What a wonderful (IT) world

Last night I lay comfortably in my bed, not being able to sleep. I plugged the miniature headphones to my Android and listened to Scott Weingart's EMCrit podcasts on treating the severe asthma patient. After that Amal Mattu's EM Cast about a 2 year old lethargic child with fever and that's when I Mr. Mattu started to echo and I found my self drifting away into the world of jumping sheep.

Earlier this week I was asked to have a short clinical case for my colleges in the hospital and as preparation time was essentially none I picked three excellent 5-minute videos from HQMedEd, all presenting a clinical scenario where the ultrasound in the ED saved the patients life (walkin and talkin!). I had even prepared to show Vanderbuilt's ultrasound video collection to show my ED colleges that learning to use ultrasound in year 2010 doesn't require an expensive international course - just a comfortable sofa with your laptop/mobile and some interest in the field!

Then, preparing for an exam next week - the insanely great Lifeinthefastlane has provided me with invaluable texts on everything I ever wanted to know about ECG, arrhythmias, electrolyte disorders (and other lab-abberancies), intoxications and ED medicines like Magnesium in acute asthma. It's so much more than just a blog. Of course I have my dear Tintinalli resting quietly in the book-shelf, just in case - but LITFL has simply provided me with everything I need to know. It's a true emergency medicine website; written by emergency physicians for emergency physicians - just the facts. The cream of the cake. The brass of the music.
With all this knowledge at the top of my cortex I was prepared for that unconscious patient the other day presenting with a new LBBB which I correctly diagnosed as hyper-K induced. After some insulin+glucose, a new ECG revealed a normal sinus rythm and a resource-draining trip to the angio-lab was spared.


And I haven't told you all the useful things I've learned by reading through my RSS subscriptions... oh my oh my...

Saint's triad

An interesting little thing to remind us of the possibility that a patient can have more than one diagnosis at presentation - something every emergency physician should be aware of! Saint's triad is the simultaneous diagnosis of cholelithiasis, hiatal hernia and diverticulitis:

Saint's triad is named after the British surgeon Prof C.F.M.Saint, the term's eponym, who established the first school of surgery in South Africa. He emphasized the importance of considering the possibility of multiple separate diseases in a patient whenever his or her history and the results of the physical examination were atypical of any single condition.[1] Traditionally, there is thought to be no pathophysiological basis for the coexistence of these three diseases. Saint emphasized that more than one disease may be responsible for a patient's clinical signs and symptoms, and his Triad provides a counterexample to the commonly used diagnostic principle that "the explanation of any phenomenon should make as few assumptions as possible," also known as Occam's Razor .[2] The principle underlying Saint's triad is also expressed as Hickam's dictum.

Source: Wikipedia

New high-quality website for EM video lectures

Almost every week I stumble upon a new medical website but very few of them ever reach my bookmark collection. In a shower of information (over)flow I only keep new links if the website can dramatically affect my medical learning progress. http://www.hqmeded.com is definitely one of these.

I haven't found an "about" section so I am not sure who exactly is behind this or what their goal is but the emergency department of Hennepin County Medical Center (Minneapolis) has their signature in the footer. It's a emergency physician made site for emergency physicians - it just cannot go wrong!

HqMedEd delivers various videos from a broad range of topics, mostly pertaining to the use of ultrasound for making the diagnosis down in the ED. Spotting a mitralis stenosis on parasternal long view to diagnose the 31 year old pregnant female coming in with acute heart failure is pretty awesome. Seeing thrombosis in the bifurcation of a lady with limb pain is a bulls eye. It's the age of the ultrasound and this site is *the* candy store for EPs interested in the topic. You might ask what is special with HqMedEd's videos since there already are lots of video sites out there... well these are special indeed. Not only are they free but also they are ultra short (3-4minutes), yet concise and informative. The authors have obviously trained their performance since they are very straight to the point and non-hesitating which is a rarity in the world of online video lectures.

Their videos are mostly stored on Youtube so I went to their channel there since it's a little easire to browse
 http://www.youtube.com/user/hqmeded
There I found also some very interesting (a little longer but still compact) learning modules, for example a tutorial on the complete FAST scan and the procedure of cricothyroidectomy.

If we go back to the website there is a "lectures" tab which - just as implied - lists a very impressive collection of video lectures like acid-base disorders, cardiovascular drug toxicity- and treatments to mention a few. The videos are set up so that you see both the slides and the speaker (a mini USC essentials format) and so makes you feel much more as sitting right there in the auditorium.

The link collection tab cannot go unmentioned, they have very good links to ultrasound websites amongst others, many of which I hadn't seen before.


All in all, a most impressive and amazing website containing videos with short and compact yet highly yielding learning material. I am very glad to see more video sites for emergency physicians, it is completely changing our medical education (meducation!) landscape and I think we will see more and more of this development in the future.

Subscribe to clinical pearls

There are all kinds of pearls floating around on the ocean floor of the Internet but we want those that are so tiny small that we can read them at a glance but still feel like full like after a Christmas evening meal. So small actually that we can have them as email. Luckily for us there are colleges out there who think the same and have made these pearls.

Here are my all time favorites, the ones I've hanged on to:

• Educational Pearls from University of Maryland School of Medicine
  Since 2007 the Maryland EPs (and again Amal Mattu is on-board, amazing how all the best EM stuff on the Net in the end winds up to Mr. Mattu!) have made one daily clinical pearl for a broad selection of EM topics. Short as skirts, information-packed as a sunny italian beach - it's a joy to be a subscriber to. And if you as me start the subscription but feel like you've missed out - you can even browse through their archives. Amazing work and will most likely go to the history books!
• EMedHome
  This is a respectable website with great emergency physicians onboard such as Peter Rosen and Amal Mattu just to mention a few. Not surprisingly then their content is of highest quality. EMedHome is actually a multi-functional website with podcasts and full text articles on updates on hot emergency medicine topics and you can read more about them in my resources list.
  As a member you can have emailed to you daily clinical question (with answer) and weekly clinical pearl, the last one I got was about 3 critical ECG features to differentiate anterior ischemia from posterior MI, a real case we had just days ago!

When I started this blogpost I thought I would be mentioning at least 5-6 of various sources. After digging trough my previous and current subscriptions I found some of my subscriptions are more like packed newsletters (like Journal Watch's high quality journal updates or Medscape's various and detailed daily/weekly email subscriptions) than tiny clinical pearls.

So email pearls aren't so many after all but my preference is quality, not quantity. My inbox is as fragile as my cornea and everything that goes into it is there for a good reason. Email overload drains your energy faster than the Krebs cycle. That's why RSS is an extraordinary solution and I am amazed so often I find out my colleges don't what what it is. Try to see RSS as "passive email", something that doesn't require your immediate attention but waits for you until you are ready. Like a newspaper actually - after all your RSS list is a compilation of headlines from all your favorite sources like blogs, newsletters or even academic journals. RSS is as essential to surviving the 21th century information overload as a pocket knife is in the jungle of Amazon. Lifeinthefastlane has an excellent article, "RSS for dummies" worth checking out.

Here are my favorite RSS clinical pearls:

• Michelle Lin has a wonderful "tricks of the trade" series on her blog with pearls that you can immediately take home to your clinical work.
• If you accept Q/A form as a clinical pearl, a few Detroit EPs have made this fantastic blog with a weekly clinical question which then i answered a few days later. They even accept answers with email and have a score board for you to tickle you ambitions. The questions are very applicable.

This will be all folks. They aren't many but they sure are good. Please let me know if you have any more to add to this list!

Video learning in emergency medicine

"He who opens a school door, closes a prison"
(Victor Hugo (1802-1885) French poet, dramatist and novelist)

Education is everything. It is the sole reason I have started this blog. IT is making education reachable to everywhere and everyone. Physicians already have access to the worlds best medical libraries through excellent textbooks and hospital libraries but they are slow to browse and search and limited to physical locations or availability. The IT revolution is made of many small revolutions. With the advent of sites such as Youtube and TED talks, multimedia education is one of these we are facing right now.

Emergency medicine has a lot of great multimedia sites today. It all started with the podcast revolution but we are seeing more of lectures coming online in the form of videos. If a picture says 1000 words you can imagine how many words a video tells. I would like to tell you about some of my recent discoveries as I believe these will significantly change the way we will learn emergency medicine in the future.


It all started with my Google-ing of common topics like anticholinergic intoxicity, hyperkalemia and general ED scenarios. Some sites came up again and again and, ending up in my bookmark collection and I remember Free emergency talks being one of the first ones. I started really liking some lecturers - names at that time completely unknown to me (except for Billy Mallone who has visited my ED in Reykjavik/Iceland on a several occasions). Amal Mattu, Joe Lex, Stuart Swadron... Actually listening to Amal Mattu's cardiology updates was a life changing experience for me, emergency medicine-wise at least! Never before had I realized the importance of learning from the viewpoint of emergency medicine. After all it is we emergency physicians who are the filters of the hospital, the gatekeepers, the ones who decide if patients go in, out or somewhere between. Why should we bother ourselves about the abyss of chronic a-fib treatment options when our role is to stabilize and admit the a-fib patient who comes in hypotensive and tachycardic! Surely we don't care about the 100+ differential diagnosis of hyponatremia when the most important issues for us is how to manage those who have seizured and have a suspected central pontine myelinolysis?! Well for me as an emergency physician in Scandinavia where EM is a young specialty, this truly was an eye opener. EPs in USA, Canada, Australia and UK have been there already but maybe your seniors will remember those days when your specialty was young.

So I started browsing the Internet to find the sources of all these excellent lecture givers. For weeks I stumbled upon new sites and I came to realize there was a whole lot of things going on digitally in the emergency medicine Web 2.0 community. I found great blogs, podcast sites, EM:Rap... check my list of primary emergency medicine resources (the most popular post yet according to the statistics of my blog) for the review of these. My style of learning emergency medicine was changed forever! This post is focusing on video learning so I will not write more about my "weeks of wow!" but to make a long story short, there were video containing websites I repeatedly got back to. This turns the scope to a college who has changed our way of learning emergency medicine.
It turns out most (almost all!) of them are the product of a genius, an emergency physician the medical society will someday make a statue of (or at least a special hat!). Let me introduce Mel Herbert (click link for a short video about his work), the Australian emergency physsie (I guess they say it like that down there) now practicing in USC, San Francisco. Although he is involved in some of the lectures himself, his contribution most importantly is that of making the lectures digital and putting them online in an easily accessible format. As an all-digitalized physician my self I know the huge amount of work he must have put into this. In addition to all this he also manages to give birth to a monthly EM:Rap session - yet one of his amazing creations. So let me introduce to you Mel's offsprings and what they will do for you!

USC Essentials

$450/year, $98/year for residents.
I guess most of US emergency physicians have heard about this great conference which runs annually (since 2001?) on the West coast with lecturers and attending guests coming from all around the US. Their lectures are straight-to-point, appropriately short and very practical. One session at the USC Essentials and you are as much up-to-date as you possible can be, perhaps only second to ACEPs annual scientific assembly. There is the USC essentials main course but they have spiced the conference with subdomains such as ECG reading (Amal Mattu onboard!), trauma, ultrasound and orthopedics to mention a few. Check out the menu on their website and you'll get a grasp of the content, there are even a few free lectures online for you to peek in your nose and sniff a few molecules of the Essentials atmosphere.
This was the first site I stumbled upon and I am still browsing trough their archives and my jaw is simply stuck on the floor. Corey Slovis' short and tactile approach to hyper- and hypokalemia, Tom Mailhot's two minute ultrasound examination of the patient in PEA (shock), Amal Mattu's cardiology updates and the legendary Greg Henry (former ACEP president) on medical malpractice... this is heaven for emergency physicians!

Emergency medicine Core content

$299/year, various discounts for residents/students.
At USC they have a weekly residency conference where residents, attendings and even consultants give lectures on common ED topics. As expected their approach is a little different to the more "sexy" USC Essentials - they cover more of the basics, all the differentials (even the rare ones), background physiology etc. Also, Core content has something USC Essentials hasn't - audience discussions and dialogs from which I have learned invaluable pearls of wisdom. Especially as they have excellent physicians such as Billy Malone and Stuart Swadron unwinding wisdom from their years of ED experience, like mature and aged volcanoes spewing hot and molten lava high up in the air!

All LA

Free!
The little brother to EM Core Content, these are from the Los Angeles EM resident conferences. The lectures are of no less quality but they are not as many. Just as Core content hey cover very interesting (and practical) topics such as valvular emergencies, trauma and pediatric emergencies - specially I like the panel discussions such as this one where their faculty discusses ACS therapy, PE diagnosis & PERC rule, beta-blockers in ACS and much more. Occasionally they have guest appearances from USC so for free you can view some of their great lecture givers such as Stuart Swadron and the USC chief residents whose lectures I have watched with admiration on the Core Content site.
If you want to try out using video lectures for free, this is a highly recommended site to try out.

EM:Rap TV

Free!
Yet another Mel product, this is a bit like EM:Rap but in video format. Short, concise videos from all corners of emergency medicine;  Mel reviewing the literature, guest appearances teaching common ED procedures, IT news... I see it as an entertaining TV station for emergency physicians, with bits of valuable educative pearls popped in every now and then.
So that's what I have found from Mel B's chocolate factory but there are other sites out there which I have to mention too.

CME download

One time $350 subscription.
Backed by The Center for Medical Education which is a 30+ years old foundation, this is no small project. It has a collection of 2.000+ video lectures from some 30+ different conferences, many of which I have never heard of and others which sound really exciting (like "Virtual procedures", "Airway and sedation" and "Expedition & Wilderness Medicine Conference"). There are some big ones there like the National Emergency Medicine Board Review which I would really love to delve into some day as it's educational value must be humongous. You can see a list of their courses right here.
Unfortunately I haven't had the time to review this one either but only from seeing the frontpage of their website, this must be an excellent library of educational videos. Considering the one-time price of $300 it certainly is a bargain too. Hopefully someday I will be back with a post about CME Download.

Others

• EMedHome is worth mentioning since they have high quality emergency physicians on board such as Amal Mattu. They have a few videos on board but those are not whole length lectures as those above and limited to special clinical findings such as an ultrasound diagnosis or examination of an Achilles tendon rupture. They seem to have started with online lectures but I can only find three of these so I assume they decided to focus on their database of excellent articles and podcasts which I hope to review some time in the future.
• Besides this, there are the usual videos at Youtube but they differ enormously in quality as there are thousands of medical videos there. My approach has been to create an account and playlists where I save those videos I want to keep, mainly ED procedures as viewing the video is so more effective than reading the textbooks. There are also some nice channels (kind of playlists other users have done) you can subscribe to. This is material for a later post.
• BMJs educational videos are an honorable mention and need no introduction since they have been around for years (some of them are available on Youtube). Then there are many many ultrasound websites out there. For all those smaller video resources (and actually video webs in general) I'd like to point out an excellent article the Life in the fast lane dudes have published.

That was all folks, the top video sites for emergency physicians in autumn 2010. I hope you have got at least a minuscule of the excitement I have for this revolutionary education form we are witnessing right in our back-yard. Obviously there are great varieties of the video format and how they are presented on websites but when it comes down to it all, it is the lecture and the lecturer who are the most important. I remember the names of the great lecturers more than the websites I saw them on as well as the content of their lectures. Therefore I am really excited to know if ACEP's scientific assembly lectures will ever come online, that would be *the* ultimate thing. I have made several Google attempts to find out if these exist but without success, yet.

Streaming video technology is just a platform for bringing that good and old style of teaching to our computer. The technology breakthrough is that you don't have to be away from your family for days or pay lots of dollars for attending the conferences but instead have it in your laptop at the comfort of your sofa, in your mobile phone while commuting or in the gym or just on your desktop PC at work. You can view it whenever you like, making use of the various "dead time gaps" found in your daily life. You can pause the video if you are suddenly interrupted to continue later and you can even adjust the playback speed at your needs to maximize the use of your time. This is simply THE most amazing way of e-learning.

To finish this off I would to point to a wonderful TEDs talk about the impact of video education.

Crocodoc- for your PDF collection

An electronic (paperless) office is key to success in a world overloaded with information. Using the data cloud you can have it accessible at all times and everywhere - at home, at work and even from your smartphone while commuting. For a doctor who is keen to constantly learn more and stay up-to-date, a mobile office is it. Actually a mobile office is much more than putting away the papers, it's also the concept of having your office tools at hand, everywhere and anytime. Contacts, calendar, email, chat... the list goes on. I will soon bring you a big and juicy post about my personal configuration which I have developed for years. For now I will tell you about one particular part of my e-office, how I manage my PDF documents.

For most documents (images, text files, notes...) I use Google docs and actually Google apps is the base for my e-office. Although Google docs can store PDF files and has a very nice online viewer there is a crucial tool missing, the ability to highlight text and write notes.

Every doctor has a collection of memorable journal articles which they have read thoroughly and want to keep for future reference. If you are as me you strive to have all reference books in electronic format. Some will be accessible online (Rosens Emergency Medicine is available online at MdConsult for example) only but others downloadable as PDF files. Just as you've dried a few kilos of marker pens while doing your stud med years you will want to highlight your PDF collection as well. There are nice applications for this, my favorite one being the free and excellent Foxit pdf reader. But it's not an online web-application (actually, it is a "desktop application") and so doesn't fit into my mobile/online office configuration. I don't want to install it on the 10-15 different computers I have access to at work and then move the PDF files between work/home/wherever-I-am... you must see it will end with a disaster.

Earlier this summer an amazing web application appeared on my radar for which I have fallen in love with. The name is Crocodoc. With a (free) login you can upload your PDF file and store it on their server for later access. It can even take an address of a web page and convert it to PDF. Once you got it there it will open up in a special viewer where you have all the highlighting and commenting tools you ever need. Now you will start to understand why I'd love to have Tintinallis Emergency medicine in a PDF file!

And so, my real physical office is completely free of papers and I can access my PDF collection from anywhere, with my highlights and comments just as I had wished for. An amazing tool!

While we are at it there is another online web-application I'd like to mention which works with PDF files. PDF escape is the only online PDF app I am aware of that allows you to upload a PDF file and then edit it's text content and fill in forms. I have used it a lot to erase patient IDs from ECGs I want to keep. It's free and let's hope it stays free.

I would be surprised if Google doesn't advance it's PDF features in the very future, making Google Docs the ultimate office tool. Actually I really hope so since I want to have as much as possible in one place.

Discussion forum for emergency physicians - hot or not?

I guess most of you have participated in some kind of discussion forum as there are thousands of them out there. They are a convenient form of communicating with other internet travellers. The discussions are archived so that you can browse or search through earlier topics and usually you can see more information about the other users on the forum. This is to compare with an early invention of the Internet - the good and old (email) postlists which are still pretty common today. I still remember a trauma postlist I was a member of. It had very interesting discussions, for example the classical one about whether or not to insert a needle into the 2nd intraclavicular space in traumatic cardiac arrest. Having the  most eager trauma specialists of the world on board meant it was a heated but professional discussion. This level of activity has never been reached in a good emergency medicine forum.

Well forums in general maybe don't have a good reputation as well intended and professional arguments tend to be killed in the end by emotional havoc, leaving the forum participants angry and irrational (since we are talking arguments, there is one that is so funny it will unwind your intestines... Monty Pythons argument clinic!). Then there are those that only want to stir up emotions, the net trolls. Still there are quality forums out there and it seems that the longer they have lived the better they get, probably as the members get to know each other better.

So I have often wondered why on earth we emergency physicians have not got a decent forum for our community? Almost every day I have a question of some kind and am burning to have it answered; a ECG riddle, clinical decision point or whatever. Every now and then I wonder "how do they do this in other countries" as comparing treatments between continents often has it's interesting pearls of wisdom. In my emergency department in Lund (Sweden) we are a very young specialty and we are very commonly hitting the walls of other specialties. So often I would like to learn from the experience of my colleges abroad who have been there and know how particular obstacles were solved. A common discussion forum is a perfect place for this.

I have to mention BMJs very interesting experiment, they have a recently launched sub-site called Doc2Doc which has the goal of "connecting doctors worldwide". It is the best try I have seen yet and they seem to be aware of the net troll problem as only doctors can register and each and every registration is processed manually. Which means they actually check if you are a legitimate doctor in your country. Impressive! There are lots of features within Doc2Doc such as the ability to start your own blog in there - all in all it is a light weight social networking site like for example Facebook - but for doctors only. I did try this out and must say I am impressed but I have not touched it for a while now as I was overloaded by information that I did not need. I am only interested in emergency medicine, the best training centers for GPs in UK or treating acromegaly surgically or medically does not touch me at all. And so I put it on ice but I will be keeping my eye on this interesting experiment.

Besides that, there are several websites having the same idea and I will not delve into them here since I have not found any with an active EM group. It all comes down to one point - we want it simple and familiar. We don't have the time or energy to try out yet another website which may or may not be worth our time. Doctors are really lazy and impatient when it comes to getting to know new websites. Then there are already thousands of passwords and web addresses we have to remember at work and every new login to remember has to be for a very good reason.

So what about the social networking sites we already know, have a login with and are familiar with? Facebook, Google groups and LinkedIn are the ones everyone knows and all of them have tools for easily creating a discussion group. Most of us already have a login at some of these sites and starting a forum for emergency physicians is really easy to do. I did a quick search of "emergency medicine" in all of these sites and well there were a few hits but none of them very active or rich of members.

I must say, I really don't understand why someone in our tech-savvy EM group hasn't been there and done this. Now that the technology is there, easier then ever before and completely free - it makes me wonder if there is some other hindrance? Could it be that physicians are shy to share their thoughts in front of colleges? Or afraid of revealing some gap in their medical knowledge? Or just find new technologies scary? I really don't know! What do you think?

Video-learn 20-50% faster!

I just love sucking in every new gadget, website or tip that allows me to learn emergency medicine faster than ever before. I believe e-learning is the field where we have gained the most from information technology and as such I believe that in year 2010 we are much better (informed) doctors than only 10 years ago.

I have recently discovered the wonderful world of video lectures in emergency medicine and it turns out there is amazing quality stuff out there which I plan to summarize very soon in a special blog post. It is just amazing to be able to sit in my living room or other convenient places and watch lectures about aorta dissection, ECG in pulmonary embolism etc. - just as if I was there. Never before have I wished as much to have consiptation - an excuse to sit in the WC with my Android all day long! As said, I will be back with those video sites but first this one small tip which will speed up your video watching by 20-50%.

VLC player is an amazing (free) software which has the goal of "playing everything you hit it with". It is not the prettiest but it a Swiss army knife of video players. I recently discovered a "play speed" feature which to my amazement worked just perfect since usually the audio will be too distorted to enjoy. This very probably can be done on other video players as well but I like VLC's way of allowing you to fine tune the playback speed, it's not only in steps of 50%, 150%, 200% etc but everything there between.
Then you can even jump back and forth through the video with keyboard shortcuts, making jumps in steps of a second, 3 secs, 10 sec or whatever you like. With this level of controls at your fingertips it is easy to step back when you feel you missed out some important part of the lecture. Also a great tool when you want to re-watch some lecture you have seen before for the sake of understanding it better.


This little tip has made it much easier for me to browse through my collection of 2-300 of amazing emergency medicine lectures I want to digest in the winter months (totalling to about 150 hours of video!).

Using the RSS power of Blogger (Blogspot)

RSS is THE technology to stay up to date in the blogsphere. Here is a quick tip for you bloggers out there who want to use RSS to the extreme.
Everyone knows that all new posts can be subscribed to by the general RSS feed. The path to this feed is easy to find from the "subscribe to posts" link which for my blog is:
 http://pricelesselectricalactivity.blogspot.com/feeds/posts/default

In Blogger settings you can prefer to have an email sent whenever a new comment is written. You might want to have it in your RSS reader instead - or even create a gadget to stream it in some custom way, the possibilities are endless. The path to the RSS comments feed is:
 http://pricelesselectricalactivity.blogspot.com/feeds/comments/default

or if you want to watch comments for a specific post:
http://pricelesselectricalactivity.blogspot.com/feeds/6234880912964361746/comments/default
Those numbers there are the postID, which is a unique identification number for each individual post and is found in the address bar when you edit the post (actually you can also find your blog ID in the very same address).

Blogger and Blogspot are to the user the same though under the hood, Blogger is a free publishing platform, while Blogspot is a free domain service provider. If you are craving for the details you can read more about it here.

In some blogs you may get overloaded with posts that you do not care about at all and you just want to read about a particular subject. Say, for example, that you only want to subscribe to my IT-tips which I tag specifically. Well it turns out that Blogger can actually give you feeds by tags, you only need to dig up the URL which is well hidden under the turf. The URL then is:
 http://www.blogger.com/feeds/[yourblogID]/posts/[feedType]/-/[labelName]

Hmm that wasn't as easy! Well you know already how to find the [yourblogID] from the adress bar and to make it simple we use "summary" for [feedType].  So a RSS feed for my IT-tips would be:
  http://www.blogger.com/feeds/2248583521093048479/posts/summary/-/it-tips



OK that's all. There are many more options for your RSS feeds such as how much text they should include, how many items etc. and if you want to dwell into this there is more to read right here:
http://www.bloggerbuster.com/2007/09/all-about-blog-feeds-part-1.html

Non-surgical causes of abdominal pain

I have come to the conclusion that emergency medicine surely must be one of the most difficult specialties in medicine. We are the the only gate-keepers to the hospital and it is our decision if the person walking in to the ER is sick or not and then if there actually is anything with that symptom that needs follow-up. Amal Mattu in his excellent ECG course has often pointed this out with regards to ECG interpretation - it is the emergency physician, not the cardiologist, who will pick up the pathologic pattern before disaster happens. Take Brugada and Wellens as an example. Treating the patient is not the difficult part, ruling in and ruling out is.

So every now and then I like to read about the not-so-common diseases which just might pass through my ER and I am responsible for reacting on. Abdominal pain is one of those traps where delay in diagnosis can cause misery to the patient. If it isn't appendicitis, cholecystitis or diverticulitis I try to strain my brain cells and think twice before deciding what to do with the patient. Often it's just back to basics and so it was a joy to stumble upon this great article from BMJs medical student journal:

Non-surgical causes of abdominal pain
It will help you think broader next time you have that abdominalia that simply doesn't fit into the common disease patterns. Tabes dorsalis, lead toxicity, porphyria... oh common don't tell me you already had these on your ddx list!

What's the date?

Commonly I look over the shoulders of my colleges and see them taking unnecessarily many steps to do simple things. One such is the task of finding out what date it is.
Everyone knows how to find the clock, it's located in either bottom or top right corner on most modern computers. Well what you maybe didn't know is that if you take your mouse pointer and move it over that clock, the date will pop up instantly (don't click the mouse, just move it there).

That's all folks!

The candy is just around the corner...

They say if you're a blogger you have to post regularly. I am not sure I can agree since writing under pressure for my part never has produced any good results. On the other hand I can understand you folks want to have the candy coming if you are to stay here. Well hang on tight, the best parts are already being written but being a tad obsessive compulsive you will not see them until I feel they are good (I just love that feature of Blogspot where you can save posts as draft and publish when they are ready - it's so easy to draft your ideas then!).

As I see in my statistics that guests to the blog are on the increase I felt I should at least tell you what you are about to see...

• I have been diggin into what video web sites are available to us and comparing them. Out of necessity since I've promised my colleges back in my ER to have them an access to the best one for the coming winter. USC essentials, CME download, LA all, EM:Rap tv... we will see who is the big winner.
• I am still digging deeper into my new Android and finding out how it can be used at work.
• The first IT tip is on it's way.
• A big site of "my most used EM resources" is being written with reference to blogs, web sites, journals, podcasts, videos and most of online material you need as an EM physician.
• I plan to review all those resources and currently have occupied my self with dwelling into blogs of colleges, yes - just your blog might be the first one! Actually the first review is out - although a little shallow.
• I am writing a comprehensive text about my method of e-learning, describing some tools and tricks of the trade I have applied trough my years as an EM physician.
• One post is about "asking clinical questions"; how to use the online databases to ask clear-cut and precise questions like "should my patient with previous MI have his ASA set out now that he has stable GI bleeding?"

Also I have putting my previous website programming experience into use and messing around with the CSS file of my blog. Just see these nice shadow effects on the title (not surprisingly, Internet Explorer doesn't support this) and voila - no borders around the images (easier said than done!).

As an Icelander, almost Swede even, my biggest problem is to coordinate my brain cells to write common-language-english. Being the OCD type I can not publish text unless I feel it's been cleaned from terrible typing [t]errors or grammatical mothballs. So you just wait folks, soon the candy will be floating all over!!

Stumbled upon: Anatomy.tv

Every physician has his/her own preference of *primary sources*. By that I mean websites, journals, blogs etc. they read the most, usually the ones they open up over the first cup of coffee in the morning. It's impossible to check all those medical sites out there as there are thousands of them and growing by every day.

But having this zone of comfortability also has some disadvantages as many doctors feel they don't need to use other sites. They feel they get enough of information from the ones they are currently using and don't see the point in trying out the new ones. Our senior colleges are a prime example - the ones who just hate the Web 2.0 revolution. Well it might work for some time but eventually they will stagnate. We all remember how beta blockers suddenly became state-of-art treatment module for heart failure. We just got blinded by old habits.

I really like to watch over the shoulders of my colleges and see what their primary sources are. Today I got to know an incredible website that somehow just has passed my radar all those years. I just couldn't believe it since it's the best I've seen in its field - basic human anatomy. The site is anatomy.tv. It's one hell of a site, presenting the human body not only in 3D but in layers so that you can easily find that structure you want to know more about. Perfect for orthopedics with its endless ligaments and muscle insertions you just love to forget. It has videos providing details such as functions of muscles. It has a special window to compare an MRI image to the anatomical view. You can click the MRI to see details of every small structure and it even has some clinical info. I haven't had the time to check the details but it's a "seeing is believing" kind of site. Definitely worth checking out.

Collaborative editing

Are you still use Microsoft Word for editing documents? Are you emailing them to colleges for review or further editing? Are you having a headache because of all the various revisions and total loss of oversight of your documents? If you just answered yes, you've totally missed the IT train. And wasting time and energy.

Collaborative editing is the concept of viewing/editing document which is kept on an online server (this is cloud computing at its best). Having a document online has many priveleges like

• you can access your documents anytime from anywhere; throw your floppies, throw your USB sticks
• you can invite others to view or even edit the document, also from anywhere
• you never ever have to worry about backups
• most servers will allow revision history which allows you to look back and see how that document looked like, say 6 months ago

Google docs (Google is sooooo much more than Gmail and web search!) is one of many different collaborative editors out there. It has many advanced features, actually so many that I've replaced my MS Office setup completely and all my documents now exist in Google Docs. I will very probably write a seperate post about this some day, more than one, since Google docs is a revolution for it self. The main drawback using Google docs is that invited editors require a Google account for accessing the document to be edited and I don't have the time or energy to persuade my colleges to convert to Google (as much as I'd wanted it). Sometimes there's these small documents I want to share and edit collaboratively and I want minimal effort.
Actually Google wave (which was just closed down) was the ultimate collaborative editing tool and many have said it was years ahead of the world.
Let me introduce to you Titanpad. In short, you create a text document online without having to login. The link (URL) then is the key and you keep it in a good place. You don't need to save or do anything other than just keeping the link. You can then exit your browser and enter that link at home and voila, you're editing the same document. Send the link to your friends by email and voila they're instantly editing your document.

This is all but man isn't it beautiful - can't you already see the endless possibilites!!! Try it out - here is a short document I just created:
http://titanpad.com/QjcpOFGQxL

My first steps in the world of Android

Five years ago I was one of the first to buy a smartphone as I had spotted many possibilities for using at work, having all medical textbooks on a small electronical device being just one of these. With the Iphone evolution everyone now has a smartphone and I am amazed at those still anchoring their pockets with kilos of textbooks.
Being fan of everything open-source (and Google actually) I was excited about Android already from the beginning. It's incredible sales numbers ("200.000 Android units sold each day") and ever increasing user base witness a new coming OS that might just swipe away competitors. And it's happening for a reason. This monster is Google based and as such has a huge group of experienced engineers and programmers which are original, grass root computer nerds and just love making good better. Also Android is "open source" and is it's core component is made of Linux. This means everyone can see the underlying code and make changes and updates as necessary and so thousands and thousands of programmers of the world are working to make Android better every minute. The perfect OS for quick and robust updates, huge database of applications and lot's of options to customize and improve to my own preference.

So this week I grabbed a Samsung Galaxy i9000. As expected it's an amazing device and has functions I had never imagined to see in a "telephone". Like walking around in my neighborhood and seeing on my phone what houses are for sale and at what price ("Layar" app, video below) - even what people in those houses have just recently Twittered (or Buzzed - that's Google's uprising social web)! What now remains to be discovered is how to apply all this technology to real life situations and work. My first impression is that I've just had an indispensable tool for improving my "Get things done" lifestyle (to be blogged later!); using otherwise wasted minutes for production and creativity, automatizing the boring parts in my life and improving efficiency in general. Until then, the feeling is a "Welcome to the Matrix" one!

Layar app in action:

Wikipedia read out to speech

The Internet-revolution has brought the most awesome tools to my fingertips making my life more fun and efficient in every aspect. There are a few exceptions though, one being a smooth and sexy text to speech conversion tool. All those great Wikipedia articles just waiting to be read with enthusiasism but there just isn't enough time. And then there's all this time riding the bike, jogging, sitting the bus... pretty much wasted time unless you're a huge fan of that not so silent background clutter. You get the point. Wouldn't it be perfect if Wikipedia could be read out loud, even saved to an audio file to enlighten your ears later on?

Pediaphon just entered my radar and gave me some extrasystoles as I have been waiting for something like this for years.

Well... it was a short walk in the park and after 2 minutes I gave up. That lady reading out the text sounded flat, bored and urinary incontinent at the same time - just as if in the peak of her middle life crises. It's more of a reminder of that our technology wonders are still only binary and we have yet to enter the age of artificial intelligence.

I place my bids on Google though, they seem to have something up in their arms that just might be the next breathtaker. If you take a closer look at Google translate you will se a small speaker icon at the side to the translated text which when clicked on will read aloud the text with some pretty good human tone. But enter some paragraphs of text and the option is gone. Is this the beginning of something? I will be keeping an eye on it... 

My primary resources: Institutions and societies

This is a subpage from my Primary Resources page where I iterate all the most important (online) resources for emergency physicians to learn and stay updated in their field.

Knowing the major institutions is essential for getting familiar to the world of EM since only then you will know how to select your journals, conferences and even favorite lecturers. The Wikipedia entry on emergency medicine will help you pick on with it's short history of EM and current practice, also AAEM has a very informative reading on the history of EM in USA.

• ACEP: American College of Emergency Physicians
  THE headquarters in USA, founded in 1968 and has 25.000 members. They run the mother of all EM conferences, the annual ACEP's scientific assembly.
• AAEM: American Academy of Emergency Medicine
  Restricts its membership to board certified specialists in emergency medicine.
• CCME: The Center for Medical Education
  "Next to ACEP, it is believed that CCME is the largest provider of emergency medicine CME in US. Providing its subscribers and course participants with a variety of state-of-the-art continuing medical education resources" (...)
  See an overview of CCME courses here.
• EuSem: European Society for Emergency Medicine
  The biggest EM assocation in Europe. Publishers of EJEM. In alternate years a congress is organised in collaboration with AAEM and referred to as ‘Mediterranean Congress of Emergency Medicine’. In the even years, the congress is co-organised by the national emergency medicine society of the country it is held in and referred to as ‘European Congress on Emergency Medicine’.

While we are speaking of the history of EM, there is one particular lecture I would really like to recommend for all EPs, new and old in this world. It is a mindblowing talk about the early days of EM and how everything started; from the need of stopping killing patients by inexperienced and untrained residents - almost medical students - in the cellars of the hospitals. The 'emergency rooms' other specialities didn't want to know about and would not by any means want to stick their feet into.
This conference is from the All LA Conference website and can be watched or listened to for free:

 Peter Rosen: Reflections on 40 Years of Emergency Medicine

My primary resources: Stayin' alive

This is a subpage from my Primary Resources page where I iterate all the most important (online) resources for emergency physicians to learn and stay updated in their field.

Academic journals

Only 10 years ago you would only read textbooks and journals to learn and stay uptodate and that would do it. As we all know, things have changed completely but we must remember that the primary source of our knowledge stems from the academics and as such, journals will always prevail whatever technological advances we will see.  These are mainly US/European based journals as I haven't had the time to check out the Canadian/Australian counterparts which I believe are of no less quality.

• Annals of emergency medicine
  Published since 1972 by ACEP, one of the primary academic journals. The annals folks also make a podcast after publication of each monthly journal, very much appreciated!
• The journal of emergency medicine
  "JEM, published eight times per year, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine."
• The American Journal of Emergency Medicine
  "Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions."
• European Journal of Emergency Medicine (EJEM)
  Published bimonthly since 1994 by EuSem.
• BMJ Emergency medicine journal
  "Is an international peer review journal covering pre-hospital and hospital emergency medicine, and critical care. The journal publishes original research, reviews and evidence based articles on resuscitation, major trauma, minor injuries, acute cardiology, acute paediatrics, toxicology, toxinology, disasters, medical imaging, audit, teaching and reflections on clinical practice. The journal is aimed at doctors, nurses, paramedics and ambulance staff."
• Scandinavian Journal of Trauma and Resuscitation (SJTREM)
  Since 1994, affiliated with 9 more societies involved in trauma, resuscitation, and emergency medicine in Scandinavia: "Peer-reviewed, international journal directed at all health professionals involved in pre- and in-hospital emergency medicine, critical care and trauma management".

Special mention:

• Journal Watch: Emergency medicine
  Edited by no other than Ron Walls (Harvard expert in airway management, amongst others) this online "journal" just has to be good. In short, JW is a group of doctors continuously reviewing the medical literature and handing out 'the cream of the cake' to the individual group of specialties. Registration is free and provides you with an email subscription, ensuring you will never ever miss the breakthrough articles or matter of importance to you as an EP.

Blogs, podcasts & vodcasts

Blogs are the modern newspapers. Written by individuals with passion rather than staff hired to produce. A blog is not started to earn money but rather to spread out a message or teachings the author believes others can have use of. A blog also provides a great platform for direct feedback with the author and a great opportunity to reach out to colleges all around the world.
With thousands of eyes in the Social network constantly online, scanning and reading the blogosphere's offsprings, a serious blogger concerned about his or her reputation will write with meticulous care for the quality and reliability of the content. And just as in any sports field, those who stand out will gain increasing popularity and stand out. In that way I have tended to seek material produced by specific authors rather than blogs or websites and that is how personal favorites like Weingart, Swadron and Mattu have taught me more in EM than many of my university teachers.

The field of EM is rich of enthusiastic bloggers and indeed it has been said that EM physicians are the most active bloggers in medicine. Wether true or not, this is definitely a field you have to know of.

There are lots of blogs out there but these are the ones I have tended to come back to repeatedly and stacked in my RSS reader:

• Life in the fast lane (Mike Cadogan, Chris Nickson and others, Australia)
  "Emergency medicine, sports medicine, toxicology and clinical medicine written by Australian physicians".
  This site is so much more than just a blog. Great articles on everything related to EM wether be interesting cases, basic review of major topics or news of important updates. The LITFL guys are true IT-nerds making the most of modern IT tools on their website providing for things like their incredible databases on EM-everthying; bloggers, Twitterers, podcasts etc. They have handbooks on ECG, toxicology, ICU drugs amongst others. They tell you about EPs doing music in their freetime. All this with the always gay and Australian humor, cheers mate!
• Resus.me (Cliff Reid, Australia)
  An EP working in the prehospital field sharing his reading of the academic EM journals, reading his blog is all you need if you want to be first to know what's happening new in the world of resuscitation, prehospital transport etc. Using his own words, "No more relying on what you learned in Advanced Life Support Courses! This is for the specialist in resuscitation. Over 40 journals as well as sources of national and international guidelines are scanned as they appear to make sure you don’t miss out on what you need to know to save lives!"
• Emergency Medicine Forum (Charlene B. Irvin, Detroit)
  Excellent choice of clinical cases, guided by the author with emphasis on the EM approach.
• Keeping Up! (Clay Smith, Jim Fiecht)
  "Keeping Up is the premier resource for Emergency Medicine physicians who are looking for an easy way to stay current with the latest literature in the specialty. Vanderbilt Emergency Medicine invites you to join hosts as they tackle articles from around the globe"
• Academic Life in Emergency Medicine (Michelle Lin, San Francisco)
  Very readable and informative blog from the west coast covering IT in medicine, clinical tips and EM education. The cream of her blog is the "Paucis verbis"; incredibly handy short lists on topics you have to know on the ER dance floor. Seeing is believing!
• The central line (various ACEP physicians)
  "Hosted by ACEP, this site will include the opinions, ideas and experiences of emergency physicians".
• Emergency Medicine Ireland (Andy Neill, Ireland)
  Andy is a great ranter and I find every post of his a joy even when the subject is boring. When reading his blog I feel like I am having a coffe-break and listening to someone passionate and dedicated to know everything there is to know about EM and being able to communicate this in a summarized and  entertaining way. I really hope one day I will meet Andy in person though I suspect my irish college will accept no less then a beer to talk over!
• EMCrit Blog (Scott Weingart, New York)
  Dr Scott is a highly respected EP who in only one year has earned a reputation as one of the best lecturers in the field with his amazing podcasts. Not surprisingly he won the "Best Medical Weblog of 2010" awards. Scott's motto is "bringing upstairs care downstairs" meaning that you as a EP should also be able to practice ICU care in your ED. Scott has amazing teaching talents being able to overwhelm you with information and pearls yet in a concise and understandable format.
• Free emergency medicine talks (Joe Lex)
  "Created by residents of the Temple University Hospital Emergency Medicine program to help distribute the vast Emergency Medicine lecture library of Dr. Joe Lex.". I just couldn't believe my eyes when I stumbled upon this site. It has a huge collection of the best EM lectures for free - Amal Mattu, Billy Malon, Corey Slovis - it's just A-Team for free!!!
• Annals of Emergency Medicine monthly podcast (USA)
  It just what it says. Amazing work!

Video/audio only

Many of the blogs mentioned above include podcasts and videocasts either predominantly or as a dessert to their main meals. Here below I will iterate those websites dedicated to audio/video presentations. Also check out my special post about video/audio education in emergency medicine, this is just the rough list:

• hqmeded.com (Hennepin County Medical Center, Minneapolis)
  A collection of excellent videos covering mostly ultrasound application in the ED but also other exciting topics. They are ultra-short, yet concise - you can watch them over your cup of coffee and feel packed of "take home points".
• USC Essentials
  Huge video collection from the USC essential conference held 1x/year on the west coast.
• Emergency medicine Core content
  From the USC residents' grand rounds. Basic topics of EM with live feedback from attendings like Stuart Swadron sitting in the audience.
• All LA (free)
  High quality lectures from the resident conference in LA, since it's free it is a great site to try out before you step up to the big brothers EM Core Content and USC Essentials.
• CME download
  Here you will find all video and PDF material from the above mentioned CCME. It basically covers most of the major EM courses run in the US.

EM:rap

EM:Rap needs a special category since it's a blog, podcast- and TV station all in one place. It is founded by afore mentioned CCME:

"Established in 2001, Emergency Medicine: Reviews and Perspective (otherwise known as EM:RAP) provides its 4000+ monthly audio subscribers with a 2.5-hour, topic-based in-depth presentation in an easy listening format. Founded by Mel Herbert and co-hosted by Stuart Swadron, these two senior faculty at the University of Southern California’s Emergency Medicine residency include in their program information from leading edge conferences, excerpts from grand rounds presentations at a number of major universities, case conferences and interviews with EM newsmakers."
I can only tell my personal opinion which is that EM:Rap is *the* ultimate resource for the EP. The EM:Rap episodes will make you as up-to-date as you can possibly be by bringing up hot topics, fresh from all the big conferences. Not only do they discuss these topics but also mix in the speakers them selves in form of interviews or audio clips from the lectures. Since every podcast includes a quick review of everything discussed in the form of a short PDF file, you can just sit back and relax and enjoy the podcast without taking notes or worry that you missed out something important. EM:Rap covers basically anything that is to interest to the EP wether it be clinical updates, procedures, medicolegal or gadgets... you simply can't afford to miss out such valuable information.
EM:Rap started out in the standard newsletter form but recently has expanded to various subsites and projects. EM:Rap is the biggest of them all, the aforementioned audio (podcast) based site and requires subscription. EM:Rap tv has some of the EM:rap content and some extras added in video format - and it's for free. And then there is the EM:Rap project which is just like a russian Matryoshka - it just unwinds more sites as you start browsing it.

Newsletters

• The Practice Journal for Emergency
  "Our mission is to provide our approximately 33,000 readers with practical, hands-on clinical information that is directly relevant to emergency and urgent care practice."
  This is a real gem, it's content is more clinically related than the ones below and it has earned it's place as one of my top prioritized EM resources - the ones I search primarily whenever I want a good overview article or detailed text on some EM topic. Try for example their excellent article series on RUSH - Rapid Ultrasound in the Shock patient, it's free and it's written by USC Essentials' Tom Mailhot amongst others (the guy who feels like a boy in a candy store while at work!).
• Emergency physicians monthly
  "Emergency Physicians Monthly (EPM) is the independent publication for emergency physicians, written by and for the docs in the trenches." (...)
  This one has my 5 stars, their articles just seem to hit that "exactly!" part of your amygdala, topics you just wish you could discuss with your colleges like patients calling you at night, silly rules for the sake of "patient security" etc... you'll love it!
• Emedhome
  "Launched in February 2000, EMedHome was created by an independent Emergency Physician. EMedHome.com's mission is to provide a user-friendly clinical resource that is designed to be the premier educational website for Emergency Physicians."
• Emergency Medicine news
  Covering general trends and issues within the field.
• Emergency physicians international
  A comprehensive newsletter serving EPs all around the world with news of ongoing matters. It started in 2010 and so I haven't had time to dig in thoroughly but what I've seen is very promising.

Postlists, forums

• University of Maryland School of Medicine: Educational pearls
  Sometimes you just want to have small, random tips and tricks sent to your home, like that "17-18% of cases of syncope are attributable to arrhythmias". You had forgot it and you never would have looked it up but it will help you on your next shift. The Maryland pearls are sent to your email once per day but also viewable in the archive. And they have got Amal Mattu on board. These pearls are not to be missed!

Unfortunately I have not seen any good EM forums out there, yet. If they are out there somewhere I will find them. And let you know!

My primary Resources: Back to basics

This is a subpage from my Primary Resources page where I iterate all the most important (online) resources for emergency physicians to learn and stay updated in their field.

Textbooks and reference

In emergency medicine there are two 'bibles' you will oftenly see referals to, they are indeed the holy wisdom of the wise grandfathers of EM:

• Tintinalli's emergency medicine
  For the enthusiastic EP, reading Tintinallis is like reading an epic fantasy novel. It's a beauty right from the beginning and you will want to read it all over a night. An online version is available through Kindle but costs a king's ransom. Kindle does though offer some options having had me consider seriously buying this version like synchronised bookmarking and highlighting. Lacking a trial version though I am not ready to throw $160 at something I might not like or use after all.
• Rosen's emergency medicine
  In no way inferior to Tintinalli's and actually growing on me since it's available for online reading through a free account at MdConsult.

Another textbook worth mentioning, especially since it's available online and for free even:

• Merck manual
  Although I prefer reading texts written by EPs for EPs, Merck is of such quality that I have used it as an reference when I need to dig into the complex maze of diseases and entities in internal medicine. Not the best for quick reference but detailed texts and tables makes it the best to read while you have plenty of time.

Good review articles are always worth reading when going back to the basics and you most probably are already using the major journals like BMJ and JAMA. My blogosphere and social network makes sure I don't miss the most important ones.

• American Academy of Family Physicians (AAFP)
  Is worth mentioning though, a great journal from our colleges serving our patients before and after the ED. AAFP has many excellent review articles and updates on conditions we commonly see in the ED but need not intubate.
• FPNotebook
  Speaking of general practice... FPNotebook may be old design but it's content is being updated regularly and has a very practible approach to the clinical entities as you can click trough iterated lists and quick info to find just that piece of diagnostic information you need, bedside. Take anemia as an example, oh those are the lab tests you need for ddx and oh these are the possibilities with microcytic anemia and things to consider for ddx. Lite but handy.

With the rise of the Internet, some new sources have come to the scene as fierce competitors to the classical textbooks.

• Medscape's Emedicine
  Is one of my favorites. Almost every single condition you will ever see in your ED, described in a well written and concise yet detailed text with standardised chapters (intro, presentation, diagnosis, treatment...) makes it a joy to read and easy to find what you are looking for, even bedside to your patient.
  Unfortunately, the fact that most topics are written by MDs of the other specialities rather than EPs often makes me even more hungry for information than when I started reading. More often I will open my good and old Tintinalli for 'the wise words of the grandfathers' - those with years of experience from the floor, working with EM patients in the ED.

And then there are the EBM sites, growing more and more every year. I have found it impossible to hold count on them all and will save this for a later blogpost on it's own. I rarely find the EBM sites really useful besides answering a specific question about a clinical scenario or subcondition. Surely bound to be very powerful but in the end I find my self doing a quick search through the major guidelines instead.

• UpToDate
  Is a bit different as it's topics cover whole conditions rather than specific questions. Obviously great work here it's wide span is also it's biggest drawback since even simple queries will yield an abundance of results, making it difficult to find that particular answer you were after. Really good though for detailed and updated texts on diseases and conditions. Because it requires a paid subscription and there are so many good alternatives, UpToDate has not had me, yet at least.

Last but definitely not least is a project which developed off the idea of using the power of crowdsourcing (using wiki) to collect links to all resources there are out there and store in a categorised format.

• Wikiemerg
  is exactly this and was started in 2011 and is funded by the University of British Columbia (UBC) and thus has potential to become one of the big sites. You will find all EM topics in an easily searchable format and within each of these a list of links to all the most important resources to read like landmark articles, texts, blogposts etc.

Not EM but worth mentioning:

• Wikipedia
  Wikipedia content is getting better every week and I totally disagree with those saying it's inferior quality. It's the layman's version of medicine, excellent for getting the outline and introduction to complex diseases. With the ever growing Medical project there are even stricter guidelines for authors to write medical pages on Wikipedia.
  Wikipedia is so much more than wiki, for example they have highly advanced templates to categorize the world's topics into tabular form (look at the bottom of the documents). Try the antithrombotic chapter as an example - never before has it been so easy to see the grouping of these bastard medicines and how they interconnect.
• ECG pedia
  My all time favorite reference site for ECG patterns. It's a wiki and it's edited by cardiologists only so expect quality stuff.
• Radiopedia
  A huge database for radiological cases with detailed descriptions and tips for e-learning.

My primary resources in emergency medicine

Emergency medicine (EM) spans all specialties within medicine and as such requires the doctor to 'know a little bit of everything'. As such the reading material is huge and not easy for the new emergency physician (EP) to find the most appropriate reading for each and every clinical topic. The patient in the ED requires a totally different approach than in other settings like in the GP's office or admitted, thus the EP commonly has more practical use of text written by other EPs rather then those of other specialties. Until recently the choice has been rather easy as there are the two "bibles" of EM; Tintinalli's and Rosen´s textbooks of emergency medicine. With the advent of Internet and recently social-media, blogs, tweets, podcasts and even video material is becoming more important since it is completely up-to-date whereas textbooks are rewritten only every 5-10 years. Certainly the times they are changing.

My style of learning and keeping up-to-date involves using online and electronic resources. Every now and then I speed through a chosen chapter in the two bibles mentioned above but increasingly commonly I end up reading some excellent texts online. On this page I want to share with you my experiences and most valuable links to these online resources.

Because of their total size, I have seperated my resources post into three seperate subpages:

Back to basics
Here I iterate the resources you will need for going back to the years of medical school and first years. The online versions of the thick and heavy textbooks, lengthy guidelines and such. Resources you will even use as your references, even bedside or on the run. Be familiar with them and they will save your butt on your next difficult case.

Stayin' alive
Being uptodate is a skill just as important and difficult as getting passed the first years in residency. Here I will mention the most important blogs, podcast and vodcast sites etc. for you to stay uptodate in a fashionable manner. The overwhelming storm of information today will not decease by any means, either you get painfully hit by it like a snow hail or you learn how to enjoy it and inhale it professionally!

Institutions and societies
Maybe the boring part but still the neccessary ones to know. You are not the only EP in the world, there are big societies and institutions having their important messages and sayings and as an active EP you must be aware of these. This page will help you out.



Other link collections
If you're still hungry for more (how is that possible?!) here are other great collections I have found:

• A great link collection from the EM physicians in Chattanooga
• Life in the fast lane's detailed list of EM bloggers