Common cold or apocalyptic strain?

Sometimes you can learn something even though its common. So make sure you're educated before you "educate" patients.


Away on holiday... sort of.

We haven't disappeared from the FOAM world but have been on hiatus for education and holiday reasons. Happy new year to all our readers!
Singhealth has been actively involved in EM and disaster medicine in the region for decades. Not only are Singapore doctors sent on relief missions but also for educational outreach in non disaster times. Here are a few photos from a recent trip to give our perspective to Nepal EM docs, nurses and administrators on pre-hospital and hospital disaster management.
On a personal note, it was heartening to go back to Kathmandu and its environs as the last time I was there was during the Nepal earthquake and much has improved both socially and preparedness wise.

Group discussion and pre-presentation work 
Outdoor hospital prep
Triage table tops

Field team bag preparation 
How to moulage for excercises

Team presentation on their preparedness plans

The "dreaded" assessment - can't have learning without it!

Group pic

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.