CLaPS (Crowd Learning and Problem Solving) is an idea I had on the flight back from SMACC 2013. The idea is to use the power of Twitter and Storify via pre-determined hashtags to capture and publish discussion around a particular clinical problem.
The clinical cases will have multiple issues and will often have more than one approach (as is often the case in medicine). Those contributing to the discussion are encouraged to provide links to evidence as needed. The discussion will be captured on storify after 1 week and published on the website.
If anyone has any suggestions for a CLaPS case feel free to contact me.
Now onto the first CLaPS problem – #CLaPSem01 (emergency medicine case 01)
Don’t Tell Me What To Do!
It’s another busy day in your metropolitan emergency department and you are a registrar (US = resident) seeing Kim, 16 year old female, weighing 65kg (140 lbs) with a paracetamol overdose.
Kim tells you she was feeling down as her friends had gone to a party without her. She had swallowed approximately 17grams of paracetamol (acetaminophen) 7 hours ago. Her mother had come home to find the empty packets strewn around the house and despite Kim’s protests, was brought to ED.
Her past history includes asthma, for which she has had 5 previous ICU admissions with intubation, the last one being 4 months ago with a ventilator wean period of 3 weeks. She is compliant with her use of preventers and relievers.
You quickly place an IV and start a NAC infusion. Shortly after it begins she becomes acutely short of breath and becomes quite anxious. You stop the infusion and give her salbutamol and her symptoms slowly resolve.
When you go to restart the infusion, she refuses. You explain the kind of reaction NAC can cause and that it is not a true allergy and offer to start therapy to help prevent it happening again but she continues to refuse. You explain the reasons for the NAC infusion and the consequences of untreated liver disease and she refuses.
Her mother talks with Kim and asks you to start the NAC infusion despite Kim’s protests.
A number of issues in this case, please contribute to the discussion by posting your comments on twitter under the hashtag #CLaPSem01 If you don’t include the hashtag, your comments won’t be captured. If you need more than 140 characters (and you might do for this one!) feel free to comment below!
Don’t know how to use twitter? Try Dr. Tessa Davis’ excellent tutorials at http://lifeinthefastlane.com/reviews/techtuts/
Thank you for supporting this new concept