Things We Like This Month – August 2020

My my, how the days just fly by. The Norwich PEM team is taking some time this month to reflect on the more serious questions in life – mainly, why is there no air con in this place, can I wear shorts to work, and what is the temperature limit at which Badgernet summaries become a meaningless mush of words and feelings?

(The answers being money, absolutely not have you seen your knees lately, and around 32C)

So, as we gently melt into a small puddle of flesh, and slope off for our 4th perspiration-related scrub change of the day, it’s time to have a look over the Things We Liked This Month, our (sometimes) monthly round up of paediatric internet stuff. So, ram that Calippo in your mouth before sister sees, turn that fan to 3, and settle down for a look at this month’s offerings. Enjoy!

Journal Articles we like

Evidence Based Medicine and COVID-19

OK, so on the surface, this may fly in the face of our attempts at minimising COVID-19 content in TWLTM. However, whilst the COVID-19 pandemic gives the setting for this excellent piece about EBM in clinical practice, the message from Simon Carley and friends echoes across modern medicine.

Here at Norwich PEM, we love evidence. We munch on journal clubs, breathe meta-analyses and drink in statistical analysis. But moreover, we love robust evidence. The message from this paper is clear: although during a global pandemic, there is a dearth of information, and an acute time pressure to get answers and results, the pressure of time is no excuse for sloppy science, and half-baked evidence. In just a few weeks we have seen the meteoric rise, and subsequent total demise of hydroxychloroquine, early intubation, azithromycin, and zinc for the treatment of COVID-19. As the paper says, “a global pandemic is the time to raise the bar, not to lower it”, and the same counts for outside global pandemia. So, join us all in a call to arms, demand better from your evidence base, and ensure that, now and in the months to come, we base our clinical responses in science, not in emotion or politics

How to use…iron studies – ADC E&P

From the complex to the simple. Or so it seems. However, there is an enormous variance in the interpretation of iron studies across hospitals and regions. Some deficiencies are easy – low phosphate likely means phosphate depletion, and will respond to phosphate supplements. Same goes for a low serum iron, right?

Taking us all the way back to 2nd Year of medical school, this is another great article from the “Interpretations” section of the ADC E&P, brings us back to basics, and walks us through when, where and why to give iron supplements. So, put that Sytron back in the cupboard for a quick minute, and read up.

#FOAMed we like

Antimicrobial Cover Cheat Sheet – Wellington ICU

Hey you! Yes, you! Do you like antimicrobial stewardship, but forget what classes of antibiotics treat what common organisms? Quietly nod along when micro suggest some better gram negative cover, then google what that actually is for the 800th time?

Well, do I have a cheat sheet for you. OK, so it’s technically from an adult medical source, but I’m confident if we wash our hands afterwards, we won’t get any cross-contamination. It’s also good. Really, really good. Choosing antibiotics is about targeting the relevant likely culprits with the narrowest possible spectrum to treat the likely cause, and we can all do our part to improve our antimicrobial stewardship.

Podcasts we like

Resus Team Leadership – EMCrit and Cliff Reid

This month we’ve been pondering – what makes for an effective resus call? Time and again, when looking back on those calls that just seemed to flow, the emphasis is not on the medicine, or the procedures, but the communication. Watching an F1 pitstop is not enthralling because I like hydraulic lugnut wrenches, it’s enthralling because in 7 seconds, you see a whole team of people smoothly walking through the motions that they have done a thousand times over.

In this episode, Cliff and Scott talk about how to effectively lead, and take part in a resus call, and how to get the best out of your team in a stressful encounter. We will all be called to lead a crashing patient at some point in our career, and getting the basics right will help enormously in steering your team through a tough spot.