Kane Guthrie packs all the Free Open Access Meducation highlights from the past year as he can into 30 minutes.

1. FOAM in Review
Kane Guthrie

2. FOAM from 2012
• The review:
– 189 different EMCC blogs & podcasts

3. Crowdsourcing

4. The Big FOAMed Hit’s
Of 2012

5. The Popular Ones
EMCrit DSI Best use of the Bougie

6. Thought Provokers
& Game Changers!

7. LMA in Cardiac Arrest
• Does the LMA decrease cerebral blood
flow?
• Using FOAMed to challenge the science!
http://bit.ly/XGYcv9

8. LMA in Cardiac Arrest
• They didn’t buy it!
• Used MRI to show LMA doesn’t impede
flow!
• Short paper response - rejected to
letter form
• So they used FOAMed instead!
– Blog post, videocast & podcast discussion!
http://bit.ly/XGYcv9

9. The Man who made Sepsis
NYC STOP Sepsis Collaborative

10. Sepsis in the ED
Lessons:
– Time sensitive disease - High mortality
– Needs early recognition
– AB’s & fluids within 1 hour
– Use lactate to find the cryptic cases
– Non invasive approach is effective
http://emcrit.org/severe-sepsis-
resources/

11. Ketamine or KetaMinh
Who’s using it more because of Minh?

12. Ketamine or KetaMinh
• What is it good for?
– Agitation/Aggression/Analgesia
– Procedural sedation
– Antidepressant
– Hypotensive patients
– Chronic pain
– The DSI approach

13. PCAs in the ED
• Review of 2 studies!
• Provide less-labor intensive analgesia
• Better pain scores
• Few more adverse events!
– Nausea, vomiting, pruritis
• Worth it in some painful conditions!

14. Critical Care Palliation
“When we can’t be aggressive with our
resuscitation – we need to be
aggressive with our palliation!”
http://emcrit.org/podcasts/
critical-care-palliation/

15. Critical Care Palliation
3 things never to say:
• “Do you want us to do everything?”
• “Do you want us to resuscitate her?”
• “I am so sorry, there is nothing more
we can do”
http://emcrit.org/podcasts/
critical-care-palliation/

16. Tranexamic Acid
The FOAMed world ask why we aren’t
using it?
– Its cheap!
– Its an old drug!
– But it works!
– ?prehospital drug

17. Pressure Poisoning
• Lung protective ventilation – Meta
Analysis
• Not just in ARDS!
• Lower tidal volumes = better outcomes

18. Pressure Poisoning
Start with:
• 6-8ml/kg by IBW for all intubated ED
patients
And protect those lungs!

19. Hypoxic Patient?
Needs lots of O2?
Not for Intubation?
What to do?

20. High Flow Nasal O2
http://emupdates.com/2012/03/01/the-
high-flow-nasal-cannula-in-the-
• Give ^60L/02/min
• Enable 100% 02, with 5/
PEEP
• Humidified
• Great for NFI pts
• More comfortable NIV
• Use for DSI!

21. PPI & Upper GI Bleeder!
• Face validity of using PPI’s
• 750 million per/yr USA
• Systematic R/V -Cochrane
• 2000 Pts
http://thesgem.com/2012/12/sgem-16-
ho-ho-hold-the-ppi/

22. PPI & the Upper GI Bleeder!
No difference in:
• Mortality, rebleeding, need for
surgery!
http://thesgem.com/2012/12/sgem-16-
ho-ho-hold-the-ppi/

23. The Best Tricks of the Trade!

24. Difficulty feeding the NGT tube?
• Try the SCANCRIT manoeuvre!
http://www.scancrit.com/2012/05/30/scancrit-
manoeuvre/

25. Opioid Induced Constipation =
Naloxone
• Give 2mg Naloxone PO
• Mix with lactulose/colonlytely
• Doesn’t induce opioid withdrawal!
http://blog.ercast.org/2012/02/the-constipation-manifesto/
=

26. Superglue for CVCs
• Need to secure that ART line or CVC
during a resus?
Forget this: Try this:
http://bit.ly/
Sf1sXY

27. Need to Chemically Cardiovert
SVT?

28. Combine Adenosine with the
• Use 20ml syringe
• Draw up adenosine & flush together
• Administer by fast IV push
• Doesn’t reduce effectiveness!
http://academiclifeinem.blogspot.com.au/
2012/12/trick-of-trade-combine-adenosine-
and.html

29. Nebulised Naloxone
• Worried about acute withdrawal with IV
naloxone?
• Still got some respiratory effort?
• Feel you need to do something?
• Gives “gentle & effective” reversal?
Try 2mg naloxone, 3mls saline in a neb!
http://www.thepoisonreview.com/
2013/02/01/nebulized-naloxone-in-
opiate-intoxication/

30. Stabilising Mandibular
Fractures
• Splinting mandibular dislocation/
fracture
• Easy as
• Putting them in a stiff neck collar!
http://academiclifeinem.blogspot.com.au/2012/05/trick-of-trade-stabilizing-
mandibular.html

31. A Dose of Dex
• Casey been doing it for a while!
• Cochrane then decided to agree with
him:
Benefits:
• Reduction of pain
• Early onset - 24hours
• Same Kids vs Adults
• No difference Bact vs Viral
http://broomedocs.com/2012/12/a-dose-
of-dex/

32. Ruling & Managing the
RESUS ROOM

33. Life, Limb & Sight Saving
Procedures
• Published in emj & Resus.Me
• Questions if we’re ready to perform:
– Time Critical Interventions
Highlights metacompetence:
• Ability to apply the intervention @ the right
time!
http://resusme.em.extrememember.com/?p=6707

34. The Usual State of Readiness
• Being ready to act with life-saving
maneuvers
• Managing your own catecholamine's
Being ready
• Cognitively
• Materially
http://emupdates.com/2012/09/26/the-usual-state-of-
readiness/

35. The Usual State of Readiness
1.Cognitively
• Invisible simulation
• Develop & prepare plans/scenarios in
your mind!
• Knowing what you need to know
http://emupdates.com/2012/09/26/the-usual-state-of-
readiness/

36. The Usual State of Readiness
2. Materially
• Equipment you need
• When you need it
• Where you need it
• Checking your equipment yourself!
http://emupdates.com/2012/09/26/the-usual-state-of-
readiness/

37. Mind of the Resuscitationist
• Being at the sharpest end of EM
• Making things happen
• Controlling your environment
• Science of human persuasion
• Standing like a leader

38. Owning the Airway in 2012
Been dominated by:
• From DL to VL
• To Human Factors & CRM
• & Tools and Techniques
• Then LMAs, retrogrades, bougies, & airway
aids –all through to the surgical airway!

39. The Vortex
Changing the way we approach the difficult airway

40. The Vortex
• “High stakes cognitive aid”
– Simple enough to be recalled
– Flexible enough to be use in any context
• Train staff in unanticipated difficult
airway
• Using single, simple, universally
applicable template
http://www.vortexapproach.com/Vortex_Approach/
Vortex.html

41. The FOAM Checklists

42. EMCrit Intubation

43. EM Updates Intubation

44. EMCrit Post-Intubation

45. EM Updates Asthma

46. In Summary
FOAMed in 2012 was all about:
• Airway management/devices
• Teaching us to use Checklist
• How to Rule the Resus Room
FOAMed showing how to practice
medicine in the future!

47. Questions

48. Thank-you
May the FOAM be with you!