Clinical Posts and Updates

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Warfarin Nomogram, 5mg Infective Endocarditis Guideline ED Referral Form
Warfarin Nomogram, 10mg Medical Clearance for Psychiatry Illness Affecting Work/Travel
Acetaminophen Nomogram Skin & Soft Tissue Infections Form 4 (Mental Health)
Code MI Meds UTI Guidelines Form 5 (Mental Health)
COPD Antibiotics PHC Antibiogram 2011 Early Pregnancy Assessment Clinic (EPAC)
Acute Heart Failure Pathway PE Algorithm Early Response Concussion Service Referral Form (
Asthma Adult Pathway Peak Flow Adult Male Peak Flow Adult Female
Asthma Peds Pathway Peak Flow Children Stroke Pathway
CAP pathway Sepsis Protocol 2012 Trauma Guidelines
CAP Abx Guideline Appendicitis Protocol

Surge Policy

Urgent Spine Imaging Guidelines


Rapid Access Clinic Patient Info (IM, Derm, Neuro)

Blood and Body Fluid Exposure

Non-Occupational PEP (NPEP) Algorithm NPEP Fact Sheet
Post Exposure Prophylaxis (PEP) Poster HIV Risk Assessment

Rules/ Resources

Ottawa Ankle Rule Ottawa Knee Rule Peak Flow Calculator
Canadian CT Head Rule Canadian C-Spine Rule Nexus C-Spine Rule
Well's DVT Criteria Well's PE Criteria PERC Rule
CURB 65 Pneumonia Severity Index SF Syncope Rule
Glasgow-Blatchford GI Bleed Centor Pharyngitis Score TIMI Score for UA/NSTEMI
ABCD2 for TIA Alvarado Appy Score King's College APAP Severity
WikEmerg UpToDate Google EM Search

CMA Clinical Resources

Pediatric Pamphlets

Radiologist Call Schedule:


CVT Surgery Call Schedule (for E-CPR cases):

Bedside Ultrasound for the Diagnosis of Acute Cardiogenic Pulmonary Edema

Have a look at this article by Dr Barbic on diagnosing pulmonary edema with bedside ultrasound:

Medical Apps for the Emergency Department

Life in the Fast Lane (LITFL) produces a segment called "Tech Tool Thursday". Have a look at their review of some of the best apps in 2014 for emergency physicians. also lists a variety of essential emergency medicine apps.

Ebola Updates:

PHC Ebola page (including info on donning and doffing of PPE)

The Latest CDC Ebola Info

BC Centre for Disease Control (BCCDC) Ebola Info for Health Professionals

More info will be added and updates provided as they are available.

Weekly Reading List

The Weekly Reading List

... and we're back...

So, 2 months off for Summer, St Paul's Emergency Medicine Update, the birth of my second child.  Things have been quiet here, but not on the Webs.

At ICEM 2012, a group of EM and SoMe (Social Media) thought leaders put their heads together over a pint of Guiness (it was Dublin after all) to come up with the next step in Medical Education in the Wild West we call the Internet.  Thus was born FOAM (Free Open Access Meducation). This was 'shortened' to FOAMed. The goal was/is to provide a loose structure and enhanced usability to the array of EMCC (Emergency Medicine and Critical Care) blogs, podcasts, tools, and resources available on the Web, and to harness that bounty to improve Medical Education. Don't take my word for it, check out the originators:

The first 2 big tools to help harness all this are: - a Google Custom Search Engine (created by yours truly) that ONLY searches EMCC blogs, podcasts, tools and Journals. This is a good first filter, and if you don't find what you need, then you can resort to the full Google. - a realtime RSS feed of all the known EMCC blogs and podcasts.  You can visit the site to see the latest, or subscribe to their integrated, single stream RSS feed.

So, welcome to #FOAMed !

Okay, but what else happened?  Here is a smattering of other good stuff from the web:

Ultrasound for Subclavian Lines - you can do that?  Yes you can!

Dr Ves at CasesBlog points us to the new Guidelines for Management of Acute Bacterial Sinusitis (it's not sexy but it is important)

Does this overdose need dialysis? Review of Extracorporeal Removal Techniques for the Poisoned Patient

Urine Drug Screening - Useful? Part One focusses on Benzos, Part Two on Opiates.

Have you been given a Field Note by a FM resident? Want to know What's up?

Is that cut 'too old' to close? Are you sure? (Journal Link)

ENLS -Emergency Neurological Life Support (What to do in the first critical hour of a neurological emergency). This is a new 'Advanced Life Support' course, but the Protocols and the background info are FREE!  Yay FOAMed.

Erowid - more than anyone needs to know about Psychoactive substances... from a slightly different point of view.

Are you scared of CROCODILEs? A new approach to Pt Safety with Learners in the driver's seat.

Finally, this is just cool!

Enjoy the weekend.

Weekly Reading List


If I say 'it was another busy week on the Internet', will you get that it is ALWAYS a busy week on the Internet?  Let's get at it then.

First, a bit of a rant from Simon Carley at StEmlyn's about the generally poor state of teaching (and use) of Clinical Skills - Does anyone use Ophthalmoscopes anymore?

Staying with a theme, gives us a great synopsis of The Value of Symptoms and Signs in the Emergent Diagnosis of Acute Coronary Syndromes. [The original paper in Resuscitation (2010) is by Richard Body, Simon Carley et al of St Emlyn's - are we getting why this is called social NETWORKING?]

Since we seem to need a refresher on H&Ps and Clinical skills, I will bring the JAMA Rational Clinical Exam Series to your attention once again. [You can access it by using the Library VPNEMLitofNote highlights the latest in the Series When Do Patients Need Blood Cultures?

Here are a few more Skill/Tool related items:

Everything you wanted to know about Capnography (ETCO2 monitors) but were afraid to ask.

The Trauma Professional reminds you that not all pts need O2 - to treat the Pt not the numbers.

Femoral lines are Dirty... or are they?

Got no IV Access, a Central Line seems excessive, and the EX-IO is out of batteries?  Try the 'Peripheral IJ' (There is Gold in the Comments here, so read the whole thing)

Compartment Syndrome is Scary, but so is the Stryker.  The cure for Fear is Education.

Ventilator-Associated Pneumonia is an ICU problem... yer not off the hook just yet - Good Care Downstairs may mean No VAP Upstairs.

I mentioned the new Anticoagulation Guidelines in this weeks Journal Club, and now the fine folks at ALiEM have updated their Paucis Verbis Card for Overanticoagulation and Supratherapeutic INR. [You can get all the PV Cards Here.] St Emlyn's has a great post reminding us why this is important - You Snooze you Ooze.

A few more gems, then I am done:

ALiEM has a new blogger, Brian Hayes PharmD (an ED Pharmacist), and he starts by debunking the Cephalosporin/Penicillin cross-reactivity myths. reminds us that COPD exacerbations can impact more than the lungs.

The Poison Review reminds us that Tylenol is not just Acetaminophen anymore.

US Physics and Knobology made ridiculously easy... mostly.

Finally, if you simply have to have more to read this weekend, the latest R&R in the FastLane is out and full of researchy goodness.


I have more, but even I am going cross-eyed.  Watch for a Special post with a Philosphical bent next week.


Featured Resource

This week I feature 2 sites I find very useful for clinical decision making and teaching.

First is MDCalc, a great online medical calculator with a primary focus on Emergency Medicine and Critical Care.  You will find it featured prominently in this site's Clinical Links Rules/Resources section.

Second is the NNT.  the NNT turns a critical and analytic eye to landmark research, reviews and meta-analyses.  In a nutshell, they evaluate each paper and then calculate a Number Neede to Treat (or Harm) for the intervention.  The Traffic Light infographic at the top of each review gives you a Go/No Go/Caution advisory about the paper's findings.  Then there is a detailed explanation of how they reached their conclusions. See how they do it all here.

They have also begun to review Diagnostic Tests (Likelihood Ratios) and Risk Assessments.

The thread connecting the 2 sites is Graham Walker (@grahamwalker) an MD/geek extraordinaire, who created both sites.  He is worth a follow on Tumblr and Twitter.

Virtual Journal Club - Evidenced Based Management of Anticoagulation



Okay, so no big trials or local research this week.  Instead a recent Review of the management of Anticoagulation and it's attendant complications.  Published in the Chest supplement on Antithrombotic Therapy and Prevention of Thrombosis, this atricle provides an 'Evidence-Based' approach to the issue.  How well the authors do at presenting a balanced approach to the Evidence is something I hope we can discuss.  In any case it appears to be the most current and authoritative recommendations on Anticoagulation and Anticoagulation-related Emergencies.

Evidence-Based Management of Anticoagulant Therapy:  Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Weekly Reading List



Another busy week on the 'Tubes.

Let's start with a great look at where EM is, where we came from, and how little has changed (and why this is probably a good thing).  Javier Benitez (Twitter, and now blogging at Academic Life in EM) gives us a 2 part (Part 1, Part 2) look back at Peter Rosen's seminal "The Biology of Emergency Medicine" from 1979! The original paper can be downloaded here.

Next a few for the learners:

If you don't already use these, you should - JAMA's Rational Clinical Exam Series.  This week, Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?

The British Journal of Sports Medicine (twitter) has a YouTube Channel filled with great Clinical Exam videos.

Another Checklist from Dr Strayer at EMUpdates - ED Procedural Sedation and Analgesia

Crossing over from the Learners to the staff, a couple of excellent posts on Journal Clubs and How to make them Effective, from the StEmlyn's crew.

Now for the 'Well that's Interesting" moment of the day - it works here, and apparently elsewhere too: the Vancouver Chest Pain Rule in Tehran.

From the UK we get Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies.

This is a hopeful story from the US DEA (how often do you hear that?) Nationwide Synthetic Drug Takedown - 19 million packets of synthetic drugs seized and $36 million in cash. Hopefully we get to reap the benefits of that...

Staying with drugs, Graham Walker (twitter) found this website StreetRx.  Not sure how I feel about this... thoughts?

After that, a bit of an antidote (literally) - Lipid emulsion therapy for poisonings: a review

Finally a bit of food for thought on Shellfish Safety - this news release about Shellfish Toxins led me to this BCCDC Advisory. From there we get an overview of DSP (a new entity), not to be confused with PSP (old, but still terrifying).

That's it for this week. Enjoy the weekend!

Featured Resource - Free Emergency Medicine Talks

This week we highlight Free Emergency Medicine Talks.  Not flashy or sexy, just 2000+ MP3s of EM talks from the best National and International Emergency Medicine Conferences.  Joe Lex from Temple University School of Medicine takes digital recorders to almost every major EM conference and records the lectures.  His residents decided that those lectures needed to be shared, and Free Emergency Medicine Talks was born.

For example, almost every session at ICEM 2012 (Dublin) was recorded and can be found here.

That's it. Emergency Medicine talks.  Free.


Virtual Journal Club - Coronary CTA


This may seem like a bit of a cop out, but I hope not. I put the ROMICAT II study on the reading list last week, but I think the topic needs a bit more exploration.  As pointed out by EM Lit of Note here, there are now 3 high quality ED based studies on the use of CCTA to help us rule out ACS in low risk patients - ROMICAT II, CT STAT, and ACRIN PA. [Note: if you think we should explore others in this forum, please let me know so I can link to them.]

While there seems to be utility in clearing these pts from the ED earlier than our traditional method (still one of the best and most efficient in the world - seriously), the evidence indicates that we may be robbing Peter to pay Paul (higher downstream testing/consultations/costs, plus the radiation issue minimal though it may be).

Are we using this test in the most effective manner possible, or is CCTA still a test in search of its proper cohort as suggested by the ROMICAT II Editorial?