FOAMed North Battleford Grand Rounds Dr. Braden Bouchard - Family Medicine Resident January 17, 2014

Free! Open! Access! Meducation

Why?

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Update Clinical Practice FOAMED

Shorten time from knowledge generation to dissemination to implementation! ! Iterate faster on techniques and treatments! ! Connect for peer review with motivated and interested clinicians in the public light

• Emergency Medicine! • Critical / Intensive Care Medicine! • Anaesthesia! ! And slowly but surely…! • General Practice / Family Medicine

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USask FOAM Collaborative @socmobem Chris Bond, Adult EM Physician! Foothills Hospital, Calgary @brent_thoma Brent Thoma, EM Resident! Simulation/Research Fellow at Massachusetts General @ermentor Nadim Lalani, Adult and Pediatric EM Physician @olszynskip Paul Olszynski, Adult EM Physician

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It’s a nice thought to be able to disseminate information so quickly and widely, but:! ! “It’s not peer reviewed”

The power that FOAMed has:! ! “24/7 near-instantaneous post- publication commentary by anyone in the world with an internet connection”! ! — Brent Thoma (@brent_thoma)

The post-publication peer review process in action:! ! ! PE Prognostication

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The Myths, according to Dr. Senthi:! ! 1. That untreated PE has a high mortality! ! 2. That CTPA has an exceedingly low risk of harm! ! 3. That CTPA is accurate at diagnosing PE! ! 4. That if we diagnose PE we can significantly reduce a patient’s risk of death by treating them with anticoagulation

Dr. Senthi’s Proposed Algorithm:! ! 1. Using a higher test threshold for CTPA (>4.8%)! ! 2. Using the sPESI score to prognosticate in the tricky mildly-symptomatic patient category! ! 3. Anticoagulation may not really be making a big difference to outcomes in simple, haemodynamically stable, small PEs

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Minh Le Cong @rfdsdoc @DrSenthi @broomedocs @MDaware @gruntdoc @SAEMEBM how many cases of CTPA induced contrast death have you seen ? Simple question Sep 12 Details Reply Retweet Favorite More Casey Parker @broomedocs @rfdsdoc @DrSenthi @MDaware @gruntdoc @SAEMEBM Answer: I don't know! Seen lots of renal failure. Multi factorial etiology. Some had contrast Sep 12 Details Reply Retweet Favorite More Chris Cole @DocOnSkis @rfdsdoc @DrSenthi @broomedocs @MDaware @gruntdoc @SAEMEBM None. Absence of evidence is not evidence of absence. Limited view from ED world. Sep 12 Details Reply Retweet Favorite More Anand Senthi @DrSenthi @rfdsdoc @broomedocs @MDaware @gruntdoc @SAEMEBM hmm .. changing the subject Minh? That question will be answered on Part4 pdocast-patience Sep 12 Details Reply Retweet Favorite More Minh Le Cong @rfdsdoc @DrSenthi @broomedocs @MDaware @gruntdoc @SAEMEBM no. just trying to get back to real world.doomsday comet has not hit earth yet too. Sep 12 Details Reply Retweet Favorite More

The post-publication peer review process in action:! ! PE Prognostication:! Weingart Weighs In

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Dr. Weingart Weighs in:! ! “The reason we work up these patients is to make sure they don’t have the predisposition to have another clot in a few weeks.”

Dr. Senthi Strikes Back:! ! Articles | 17 July 2001 Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and D-dimer Philip S. Wells, MD, MSc; David R. Anderson, MD; Marc Rodger, MD, MSc; Ian Stiell, MD, MSc; Jonathan F. Dreyer, MD; David Barnes, MD; Melissa Forgie, MD; George Kovacs, MD; John Ward, MD; and Michael J. Kovacs, MD After 3 months, patients were followed up for development of thromboembolic events at a return appointment or by telephone contact.!

Resources Emergency / Critical Care:! • Mike Cadogan & Chris Nickson! • lifeinthefastlane.com • foamem.com • www.ultrasoundpodcast.com • emcrit.org ! General Practice / Family Medicine:! • FOAM4GP.com

Dr. Tim Leeuwenburg! @kangaroobeach

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