#FOAMed Review 8th Edition

Welcome to the eighth edition of the #FOAMed Review! The idea of the FOAMed 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. Check out our indexing section #FOAMexplore which allows you to view previous #FOAMed review by edition or by selecting from CORD curriculum categories.

---

Onto the FOAMed. 

---

RSI & LARYNGOSCOPY [VIDEO]: This is a must watch for introduction to intubation in the emergency department! Concise walkthrough from positioning and pre-oxygenation to intubation medications and laryngoscopy. Also includes some nuance pearls in specific situations such as trauma and the acutely acidotic patient. Visit Seth Trueger @ MDaware for more great posts.

HIGH TENSION LACERATION REPAIR [VIDEO]: Excessive tension on a laceration during healing can affect its blood supply and lead to poor appearance. Learn trick of the trade at ALiEM with Dr. Brian Lin on transforming a V -> Y laceration for high tension repairs.

MAXILLOFACIAL EMERGENCIES [ARTICLE]: This article focuses on the emergency assessment, triage and non-specialist management of oral pain and odontogenic infections. Great read and review! Click below to check it out!

Original Article 

TRANS-ESOPHAGEAL ECHO [VIDEOCAST]: Yes you are reading this correctly. Hoping for a new age of echocardiography with the right test for the right indication. Three high quality videocasts from the masterminds at Ultrasoundpodcast. Continuous TEE during cardiac arrest! And yes this procedure is low risk! Definitely less than an intern putting in a central line!

Part 1        Part 2        Part 3

---

More FOAMed. 

Toxicologic Disorders

ACUTE COCAINE TOXICITY [BLOG]: Interesting clinical case and management of cocaine induced dysrhythmia @ Dallas EM!

Resuscitation 

A CASE FOR PROLONGED CPR [PODCAST]: This is one case presented and discussed by Scott Weingart that may make you re-consider when to stop CPR. And lytics pushed after 45 minutes @ a cath center! It couldn't get more exciting! 

Cardiovascular Disorders  

AORTIC DISSECTION [PODCAST]: Improved strategies for picking up aortic dissection early and findings you may not previously consider as 'think aortic dissection.' Given by one of a kind educator Rob Rogers. 

Traumatic Disorders  

MRI in C-spine Clearance [BLOG]: EM Nerd with yet another creative discussion, this time on the literature regarding MRI for persistent C-spine tenderness after negative CT in trauma patients. Useful? Overdiagnosis? Check out his post here.  

---

See you next week. 

#FOAMed 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. 

Figure 1 Image of the Week #2

What is the name of this clinical finding and what does it suggest?

---

Pondering. 

---

Answer.

---

Image of the Week -  Caput Medusae 

Caput Medusae is the term used to describe these tortuous veins when they become prominent on the surface of the abdomen. It is classically associated with portal hypertension and cirrhosis. 

The differential for this particular case also includes Inferior Vena Cava Obstruction (IVCO). To distinguish between Caput Medusae or IVCO, occlusion of the vein is required. If it flows towards the legs, it is Caput Medusae. If it flows towards the head, it is IVCO. 

View fullsize

How to determine blood flow in a vein

This is a stark finding and the diagnosis of cirrhosis or portal hypertension is usually not this obvious. To exclude cirrhosis, combinations of normal laboratory findings are most useful. Check out the JAMA article below that looks at clinical indicators that are useful in identifying cirrhosis in adults with suspected liver disease. 

Original Article

To see more cases like this, visit Figure 1. I encourage you to check it out and continue to work on your visual diagnosis skills!

---

#FOAMed Review 7th Edition

Welcome to the seventh edition of the #FOAMed Review! The idea of the FOAMed 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. Check out our new indexing section #FOAMexplore which allows you to view previous #FOAMed review by edition or by selecting from CORD curriculum categories.

---

Before the FOAMed...

We still want to hear from you regarding what your go to pressor is for septic shock? Click on image below to fill out 30 second poll. So far we have responses from around the world!

---

And now onto the FOAMed.

---

DIGITAL INTUBATION [VIDEO]: Learn how to perform the scalpel finger bougie cricothyrotomy with Scott Weingart at PHARM. This technique is awesome!

---

PNEUMONIA OR EFFUSION [VIDEO]: Hone your ultrasound skills with this short video on how to distinguish between consolidation and fluid on lung ultrasound. Soundtrack included. 

---

HIGH SENSITIVITY TROPONINS [PODCAST]: Are high 'analytic' sensitivity troponins better for patient care? Understand the difference between analytic sensitivity and diagnostic sensitivity as well as the debate on this controversial topic at St. Emlyns. 

---

EPISTAXIS [VIDEO]: Creative, humerous and educational video on the management of acute epistaxis that will leave you with some key nose bleed management pearls as well as a good laugh or two. 

---

More FOAMed. 

Hematologic Disorders

VON WILLEBRAND DISEASE [BLOG]: A brief run through of the most common coagulopathy that we may encounter in the ED over at Pediatric EM Morsels. 

Cardiovascular Disorders

PERICARDITIS [BLOG]: The literature for colchicine in acute pericarditis looks enticing. Take a look at the discussion of the evidence over at Rebel EM which may push you to change your management. 

Neurology

INCREASED INTRACRANIAL PRESSURE [PODCAST]: New concepts in understanding increased intracranial pressure. We like to think its all about the arteries, but maybe we should be giving the venous system a little more love. Back to the Monro Kelly Doctrine and what we have learned from studying patients with HACE (High Altitude Cerebral Edema).

Toxicologic Disorders

SALICYLATE OVERDOSE [PODCAST]: Another excellent installment from EM Basic on the diagnosis and management of salicylate overdose. This is a must listen! 

---

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. 

Vasopressors in Septic Shock! What do you use?

---

Pollster was designed to ask the big questions in emergency medicine that all practicing EM physicians/personnel want to know! The goal is to use create extremely brief surveys and utilize social media to spread the word and gather as much data as possible! We will then use this data to generate info-graphics to make interpretation of the data easy, fun and lead to generation of new discussions! Check our previous pollster on 'How do YOU Intubate.' 

This week we want  what your first choice vasopressor is for septic shock. What are you most likely to start first and when are you most likely to pull the trigger and start the vasopressor agent. 

Have a learning pearl you want to share with regards to this topic? Want to discuss a bit of nuance regarding pressor choice in septic shock? Leave it in the additional comment box, we would love to know and share it! 

---

Vasopressors in Septic Shock

---

Thank you, we look forward to all of your responses!