The 18th edition of our series of eminence-based evidence:

A free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 11 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famers’

• Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. Epub 2010 Jul 31. Review. PubMed PMID: 20674088

Levitan et al get into some great technical aspects of video and alternative devices for laryngoscopy. The point here is that while VL may make laryngoscopy easier, tube delivery and placement may paradoxically become more difficult, primarily because of the sharper angle between the blade and the trachea. Porn for airway enthusiasts.

Recommended by Seth Trueger

This week’s R&R recommendations

Airway

Critical Care

Emergency Medicine

Technology

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Mike Mallin is half of the enthusastic educational entertainment team that dreamed up and present the now legendary Ultrasound Podcast ( the other half being Matt Dawson). Mike was at SAEM2012, where he spoke about the history and educational philosophy behind their magnificent creation.

Check out what he has to say:

.. and don’t forget about their awesome One Minute Ultrasound App.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

For bloody ages now I’ve been meaning to give EM Lyceum a shout out. Fortunately, thanks to SAEM12 I can now easily let the creators of this interesting blog-based approach to emergency medicine education speak for themselves:

Check out the EM Lyceum for evidence-based debate on key and controversial topics in emergency medicine. Fans of the LITFL case-based Q&As will love the rough and tumble of the Lyceum. Our hats are off to the creators, Whitney K. Bryant and Anand Swaminathan.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

aka American ER Doc Gone Walkabout… 016

Retrievals: we don’t use the term in the US – moving a patient from one hospital to another, even in the rare instance that a Doctor is in attendance, is a transfer.

I had a golden retriever who loved to go to the lake and fetch a stick that I threw out into the water. She’d retrieve the stick, and come to shore wet and shaggy, and shake water all over me. While I was in Taz, every time I heard the term retrieval, I got that image in my head. Some retrieval doctor, all wet and soggy, bringing me a comparably bedraggled patient and then shaking water. Sometimes when you have to learn a new usage for an old term, it’s hard to rid yourself of old images. Just sayin’.

In the US it’s a transfer: here I sit in a little 8 bed rural ER. I’ve got an active upper GI bleeder, limited blood supply, and pseudo-stable vital signs. The nearest gastroenterologist is nearly 200 km away, but no beds. I’ve got 8 potential hospitals nearly 400 km away, no GI on-call or no beds. 550 km away, 3 more calls. Nothing. Albuquerque, different state, same distance. Maybe. Try the first hospital again, 13th call, somebody died or something, we have a bed! Patient reasonably stable. Couple more calls to talk to the GI consultant, then the hospitalist who will actually be the admitting doctor. Now, calls to my little hospital’s transportation manager. The sending hospital will pick up the costs of the transfer, so everything goes through contracting channels (Can we save some money with a BLS ground transfer? How about ground ALS – probably 4 hour round trip? I think not.) Weather check: no snowstorms, no dust storms in the desert, we’re good to go. Finally, helicopter arrival, flight nurse handover, and away he goes.

In Launceston, I have a 60 year old guy, known 6 cm AAA but high surgical risk so not repaired (not sure why endovascular hadn’t been considered). Now, severe abdominal and back pain, vomiting. Observations pretty good – tachycardia, but blood pressure OK. Retrieval to Hobart to try a now even higher risk surgery? Or comfort care in Lonnie. Since immediate trip to theatre isn’t an option, a CT to confirm working diagnosis shows that the working diagnosis is wrong – the guy actually has pancreatitis from a CBD stone with an inflammed pancreas sitting right on top of the AAA. Pretty cool images. We’re already providing comfort care, so delete the “only” part of comfort care, add an ERCP and CBD stone retrieval (I think comfort is good, even if you don’t die). Skip the retrieval.

Lonnie again: Thoracic aortic dissection, retrieval heading to Melbourne. Only a little bit of esmolol in the ER. Search the whole hospital – a bit from theatre, a bit from ICU. I think we’ve got enough esmolol for the retrieval reg to make it to the airport at Melbourne (Launceston’s best known suburb). Smooth retrieval – only a couple phone calls.

Lonnie again: Small subdural, mental status pretty good, no other significant injuries. Download PACS images into my gmail account and email them to neurosurg reg in Hobart (can’t do that in the US, 20 years in jail for violating privacy rules – no penalty for violating rules of common sense). Advice from neurosurgeon: Ought to be able to watch that and rescan in 6-8 hours. Save the trip (plus, tight on beds in Hobart, too). Nobody goes crazy! Nobody yells and screams about legal liability! This can’t be America! (Plus, I know that in the US, at University Hospital, we’d get the same advice: keep him in the ER, we don’t have inpatient beds, scan again in 6 hours, if he’s stable we can let him head home.) No retrieval tonight.

Back in the States: Indian Health Service: shovel fight (I’m not sure why, but shovels seem to be the weapon of choice on the Rez – rare to see a gunshot wound or knife stabbing, but people whack each other with shovels). GCS 14, looks pretty good, localized traumatic SAH – maybe a few pixels thick. And an orbital blowout fracture, with some entrapped fat and no discernible globe injury. If he was at University Hospital – 6 hour obs, repeat CT, home to follow up with one of the facial surgery or ophthalmology services (if they’d see him with no insurance – not an issue on the Rez – almost as civilized as Oz). If I was working the overnight shift on the Rez, I’d just keep him in the ER and do the same, but I’m going off service. The trauma surgeon wants nothing to do with trauma above the clavicles. The nearest trauma center has a neurosurgeon and will be glad to take the head injury, but has no ENT on call for the weekend and therefore (despite my assurances that the blowout fracture can wait a few days) won’t take the face. I did a quick review of anatomy and learned that the face and brain are permanently attached, so on to more phone calls and eventually a 350 km air transfer, at a charge of $15,000 for no immediate treatment. Something seems wrong here, people.

OK, so enough of the stories.

So, are there some differences (remember this is just one Doc’s experience, with limited reference to the broader picture) between Oz and the country to the Northeast?

Perhaps the most noticeable: Doctors on the retrievals. In the states, the retrieval is invariably a nurse and/or paramedic. Generally works fine, but occasionally, especially on longer transfers with complex patients (aortic dissections crossing the bass strait) having that extra physician expertise is reassuring. Not sure what the NNT for one improved outcome would be – might be an interesting study.

Willingness to consult at a distance and not transfer. Aided by sensible privacy rules that allow us to share clinical information and images even if it’s not a perfectly secure connection (Good Lord, someone might look at that head CT and use it for a nefarious purpose!). And, lack of legalities. It was common in Lonnie to get a call from a GP in some town or some little island that I had never before know existed, with a question about how best to manage without transferring (sometimes that decision tree was aided by washed out roads or weather that promised to keep flights shut down for days). My experience in the US is that even trivial matters that are in “someone else’s specialty” get transferred: the minor traumatic SAH noted above. Or, the alcoholic in moderate withdrawal who has vomited a few times with specks of coffee grounds – thus turning him into ” a dread upper GI bleed.” Internal medicine can’t handle him here, gotta send him where there’s a gastroenterologist, where the patient is treated for withdrawal, a PPI is added, and eventually scoped if there is insurance payment for it. Quite a bit of cost for no identifiable clinical benefit. I’d like to think that the lawyers are the bad guys, but come on doctors, stand up and say we can do this at a minimal risk. I admit, it’s an understandable attitude: extra work for me, at some risk of having to defend my actions in the unlikely event that this turns into a major GI bleed that requires unavailable GI expertise. (Then again, the hospitalist who turns down the admission and insists on transfer of the incidental GI bleed, is not the person saddled with the 13 phone calls to arrange the transfer.)

Multiple phone calls. Some of this is just availability. At Lonnie, there were only one or two options, so rarely did I have to make calls. And, I understand that in many places on the mainland there are centralized options for arranging an accepting doctor and hospital as well as the retrieval itself. I am impressed that, in my setting in the States, the multiplicity of options generates a lower impetus to go an extra step: If there was only one available trauma center, the neurosurgeon might have accepted the head injury even without immediate ENT backup. But, there’s another trauma center down the road (or flight path) -try them. Or, we’re a little tight on beds, why don’t you try hospital X or Y or Z, I’m sure that they will be able to help. Things have improved in recent years in that most receiving hospitals have a call center or access center to minimize the number of calls to that specific hospital but lack of a clearinghouse to direct you to hospitals with available specialists and available beds can generate a lot of calls for the doctor at the sending hospital. In many cases, there is a complete disconnect between the specialist hospital and the retrieval service itself, thus necessitating another set of calls after the doctor has identified the receiving hospital. That process was similar in Tassie, but had only the medical layer, not the payment arrangement layer superimposed on the medical layer. Some places in the US get even a bit more complicated in that there are multiple overlapping (read that competing) air ambulance operations.

There was one funny incident of where the lack of payment issues generated interesting behavior. I got a teenaged girl with streptococcal pharyngitis and scarlet fever – moderately ill, transferred by fixed wing from a small outlying hospital. Turned out that the GP wasn’t terribly worried, but since there was a retrieval flight on the ground at his local airport for some other reason, just loaded the girl on and sent her back in to Launceston. A little fluids, a little steroids, and by the time the girl’s parents arrived by land a few hours later, she was ready to go home. Some might argue: terrible waste of resources. I would argue that an occasional retrieval that is non-therapeutic when retrospectively reviewed, is a small price to pay for a system that allows efficient arrangement of the retrievals that are important.

One other circumscribed instance in the US. We are now seeing more defined referral pathways for specific clinical scenarios. At the Indian Health Service hospital, we now have pre-specified trauma protocols for transfer to one of two trauma center options – as long as they aren’t grossly overloaded, or involving a subspecialty not available. And, an arrangement for STEMI patients that involves a single call with minimal nitpicking on the phone, a pre-specified pre-transfer treatment algorithim, and guaranteed acceptance unless truly unusual circumstances. We still have a second set of calls for the flight service. (We’ve also had to make a third set of calls for someone to take care of the horse that the STEMI victim rode to the ER. But, that’s a different issue.)

I hope that you Aussies have a little sympathy for me. I realize that my transfers ranging from 200 to 500 km are trivial compared to retrievals from places like Alice Springs and Broome. (Tassie and even transfers up to Melbourne were relatively compact compared to the big island.) And, such distances place a premium on retrieval doctors on the flights. And, such distances place a whole new light on the ability and willingness to handle, without transfer, moderately severe problems outside of your own specialty field. (I would argue that the Australian training system involving far more exposure to and experience with a broad range of medicine and surgery, prior to beginning specialty training, when compared with our American system that focuses on a specialty much earlier, is invaluable in dealing with such circumstances.) I recall that Australia is 3/4 the land mass of the US, with 1/13th of the population. And that the weather and traffic reports for all the major cities of the entire nation could be given on ABC in about 2 minutes (Cold and wet in Hobart, fine in the other 6 capital cities.)

I can imagine that when a 2000 km retrieval is involved, I would be delighted to see that retrieval registrar – even if, like my dog, he’s wet, bedraggled, and shakes water all over me.

Later, mates.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Graham Walker is an emergency physician at the cutting edge of how our specialty interfaces with technology and social media. You know him, of course, from MDCalc, TheNNT and perhaps even his new blog Gmergency! Graham recently gave a talk at the Stanford Grand Rounds called ‘E-mergency Medicine’.

Here it is:

http://www.youtube.com/watch?v=qtkggenLmlE

You’d be stupid not to watch it.

Graham looks to the past to show how slow the spread of ideas used to be (think Semmelweis then Lister and Halsted) and compares it to the social media driven present (using EMCrit’s Delayed Sequence Intubation and the Best Use for a Bougie as examples). He cuts through the flaws of traditional peer review and suggests that social media-based crowd sourcing may be the way forward (although he highlights the potential pitfalls too). He also talks about his concept of a peripheral brain using a website as a readily accessible resource. Graham goes onto discuss the key resources he uses to stay up-to-date and keep learning: including the best blogs, podcasts and iphone apps. he finishes with his view of the future for emergency medicine academics and learning.

References:

• Full reference list for talk - Stanford Grand Rounds, May 9, 2012.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Seth Trueger (remember him from posts such as Awake Intubation in Audio and Best Use for a Bougie) got caught on video at the recent Society of Academic Emergency Medicine 2012 Annual Meeting. He shares his top six electronic resources, including blogs, podcasts, websites and iphone apps.

Here’s the video:

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

aka Trauma Tribulation 030

A 24 year old man has been stabbed in the right upper limb with a large kitchen knife. The ambulance officers have just brought him into the emergency department. They report that there was a large amount of blood at the scene. They describe brisk pulsatile bleeding from a wound proximal to the man’s right elbow and have treated it with a compression bandage, that appears to be soaked through with blood dripping onto the floor…

Looks like your dinner break is going to have to wait!

Questions

Q1. How would you recognize severe arterial hemorrhage from extremity trauma?

Answer and interpretation

Q2. How would you manage severe arterial hemorrhage from extremity trauma?

Answer and interpretation

Q3. What is the best way to apply direct pressure when there is arterial bleeding?

Answer and interpretation

Q4. What is the best way to apply a pressure bandage over a bleeding point?

Answer and interpretation

I like the ‘nugget method‘ described by Shokrollahi et al (2008) as follows:

• The occluding finger should be substituted with a dental roll or tightly folded “nugget” of gauze.A tourniquet may be temporarily applied proximally to facilitate this.
• Once the positioning is correct and no further bleeding is occurring, slightly larger or less folded pieces of gauze can be placed one on top of the other, creating an inverted pyramid of gauze.
• The layers of gauze are secured with a loose bandage. Only very light pressure need be applied to the top layer of gauze to maintain hemostasis, as the pressure is “focused” onto the bleeding point. This technique is based on the equation: Pressure=Force/Area
• The tightness of the bandage can be judged from the amount of pressure needed to maintain hemostasis when applying the top layer of gauze.

From Shokrollahi et al (2008) — click image to enlarge

Hat tip to Scott Weingart for this one. I’ve used it on a few bleeding AV fistulae and it works like a charm.

—

Q5. How is a tourniquet applied in the presence of an uncontrolled arterial bleeder?

Answer and interpretation

Q6. What are the two transition points where proximal control of a peripheral vascular injury becomes exceedingly difficult?

Answer and interpretation

Q7. What are the hard signs of vascular injury?

Answer and interpretation

Q8. What are the soft signs of vascular injury?

Answer and interpretation

Q9. How is an arterial pressure index (API) performed and calculated? What does it mean?

Answer and interpretation

Q10. What are the surgical options for repair of vascular injuries?

Answer and interpretation

References and Links

Lifeinthefastlane.com

• Trauma! Extremity Injuries
• Trauma! Major Haemorrhage
• Trauma! Massive Transfusion

Textbooks and Journal Articles

• Conrad MF, Patton JH Jr, Parikshak M, Kralovich KA. Evaluation of vascular injury in penetrating extremity trauma: angiographers stay home. Am Surg. 2002 Mar;68(3):269-74. PubMed PMID: 11893106.
• Feliciano DV, Moore FA, Moore EE, West MA, Davis JW, Cocanour CS, Kozar RA, McIntyre RC Jr. Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma. J Trauma. 2011 Jun;70(6):1551-6. PubMed PMID: 21817992.
• Fildes J, et al. Advanced Trauma Life Support Student Course Manual (8th edition), American College of Surgeons 2008.
• Inaba K, Potzman J, Munera F, McKenney M, Munoz R, Rivas L, Dunham M, DuBose J. Multi-slice CT angiography for arterial evaluation in the injured lower extremity. J Trauma. 2006 Mar;60(3):502-6; discussion 506-7. PubMed PMID: 16531846.
• Inaba K, Branco BC, Reddy S, Park JJ, Green D, Plurad D, Talving P, Lam L, Demetriades D. Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma. 2011 Apr;70(4):808-15. PubMed PMID: 21610388.
• Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008 Feb;64(2 Suppl):S38-49; discussion S49-50. PubMed PMID: 18376170.
• Legome E, Shockley LW. Trauma: A Comprehensive Emergency Medicine Approach, Cambridge University Press, 2011.
• Levy BA, Zlowodzki MP, Graves M, Cole PA. Screening for extremity arterial injury with the arterial pressure index. Am J Emerg Med. 2005 Sep;23(5):689-95. Review. PubMed PMID: 16140180.
• Lynch K, Johansen K. Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma? Ann Surg. 1991 Dec;214(6):737-41. PubMed PMID: 1741655; PubMed Central PMCID: PMC1358501.
• Lundin M, Wiksten JP, Peräkylä T, Lindfors O, Savolainen H, Skyttä J, Lepäntalo M. Distal pulse palpation: is it reliable? World J Surg. 1999 Mar;23(3):252-5. PubMed PMID: 9933695.
• Marx JA, Hockberger R, Walls RM. Rosen’s Emergency Medicine: Concepts and Clinical Practice (7th edition), Mosby 2009. [mdconsult.com]
• Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004 Jun;56(6):1261-5. PubMed PMID: 15211135.
• Shokrollahi K, Sharma H, Gakhar H. A technique for temporary control of hemorrhage. J Emerg Med. 2008 Apr;34(3):319-20. Epub 2007 Dec 27. PubMed PMID: 18164163.
• Newton EJ, Love J. Acute complications of extremity trauma. Emerg Med Clin North Am. 2007 Aug;25(3):751-61, iv. PMID: 17826216.

Social media and Web Resources

• Broome Docs — Clinical Case 018: Life and limb (not life OR limb) 
• ScanCrit — The Mother of All Tourniquets (abdominal aorta tourniquet!)
• The Trauma Professional’s Blog — Using CT To Diagnose Extremity Vascular Injury
• The Trauma Professional’s Blog — Penetrating Injuries to the Extremities

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Welcome to the resuscitated  63rd edition!

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.

The Most Fair Dinkum Ripper Beaut of the Week

SCANCRIT

• Wow! The ScanCrit boys have got a post that will knock your socks off on…. Avalanche Survival - something we don’t really see down here in the land of the OZ! This post is packed full of some amazing stats, insight, pictures and videos .The concept of the patient receiving a free airway or air pocket is fascinating and really does decide who lives and who dies.  A must read (& watch) post that is as clear a ‘ripper beaut’ as there ever has been.

The LITFL Review Top 20 of the Week

ER CAST

• Rob’s newest podcast (featuring Ryan Radecki) on Pulmonary Embolus Outpatient Treatment answers these big questions: Do we need to hospitalize all patients diagnosed with pulmonary embolism in the ED? Can some be discharged and managed as outpatients? Plus many more questions around the management of low risk PE in the ED!

Free Emergency Medicine Talks

• Joe’s pick of the week goes to Michael Winters, an engaging and inspirational speaker on all things ED critical care. Listen in for take on: What are the New Sepsis Biomarkers? Can they help in ED?

Emergency Medicine News

• High-Risk Orthopedic Injuries: Tibial Plateau Fracture - A must read article so you don’t get “tripped up” from this complex often missed injury.

SCANCRIT

• Nasal Pharyngeal Oxygen - a different way of delivering oxygen and its sure to impress the nurses in ED.. .not sure about ICU!

 Twee-D and Twitical Care

Starting nights on the ITU tonight. Always remember your ABCDE's: Arrive, Blame, Criticise, Delegate, Exit.

April 6, 2012 6:27 pm via EchofonReplyRetweetFavorite

@bungeechump

Chump

News from the Fastlane

• Firstly my apologies for the lapse in LITFL Reviews – hopefully will all good intentions we can keep bringing you the LITFL review regularly from now on.
• There’s been a few changes to LITFL RSS feed, and we now have a Vimeo account! To find out more read LITFL RSS Feeds.
• Come to Perth in June - not only get to meet some of the awesome LITFL team but also get too listen to some fine speakers at ACEM scientific meeting.
• Who thinks physiology is boring? Well, prepare to be proven world.Michelle Johnston @Eleytherius -one of the most hip hop and happening emergency physicians now brings us the Physiology Philes - see for yourself below:

The Final Words

•  We’ve reached the point, as doctors where we can’t do it all by ourselves. We can’t know it all.

- Atul Gawande

•  ”There is no use for the term costochondritis.”

- Judd Hollander

That’s it for now…

Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps you to deal with anyone, anything, anywhere at anytime for at least another week! If you’d like to suggest something for inclusion in the next edition of The LITFL Review, email our roving reporter: kane AT lifeinthefastlane.com

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Yesterday I put up a quick post on the Social Media Revolution, featuring links to some great social media presentations from the Society of Academic Emergency Medicine 2012 Annual Meeting, which is currently in progress in Chicago.

I’ve been really impressed with how the organisers of this conference have embraced social media to highlight all the cool stuff that’s going on there. Apart from using the twitter hashtag #SAEM12 to keep track of twitter commentary, the inclusion of talks by some great people on the intersection of social media and emergency medicine, and the conference even having its own iphone app (!), there are the amazing videos.

The videos are gold. A seemingly innumerable number of short video presentations have been uploaded onto the Academic Emergency Medicine Vimeo page, and I have been following @ScottJoing trying to keep up with them all. As an aside, you should all know Scott from the HQMEDED project — a brilliant beacon of the asynchronous learning/ social media/ online video medical education revelatory revolution. But back to the SAEM videos — they’re well produced and to the point, and a great way for presenters to get the message of their research out there.

As an example, check out @EMIMDoc ‘s slick presentation on the best emergency medicine blogs around:

I never thought I’d see the day that the ‘Funtabulously Frivolous Friday Five‘ and the ‘Utopian College of Emergency for Medicine‘ would feature at an academic emergency medicine conference, but there you go!

Keep up the great work @SAEMonline.

PS. Don’t forget to check out Academic Emergency Medicine‘s cool Peer Reviewed Lecture (PeRL) project as well!

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Is social media a fad?

We don’t think so.

We need to embrace the inevitable, and find ways to use it for the greatest good.

Social media is about people, medicine is about people, education is about people.

So, what’s the problem?

http://www.youtube.com/watch?v=dA5Fn_Q10Tk

Check out these Prezi presentations on Social Media in Emergency Medicine delivered yesterday at the SAEM 2012 annual meeting that is currently running in Chicago:

• Social Media and Academic Emergency Medicine: New Tools, New Residencies — Robert Cooney (@EMeducation)

• Social Media Professionalism for the Academic Emergency Physician — Nick Genes (@nickgenes)

• Social Media Engagement and Collaboration — Jason Nomura (@takeokun)

You can also mix it up with the LITFL team on Twitter:

@precordialthump

@sandnsurf

@antidoped

@edjamesburns

@eleytherius

@peterallely

@doctorgerard

@oliflower

@ercleve

@trainthetrainer

@jjlarkin78

@rfdsdoc

Life in the Fast Lane Medical Blog - Emergency Medicine education blog