Webucation 22/10/17

This edition of web wisdom encompasses mythbusting in trauma and radiology. Also a tour de force in dissections and finally a must hear podcast if you work in medicine at any level - all about UTIs. 
The last podcast will stun you. not because its a sexy topic but maybe because it will make you remember the relevant issues in a most common presentation. Test yourself - do you know how to handle UTIs?

Ortho damage control

Nice vid on damage control surgery from the orthopaedic standpoint. Dr Ebraheim's other educational videos can be found here.

Don't over-complicate it

Good reminder (for some this may be new!) on overuse of an important test. Thanks to Journalwatch for this read.

Daniel J. Pallin, MD, MPH Reviewing Torres J et al., Am J Emerg Med 2017 May 26;
Even with selection bias and inclusion of injection drug users, this single-center study found that only 7% of blood cultures in admitted patients were positive.
Blood cultures are positive in about 4% of all comers with cellulitis. In a prospective, observational, single-center study, researchers assessed the rate of positive blood cultures in admitted patients with skin and soft tissue infections, and in the subsets with injection drug use or fever. Importantly, the investigators did not determine who would undergo blood cultures.
Of 246 admitted patients with skin infection, 86 (35%) had blood cultures, and 7.0% of cultures were positive. Among the 29 blood-cultured patients who were febrile, 3.5% had positive blood cultures. Of 101 admitted patients who were injection drug users, 46% had blood cultures, and of these, 8.7% were positive.
This study is difficult to interpret because the investigators did not determine who underwent blood cultures, and it is likely that sicker patients were the ones who did; moreover, inclusion of only admitted patients enriched the sample for sicker patients. Therefore, the results represent upper limits for blood culture positivity.
Blood cultures should never be done for patients with uncomplicated cellulitis, whether admitted or not, and fever is not an indication. For admitted patients with cellulitis and injection drug use, blood cultures may be a reasonable option. Don't forget that cellulitis complicating lymphedema often results in bacteremia, and cultures are indicated in this group. Of course, blood cultures are indicated for septic patients and those with suspected necrotizing soft-tissue infection.

Webucation 30/8/17

Webucation this time comes from subjects encompassing departmental ethos, paediatric and adult trauma, ECG dilemmas and even TED talk skills. As always credit to the original content creators. Do visit their sites.
The last 2 links are worth the listen on your way home or on a jog. They describe and portend resuscitation at its best when elements align. Both talks show what can be if we get the heady mix of training, tech and guts right.

Cantor being candid

Richard Cantor is one of the gems in paediatric EM talks. His candour combined with raw experience are always at the forefront. His lessons just may prolong your career and a little one's life.

Kudos to a course well done

Most workshops will leave you with some valuable skills and insight. Plus you meet like minded people from all over the world!
To that effect, I highly recommend the APELSO Hong Kong ECMO course. Run by staff from Queen Mary/Grantham hospitals, it was exemplary in demystifying and deciphering everything extra-corporeal. Just like the excellent Reanimate, this course combines didactics, simulation and practical exercises but lasted for 5 days rather than 2. Here's some pics taken with permission. 

Dr Thomas Mueller's (Regensburg, Germany)
take on ECPR

Full circuit with dedicated Apps for simulating monitors

Veno-Arterial circuit with reperfusion cannula 

Scenarios were realistic and focused on basics of troubleshooting

They even brought in fluroscopy in the sims
Transportation sim for interhospital transfers on circuit 

Live action mannequin for the sims - can't get more fidelity than that

Cannulation combined with nursing and CPR team

You can sign up for more courses like this here if interested in ECLS.

Shocking updates

  1. New look for the website. Have been experimenting with some designs lately so apologies for changing look.
  2. We'll have a few more posts from new contributors to this site. So stay tuned for more radiology quizzes and resident perspectives.
  3. To add to our guides on common ED drugs and ventilation, here is an easy to use guide on Shock. The jpg is below and the pdf is also downloadable from our guides page

Feel free to use / print / spread.