I was up at 4 to catch the start of Essentials 2012 in Los Vegas @ home. For those who don’t know Essentials of Emergency Medicine is a four-day emergency medicine conference run by Mel Herbert and the good people from EMRAP.
Now as you would expect from the EMRAP team this is succinct, punchy, super relevant 5, 10, 15 minute talks about what we really want to know on the floor at work in an ED, and they make it available online.
It’s pretty cheap for residents / RMOs at $170 USD or $206 NZD, and $850 USD or $1100 NZD for consultants you get to go to an excellent international emergency medicine conference, not have to leave your partner or family, and not have a carbon foot print the size of New Zealand flying there. And you will be up to date with (almost) everything you need to pass exams and more importantly to be a good doctor for your patients. For the consultants of course it’s easy CPD points.
Technology is still trying to keep up with these boys and girls who are pushing the international education envelope and we lost the stream several times today but some of the high lights for me:
- As always there are some funny videos: idiot tries to break the ice on his swimming pool with his butt
- Medical therapy for priapism doesn’t work (don’t know what does work yet as we lost the stream after the intro – but I think it involves big needles)
- Neutropenic patients
- No fever -> no blood cultures, home.
- Fever -> blood cultures, antibiotics, admit
- Abdo pain, fever: may be Typhlitis = neutropaenic enterocolitis = surgical emergency -> CT abdo and urgent surgical consult
- Tumour lysis syndrome: never sticks in my head because I’ve never seen one (or have never recognised one). Usually seen in the first 5 days of oncology treatment, but can also occur in untreated cancers. High cell turn over causes hyperuricaemia, hyperphosphataemia and renal failure with hypercalcaemia. Mx: treat hyperK, fluids +++, cardiac monitoring, correct other electrolyte abnormalities (but treat hyperPO4 before giving Ca2+), needs ICU bed and repeat electrolytes q 4-6 hours
- ACE inhibitor induced angioedema. Give 2-3 units of FFP and watch very carefully, if progressive of tongue swelling intubate early.
- Penetrating foot injuries. If nail has gone through eg rubber soled shoe go hunting for imbedded rubber. Tetanus booster if due. No prophylactic antibiotics. If still sore in a week: MRI and probable operative exploration.
- Mobile Health: phone based patient education / motivation / reminders. Phone ownership high across all racial and socioeconomic groups. eg one program to educate young mums sends out an education snippet three times a week. As some of you will know I’m a meditation junky … and yes, there is an app for that eg Mindfulness TS
- Then there was a 2 hours session on the finer points of ECGs that we need to know: how do you tell early repolarisation from STEMI. Early repol:
- In V1-V4,
- There will usually be sharp deflection after the J point in V4 (“Fish hook”),
- Other than the fish-hook the J point should be a gentle curve into an upwardly concave (smiley face) ST elevation. If you see this it is early repol or hypothermia.
- A sharp, almost right angle J point is more suggestive of STEMI
- Early repol will not have reciprocal ST depression in other leads.