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.
Explore This IssueACEP Now: Vol 33 – No 06 – June 2014
Increasingly, 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.”