Photo by Suzanne Neubauer

By David Hoffman DO

Alright fellow FOAMers, this week we are highlighting a few excellent websites with an incredible amount of pertinent and free information. Both of these websites have some essential pearls of wisdom to glean.

Additionally, we’ve summarized two recent blogs to emphasize the utility of these sites and keep us abreast of current in-vogue topics.

So without further ado…


Rob Orman (you may have heard him on EMRAP) blogs about topics relevant to your practice. He shortens topics to their bare bones, keeping things concise, easy to follow, and often includes a nice algorithm that you can apply to your daily practice.


Brought to you by a group of emergency physicians at Bellevue Hospital Center, including Dr. Anand Swaminathan, they tackle a subset of questions pertinent to clinical practice monthly. You can use the website to stimulate conversation at work or just strengthen your own personal database.

Review of blog post from

Topic: PEA made simple


Step 1: Look at the QRS. Is it wide or narrow?

Step 2: Look at the heart with ultrasound

Step 3: Empiric Treatment

Bottom Line:

Assessing the QRS can help guide a more targeted approach to/treatment of PEA than the previous ACLS algorithm.


  1. Wide QRS: Think Electrolytes
  2. Narrow QRS: Think Structural

This was highlighted nicely in a recent Grand Rounds by Dr. Rifenbark (PGY-3). His lecture is available here.


Review of blog post from

Topic: Syncope


In which patients with syncope do you get a NCHCT?
In which patients with syncope do you get a troponin?
Do you get orthostatic measurements in patients with syncope, and how do you use them?
Do you manage patients with near-syncope differently than those with syncope?

Bottom Line:

  • CT Head?: Only if a) neuro deficits, b) complaints of HA, or c) signs of head trauma.
  • Troponin? Only if a) EKG changes or b) Chest Pain. C) Consider in pt with significant risk factors (CHF or CAD, old age, no prodrome).
  • Orthostatics? Not helpful, but testing patient’s symptoms when changing positions (i.e. supine to sitting, or sitting to standing) is helpful in assessing volume status/blood loss.
  • Presyncope (lightheaded, faint, dizzy): Treat similar to syncope.