The First10EM monthly wrap-up for March 2024

The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. Obviously the format means the focus is mostly on content I have found, but I hope the community gets engaged in the comments, sharing books, podcasts, FOAMed, or anything else that you think would benefit or delight the broader emergency medicine community.

I have launched a YouTube channel the supplement the material found on First10EM: https://youtube.com/shorts/MnSopFFgNWs?feature=share

The first two videos are out (with plenty more already recorded and ready to upload):

There are also some YouTube shorts (although I don’t really know what to make of this format yet):

The YouTube algorithm doesn’t know anything about a brand new channel, so early likes and subscriptions can really have an outsized impact on its success, and making sure my content gets served to the correct audience. 

To go along with the YouTube channel, the short videos will probably also be posted to:

TikTok: https://www.tiktok.com/@first10em

Instagram Reels: https://www.instagram.com/first10em/

Facebook Reels: https://www.facebook.com/first10EM

I don’t know exactly how these short form videos will integrate with everything else. 1 minute seems way too short for most content, especially when I love doing deep dives. My guess is that the highest quality content will all be on the main YouTube channel, and the rest of these social media streams are more about spreading the word for the main YouTube channel. 

What I am reading

Tomorrow, and Tomorrow, and Tomorrow by Gabrielle Zevin was a truly lovely book (I found it because another one of my favourite authors/people, John Green, said it was one of the best books he had read.) Some 80s/90s nostalgia, as the lead characters are video game designers from that era, but the novel is just rich with emotion and fantastic relationships. I liked it so much that I bought all of Gabrielle Zevin’s other books within about 1 minute of finishing this one.

I read Abraham Vergese’s Cutting for Stone while I was in medical school and truly loved it, although enough time has passed that my memory of the actual story is somewhat vague. The Covenant of Water is a similar saga, with a beautiful story, and enough medical trivia to truly tickle the nerd in me. I really loved this book, and my guess is that most of my readers will too. In one of the few remaining positive social media experiences, I was prompted to read this book through Twitter (I believe there is an upcoming online book club if you are interested), so thank you @barttels2.

Interesting media

My time for reading full books has definitely diminished dramatically since having a kid, which means that I especially love the opportunity to listen to LaVar Burton read me short stories on the way home from work and his taste in short stories (heavy on science fiction) fits beautifully with mine. If you’ve never found the Lavar Burton Reads podcast, I can’t recommend it enough.

This short video by Hank Green about confronting his own biases and mistakes he made when encountering misinformation on the internet is a very good use of 10 minutes for anyone who uses the internet as a source of information.

From the other Green brother, “The deadliest infectious disease of all time” is a really great long form look at tuberculosis on Crash Course that I think a lot of people will find interesting. (Shortly after adding this video recommendation, I received a bulletin from Toronto Public Health telling me that tuberculosis rates are on the rise in Toronto.)

You might also want to watch this, and considering signing the MSF petition to lower the price of testing for multi-drug resistant Tb in low and middle income countries.

Although it feels like science has come a long way, and that we mostly know how the universe works, nothing could be further from the truth (excuse me, dark matter). Nothing is quite as humbling, or as exciting, as the realisation that our basic understanding of physics isn’t correct. This short news article on the Hubble Tension, started me down a long rabbit hole of YouTube videos on this topic, which might be interesting to similar nerds. 

My Favourite FOAMed this month

I honestly don’t know if Rob Orman’s Stimulus podcast counts as FOAMed or just fantastic media. I mostly listen for non-medical life advice, insight, and stimulating conversion. Either way, the recent episode “Making the Trade” I think is going to be a valuable listen for many people in medicine. Sunk cost is strong in medicine. We spend so long becoming doctors, and our identities are so tied up in being doctors, that most of us don’t even pause to consider whether we are enjoying our day to day jobs (and if we do, it can be a painful reflection). We feel boxed in. But life is short. (Or as they say in the podcast, a lifetime is a long time, but it will not take you very long to live.) The fact that you spent a decade becoming a physician does not handcuff you to your current job for the next 3 decades. Personally, I still love the day to day practice of medicine, but I think the podcast is brilliant for provoking reflection about your career and life in general.

The SGEM extra episode on the philosophy on emergency medicine is also a good listen for broader theoretical questions. 

(Apparently I didn’t do much clinical learning this month, and spent too much time with my head in the clouds.)

That being said, Weingart did an excellent 2 part series on iodinated contrast issues (part 1 here and part 2 here) that I think is worth listening to for anyone working in emergency medicine or critical care. I think everything he says is correct, but – as he notes is part 2 – I have some concerns about the way the data is presented. At this point, every single controlled study looking at intravenous contrast for CT has shown absolutely no risk of renal injury. Although Scott is correct that we can’t prove there is no harm, especially in patients with pre-existing chornic renal disease, every bit of data we have suggests contrast is safe. On the other hand, I witness the harm of this myth every single shift that I work, where patients are forced to wait hours for scans that should be done immediately “because we need to see their eGFR first”, and there is frequently harm from delayed diagnosis. Therefore, given that there is clear harm in waiting for bloodwork and absolutely no proven benefit, I think the messaging on this topic needs to be much much stronger. The burden of proof has shifted. Until someone can prove that there is harm from contrast, we should just proceed as if there is not, and stop the whole charade. Practically speaking, Scott agrees with me that all of these time sensitive scans should occur without any bloodwork. I was just worried that the whole first podcast, which focused on a very specific subset – patients with eGFRs less than 20 – was going to reinforce the concept that knowing the eGFR is important, and continue the current harmful practice of radiology demanding bloodwork before essential time sensitive contrast CTs.) You can also find a longer First10EM post on ‘CIN’ here.

Quotes or Thoughts

In a world where you can be anything, be kind.