Existe el concepto errado de que #FOAMed es sólo para personas interesadas en la medicina de Urgencias y Prehospitalario. Es cierto que grran parte del movimiento está dedicado a estas especialidades, pero existe una inmensa variedad de otras especialidades que utilizan #FOAMed para difundir, discutir y desarrollar ideas y mejorar sus competencias. 

Esta guía es para todos ustedes, allá afuera, que buscan una pequeña ayuda para descubrir el movimiento #FOAMed. Quizás quieres involucrarte en el ciclo 24/7 de novedades en tu especialidad o quizás quieres contribuir. En el 2016, esto no podría ser más fácil.

1. Es gratis
2. Es fácil de usar
3. Es el futuro de la educación médica

Como comenzar
​1. Entra a twitter. Crea una cuenta gratuita y usa la etiqueta #FOAMed para descubrir a quien seguir
2. Instala twitter en tu teléfono. Verás las actualizaciones de los que sigues en tu especialidad.
3. Crea una lista (marcadores) de tus blogs o páginas web favoritas que utilizan #FOAMed
4. Googlea #FOAMed y tu especialidad para ver los resultados
5. Usa el sitio LinksMedicus para encontrar las páginas #FOAMed de tu especialidad como también otros sitios increíbles!
6. Involúcrate en conversaciones utilizando en hashtag  #FOAMed en twitter
7. Inicia conversaciones acerca de cualquier tema médico utilizando el hashtag #FOAMed junto a #Radiologia, por ejemplo
8. Invita a tus colegas a hacer lo mismo- caras amigas con mucho que aportar.
9. Pon tus presentaciones online utilizado Slideshare o alguno similar, es gratis. Puedes linkearlo a twitter!
10. Si tienes un montón de material o presentaciones, crea un blog gratuito en Wordpress o similares y publícalos online!

Aquí hay algunas herramientas de búsqueda #FOAMed

Melatonin - considered by some to be a 'herbal myth' and others as a useful adjunct to help sleep in ICU patient and adults >55 years old. There is biological plausibility that melatonin could be a useful adjunct to aid restful and efficient sleep in those who could be deplete in melatonin. 

Overall - a meta-analysis here in 2013 showed that there was some evidence to say that it could work in some cohorts. Given its relatively safe profile, it could be useful to trial in patients with a sleep disorder. Particularly it could be of use in ICU, but, the evidence is currently out - awaiting a larger RCT. It's a cheap drug and even cheaper in the USA where it is available OTC. In patients who are restless or unable to sleep in a busy ICU, perhaps it has a role in being a first drug of choice before considering more 'heavy' sedative alternatives given it is a non-narcotic. 

The studies mentioned below are indeed rather small and a few are single-centre analyses, so we cannot say for certain whether there is true efficacy, but many practitioners would agree, it's certainly worth a go providing there are no obvious contraindications in your local formulary (primarily, not to use in patients with autoimmune conditions) and the person does not require heavy sedation for other reasons.

Outside ICU, the drug is quite popular with GP's and could even be used more frequently as a first line alternative to Z-drugs or benzodiazepines in a hospital cohort. Sleep deprivation, it will come as no surprise, is rife in hospitals - I think we can all agree, that any adjunct to promote restful sleep without being profoundly 'sedating' could be a useful drug. I look forward to seeing more definitive studies in the future.

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Full article here and here.

 Dr. Sergey Motov (USA Emergency Medicine) & Dr. David Lyness (UK/IRE Anaesthetics)
Originally put on this website in July 2016
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Taken from Dr Motov's work on a CERTA regime.
This is published in conjunction with the CERTA concept explanation here. 
We can all provide superior analgesia by using medication and techniques other than just opioid medications.
This is NOT a definitive list and in all cases, local policies and protocols should be followed. Check your local formularies.
This is NOT a prescribing guideline - it is for information ONLY.

We do not dispute the role of opioids in many spheres of practice, including emergency medicine, ICU and anaesthetics, rather we wish to highlight the pandemic of high opioid and opiate use. There are many medications available to reduce the amount of opioids used.
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You may find, when considering  your analgesia regimes that opioids are not always  the best options for emergency pain issues.
We would advocate the use of nerve blocks in the first instance to control acute pain, when feasible. 

1. Consider the use of PPI's when using NSAID drugs.
2. Caution with using NSAIDs where surgery could be imminent.

With respect to alternatives listed for non-radicular back pain, it has been brought to our attention that a new study was presented in 2017 which showed that "diazepam has no benefit when added to naproxen vs placebo" in acute low back pain. See here.

This document is for review in 2018 - so please contact us if you have anything to add!

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​References in document below...

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I have collaborated with Dr. Sergey Motov from New York, USA to bring a series of infographs on a great new concept of CERTA pain relief with the hope of reducing opiate use. This is the latest line in thinking about MULTI MODAL pain relief and characterises the ideas behind multiple analgesic combinations to reduce pain, reduce sedation and provide maximal analgesia to patients in acute pain. Part one below describes the MAIN concepts of CERTA. It should be food for thought to all...

Channels, Enzymes, Receptor Targeted Action!

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