July 14, 2010

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... 

July 13, 2010

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 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.


  • 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.

July 12, 2010

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: