Tactical Medicine News Blog

Dr. Andrew Worster and the BEEM (Best Evidence in Emergency  Medicine) group from McMaster University has teamed up with EM Cases, Justin Morgenstern (@First10EM) and Rory Spiegel (@EMNerd_) to bring you a blog that blends the BEEM critical appraisals in a case-based, interactive, practice-changing format. In each post we choose the most important literature on [...] The post BEEM Cases 1 – Pediatric Minor Head Injury appeared first on Emergency Medicine Cases.

As a follow-up to last year’s inaugural JGME-ALiEM Hot Topic in Medical Education on the Resident as Teacher role, this week we will be conducting a cross-disciplinary discussion about a unique instructional strategy called team-based learning (TBL). Originally developed by Dr. Larry Michaelson, a professor of Business at the University of Oklahoma, over the past 15-20 years TBL has been increasingly incorporated in health professions education. Prominent in undergraduate medical curricula, TBL focuses on active learning, collaboration, and application to real-world problems. As educators consider its value in postgraduate education, TBL is our “hot topic” for 2016. Whether you are hearing about TBL for the first time, considering incorporating it into your practice or just curious to stay on top of what’s hot in meded, we invite you to engage in the discussion of the JGME publication entitled “Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching” by Balwan et al. using the Twitter hastag #JGMEscholar [free article PDF]. Similar to previous ALiEM-Annals Journal Clubs, a live Google Hangout will be held with the authors and selected experts. Ultimately, a curated summary from discussions (ALiEM blog, Twitter, Google Hangout) will be published back in JGME. Some of your best tweets and blog comments will be featured.

Background: Left Bundle Branch Block (LBBB) on the ECG makes accurate recognition of ST-Elevation Myocardial Infarction (STEMI) rather difficult. The 1996 and 2004 American College of Cardiology/American Heart Association (ACC/AHA) STEMI guidelines recommended immediate reperfusion therapy for patients with potentially ischemic symptoms and new, or presumed new, LBBB. In 2013, this recommendation was removed from the guidelines. Historically, reperfusion decisions in LBBB have been determined by the original Sgarbossa criteria published in 1996, but there are three key limitations to the original study by Sgarbossa et al: The original Sgarbossa criteria (i.e. the “weighted” Sgarbossa criteria) depends on a point system that rely on 3 findings, only 2 of which would provide enough points (i.e. 3) to make the diagnosis of AMI. Using the Sgarbossa criteria without the point system (i.e. the “unweighted” Sgarbossa criteria) increases sensitivity but decreases specificity. Sgarbossa et al diagnosed AMI by creatine kinase MB (CK-MB) elevations instead of angiographic evidence of acute coronary occlusion (ACO), which limits the sensitivity of the rule because it combines NSTEMI and STEMI patients in the outcome definition Finally, Sgarbossa et al used an absolute criterion (5mm) rather than a proportional criterion for excessively discordant ST elevation lowering the sensitivity of the criteria. The modified Sgarbossa criteria replaces the absolute 5mm discordant ST elevation with a proportion (ST elevation/S-wave amplitude ≤ -0.25). In other words, the modified Sgarbossa criteria only changes the last of the original Sgarbossa criteria with the first two criteria staying intact. Now, if any of these criteria are met, the cardiac catheterization lab should be activated. We have written on REBEL EM before about the modified Sgarbossa criteria and one of our conclusions was this rule looked very promising, but needed an external validation study. Well that study is now here and for full disclosure I am one of the authors on the paper.

A Few Short Notes on Tropical Butterflies [1] is the brilliant debut collection of stories by physician turned-author John Murray. Inspired by his background in science and medicine, the novel focuses on the lives of researchers, physicians, nurses, explorers and collectors, who share a love for detail and scientific explanation. Murray’s stories are a wonderful balance of fiction and facts, which take the reader to the most enthralling places around the globe: from the slums of Bombay during a Cholera epidemic to remote areas of the key west; from the peaks of the Himalayas to a United Nations refugee camp in Africa. Entomology, microbiology, and neuroscience are among the areas of expertise described in this book. Despite an obsession by each of Murray’s characters to categorize and create order of the world through their field of study, the core of the stories deals with an emotional hurdle that requires the protagonist to respond to a more chaotic inner and personal world.

Every year, we try to get a unique gift for many of our core team members to show our appreciation for them, their tireless enthusiasm and dedication to education, and pioneering spirit. It is only a small token of our appreciation. A few months ago, we have expanded to giving out such gifts to members of our Chief Resident Incubator as well. Inspired by custom socks that the Slack company made for its employees, I thought — why not ALiEM socks?