for the assessment of airway difficulty is second nature to many EM providers, but it’s always worth repeating: “Walls – LEMON. L – look externally (gestalt), E – evaluate 332 [that’s shorthand to say that in patients with “easier” airways, you should be able to fit three fingers between their incisors, the mandible length should be at least three-fingers wide, and the distance between the hyoid bone and the thyroid bone should be at least two-fingers wide], M – mallampati, O – obstruction/obesity, N – neck mobility.”
Pik Mukherji, MD, EM/IM attending at Long Island Jewish Medical Center in New Hyde Park, NY (@ercowboy), seems to bask in his role as self-appointed FOAM skeptic and is known for his rhyming Twitter profile, “Devil’s Advocate (by choice and intent), Offense (if given) Never Meant.” Dr. Mukherji also enjoys a reputation as a master educator. His points on Twitter are always succinct and relevant, like this excellent reminder for resuscitating hypoglycemic patients of all ages: “Rule of 50s to correct sugar: % dextrose x cc/kg=50. Adult gets D50 at 1cc/kg. Kid gets D25 at 2cc/kg. Infant gets D10 at 5cc/kg. #EMConf.”
The final entry for this month’s installment of “The Feed” doesn’t exactly fit the “traditional medical education” category, but it’s so good that I have to include it. From University of Maryland ED pharmacist and toxicologist and frequent Academic Life in Emergency Medicine contributor—and arguably its MVP—Bryan Hayes, PharmD (@PharmERToxGuy), comes, “The 2014 list of Oral Dosage Forms That Should Not Be Crushed. From @ismp1. http://www.ismp.org/tools/donotcrush.pdf #FOAMed.” This online PDF from the Institute of Safe Medication Practices, a nonprofit patient safety organization, contains a list of all medications that should not be crushed. For each entry, the list includes the active ingredient, the relevant formulation (tablet versus capsule, etc.), and a brief and precise reason the medication shouldn’t be crushed. Some of these are obvious and trivial (such as the advice to avoid crushing any extended-release formulation), while others are obscure yet important and downright fascinating. For example, did you know that you should never crush Cellcept (mycophenolate mofetil, an immunosuppressive agent for transplant patients) because direct exposure to the active ingredient can enhance tumor production? I sure didn’t. Insights like these are what cause so many of us to keep drinking from the endless fountain of FOAM.
Dr. Faust is an emergency-medicine resident at Mount Sinai Hospital in New York and Elmhurst Hospital Center in Queens. He tweets about #FOAMed and classical music @jeremyfaust.
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