MORE SMACC GOLD with Dr Steve McGloughlin – The Dying Traveller

Dr Steve McGloughlin is a great speaker. He used to work with me at RFDS Cairns when he was still a registrar so it was great catching up with him since his transition to being a consultant at the esteemed Alfred hospital in Melbourne!

Filed under: Emergency medicine and critical care, FOAMEd, Interviews of interesting people, SMACCGOLD Tagged: dying-traveller, SMACCGOLD, steve-mcgloughlin

#FOAM Review 4th edition


Welcome to the fourth edition of the #FOAM Review! The idea of the FOAM review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Each review will include highlights from the highest yield blog, podcast, video and web sources around. Over a year's span we will be sure to include topics from all core EM content areas...even the ones that may not be the coolest. Look out for the #FOAM review curriculum and indexing page in the next few weeks as we continue to update the website! 


BUT FIRST A QUICK TANGENT! If you haven't already, let us know what is YOUR 'go to' tool and meds for the standard intubation! Click on image to the left and share your practice with the world! We will publish interactive info-graphic next week with the results!


INTUBATION CHECKLISTS [MULTIMODAL]: We intubate in the emergency room daily. and often encounter the difficult airway. Do you use a checklist/algorithm for when @$!^@ hits the fan? Check out some approaches from experts below: 

ANKLE-BRACHIAL INDEX [VIDEO/BLOG]: Patient presenting with a cold leg? Oh and by the way, they mention they have diabetes, HTN and 40 pack year smoking history. You should probably check their pulses, or an ABI if you can't palpate anything. High yield video on the technique here and excellent pocket resource regarding acute limb ischemia on ALiEM. 


POCUS IN SOB [BLOG]: POCUS for respiratory complaints may improved likelihood of diagnosis at 4 hours but does it improve patient outcomes? Read two different posts from St. Emlyns & EM Literature of Note on the recent Lancet article regarding POCUS in patients with respiratory symptoms. Or get in on the twitter discussion here

Original Article: Point-of-Care Ultrasonography in Patients Admitted With Respiratory Symptoms: a Single-Blind, Randomised Controlled Trial

LATRODECTUS ANTIVENOM: [BLOG]: The RAVE-II study is out in the Annals of EM may be practice changing. We enjoyed the succinct review at EBM Wild. Read it for yourself


Original Article: Randomized Controlled Trial of Intravenous Antivenom Versus Placebo for Latrodectism

More FOAMed.


MANAGEMENT OF DOG BITES [BLOG]: Do we still need to allow dog bites to heal by secondary intention? Should antibiotic prophylaxis be standard of care? Take a look at the evidence at Rebel EM. 


FLUID MANAGEMENT [PODCAST]: There has been quite a bit of talk regarding maintaining the glycocalyx during fluid resuscitation. Listen to the SMACC lecture by Jeremy Cohen, hosted on The Intensive Care Network, and think about what your strategy should be.


VERTIGO [PODCAST]: The HINTS exam is your friend when a patient presents with vertiginous symptoms. Tips to distinguish between central and peripheral etiology at The Washington University Emergency Medicine Journal Club. 


BURNS [BLOG]: Step by step breakdown on key questions you need to answer about major burn management at LITFL. Minor burns need love too so check out the bottom line need to know at Don't Forget the Bubbles. 

See you next week.


#FOAM review is brought to you by Michael Macias. If you want to recommend content you think should be added to our curriculum, send me an email, I would love to hear from you. 


How Electronic Health Records Sabotage Care

Our new information overlords bring many benefits to patient care.  No, really, they do.  I’m sure you can come up with one or two aspects of patient  safety improved by modern health information technology.  However, it’s been difficult to demonstrate benefits associated with electronic health records in terms of patient-oriented outcomes because, as we are all well aware, many EHRs inadvertently detract from efficient processes of care.

However, while we intuitively recognize the failings of EHRs, there is still work to be done in cataloguing these errors.  To that end, this study is a review of 100 consecutive closed patient safety investigations in the Veterans Health Administration relating to information technology.  The authors reviewed each case narrative in detail, and divided the errors up into sociotechnical classification of EHR implementation and use.  Unsurprisingly, the most common failures of EHRs are related to failures to provide the correct information in the correct context.  Following that, again, unsurprisingly, were simple software malfunctions and misbehaviors.  Full accounting and examples are provided in Table 2:

Yes, EHRs – the solution to, and cause of, all our problems.

“An analysis of electronic health record-related patient safety concerns”