UCONN Emergency Medicine Interest Group

Posts Tagged ‘Max Falkoff’

Connecticut Toxicology – last call

In ANNOUNCEMENTS, CONNECTICUT TOXICOLOGY on March 25, 2012 at 3:13 PM

The Connecticut Toxicology project will be concluding data collection by April 1st, 2012. If you have not already, please feel free to take a look at one or more of the modules, accessible by going to the “Connecticut Toxicology” tab above and scrolling down through the choices. Please make sure to complete both the pre and post-module surveys.

Thank you,
Max Falkoff, MS4

Advertisements

Web Spotlight 2: Free Emergency Medicine Talks

In REVIEWS on February 17, 2012 at 6:18 PM

Free Emergency Medicine Talks
Summary
Format:MP3 storage site.
Author: Joe Lex of the Temple University Hospital EM program.
Audio/visual media?: yes, audio online.
Recurring features: Joe’s “pick of the week”, a single talk highlighted (you guessed it) weekly.
Why you should check it out: pretty much as much audio content as you could possibly stand to listen to, and then some, on a huge variety of topics that are well-organized by tags corresponding to the subject (e.g. critical care, endocrine emergencies, resuscitation, radiology, toxicology, wilderness medicine, etc.). The range and depth of the lectures is so broad that there’s pretty much no topic in EM that isn’t covered. Lectures and talks are generally either 30 minutes or 1 hour in length, either one-offs or as part of a collection from national/international conferences.

Connecticut Toxicology: Plant Edition

In CONNECTICUT TOXICOLOGY on February 8, 2012 at 3:34 PM

Feed me Seymour, feed me!

The latest modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These modules are all about plant life– from a general approach to their identification, to several individual poisonous or otherwise unpleasant plants. Did you ever wonder what would happen if you ate those berries that mom always told you to stay away from? Learn all about it by taking the modules! This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated.

This is also the last group of modules to be released, meaning that the Connecticut Toxicology project is now completely published and available. Please feel free to explore!

Off Service #3: Critical Care

In OFF SERVICE on February 4, 2012 at 5:19 PM

I’m in the ICU this month, where acid-base disorders are more the rule than the exception. One issue that frequently comes up is metabolic acidoses and the specter of mixed acid-base disorders looming its ugly head. I feel this topic is frequently made overly complex, and thus ends up being ignored, when figuring it out is really not that complicated. I think this is because of the delta gap, or in Dr. Henry’s words, the “delta-delta”:

Delta-delta = (measured anion gap from labs – normal anion gap)/(normal HCO3 – measured HCO3 from labs) = (measured anion gap from labs – 12)/(24 – measured HCO3 from labs)

I think this equation gets easily confused because of the fact that the calculation involves subtraction in the denominator. Since I am not particularly facile at math at the drop of a hat (or at least, not with an ICU team as my audience), I will outline the very simple way that I have reasoned how to determine if a mixed acid-base disorder is present, in a way that should be easy to remember:

In the setting of an INCREASED anion gap metabolic acidosis (AKA an anion gap metabolic acidosis):

If there is an additional METABOLIC ALKALOSIS…

HCO3 is HIGHER than it should be, therefore…
The denominator is SMALLER, therefore…
The delta-delta is BIGGER, and…
If the delta-delta > 2, there is an increased anion gap metabolic acidosis AND a metabolic alkalosis.

If there is an additional NON-ANION GAP METABOLIC ACIDOSIS…

HCO3 is LOWER than it should be, therefore…
The denominator is BIGGER, therefore…
The delta-delta is SMALLER, and…
If the delta-delta < 1, there is an increased anion gap metabolic acidosis AND a non-anion gap metabolic acidosis.

For a more comprehensive discussion, see this selective project created by a UCONN student here.

Why should you care? Well, particularly if you are resuscitating with large volumes of normal saline (which contains a lot of chloride), the pH may not give a full indication of what is going on with the patient, and you may make changes in your management accordingly. For instance, you might want to switch to Lactated Ringers as your IV fluid.

Click below to see a BONUS section on patients with hypoalbuminemia, and how not to miss metabolic disturbances in this population!

Read the rest of this entry »

Connecticut Toxicology: Mushroom, Mushroom!

In CONNECTICUT TOXICOLOGY on January 10, 2012 at 2:40 PM

The last modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These modules are all about mushrooms- the basic process that a mycologist uses to identify them, and several species of poisonous¬† mushrooms that you really want to know. This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated. The modules will eventually also be released in podcast form; however, due to computer issues, this will be somewhat delayed. Check them out!

Connecticut Toxicology: Marine Edition

In CONNECTICUT TOXICOLOGY on December 30, 2011 at 9:05 PM

The newest 2 modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These 2 modules are marine in theme, with one module on jellyfish, and the other on stingrays. This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated. The modules also come in podcast form, meaning that you can download them as MP3 files and listen to them on your iPod, or whatever other MP3 player or smartphone you might own on the go. Check it out!

Connecticut Toxicology: Snake, Snake, it’s a Snaaaaake!

In CONNECTICUT TOXICOLOGY on December 23, 2011 at 5:51 PM

HISSSSSSSSSSSS….. The next module of Connecticut Toxicology has been released! Access it by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. This latest module is about the two venomous snake species that live in Connecticut- do you know what they are? This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated.

Book Review: Emergency Radiology – Case Studies

In REVIEWS on December 17, 2011 at 8:37 PM

This review is for the book Emergency Radiology: Case Studies, by David Schwartz, which can be purchased here. The reviewer has received no financial renumeration for this review.

I read this book prior to and during my radiology rotation to improve my knowledge about radiology specifically relevant to EM. There are several other books dedicated to this topic, but I felt this one struck the best balance between brevity and comprehensiveness. I felt that this case-based emergency radiology text was extremely helpful and well-written.

The text of the book is 559 pages. It is divided into 7 sections: chest X-ray, abdominal X-ray, upper and lower extremity X-ray, C-spine X-ray, head CT, and facial X-ray. Each section has a number of cases which serve to illustrate a particular point. The majority of the material presented was based on plain films, which I felt was appropriate, given that these are the most likely films that an emergency physician will have to interpret before the official radiologist reading; the exception to this is the section on head CT, which is, of course, a very important modality for EPs to be facile with. Notably, many of the cases describe initially missed findings by the radiologist, the emergency physician, or both, which resulted in a bounceback or other adverse outcome. The cases are also mostly not obvious- the book specifically addresses many more subtle findings that would and are often easily missed if they are not specifically looked for, such as hidden infiltrates on CXR, soft tissue swelling as a marker for fractures, and stroke mimics. Thus, the book definitely goes beyond the introductory level, and would very likely be a valuable read even to an experienced emergency medicine resident or attending.

Strengths of the book included the very clear writing style by a single author, excellent quality and quantity of images (there is nothing, in my opinion, more frustrating than trying to learn from terrible quality images), focus on radiology that is critical in EM, level of detail, and range of material presented. Weaknesses included omission of some topics that probably would be helpful (eg. hip dislocation), and general lack of ultrasound (although I understand that this is more of a conventional radiography book). In the end, I would definitely recommend this book.

Overall score (out of 5 stars):

Connecticut Toxicology: Creepy-Crawly Edition!

In CONNECTICUT TOXICOLOGY on December 9, 2011 at 9:12 AM

The first 2 modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These 2 modules are creepy-crawly-themed, with one module on the poisonous spider that lives in Connecticut, and the other on those pesky stinging bees, wasps, and hornets (AKA Hymenoptera, for those who are more Latinate-inclined). This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated. The modules also come in podcast form, meaning that you can download them as MP3 files and listen to them on your iPod, or whatever other MP3 player or smartphone you might own on the go. Check it out!

Web Spotlight 1: Life in the Fast Lane

In REVIEWS on November 27, 2011 at 3:57 PM

This is the first in a new series of posts highlighting some of the best online-based EM resources that can be found. Many of these are already present in the Links section, but this series is designed to give a little more information and guidance on what is out there, with a reduction in the risk of “information overload”. So, without further ado, here we go!

Life in the Fast Lane
Summary
Format: multiauthor blog.
Authors: a group of primarily Australasian emergency physicians and intensivists. Lead authors are Mike Cadogan and Chris Nickson.
Audio/visual media?: yes, although primarily just images.
Recurring features: links to current literature of interest, clinical cases (with special series on toxicology and EKG cases), rapid Q&A based explorations of topics of interest (e.g. noninvasive ventilation), and (sometimes questionable) humor.
Why you should check it out: virtually a one-stop shop for EM education needs. Very connected to other sites as well, so you will learn more about what it out there. The recurring series are excellent, especially the Q&A based cases and overviews of interesting topics, as they give you a chance to think about the answer before actually seeing it, and can be read through in just a couple of minutes. The EKG cases are great, and while are more advanced than what we are getting in medical school, are very accessible by the writing style. One very minor point to note is that given the authors are primarily from Australia and New Zealand, there may be some slight differences in drug names/drugs used (e.g. suxamethonium vs. succinylcholine), spellings, and scope of practice (for example, it appears that there are rural GPs in Australia that seem to be able to do virtually anything) but I have not to date found this to be a significant issue.

%d bloggers like this: