The LITFL Review 001

Welcome to the very first edition of The LITFL Review!

What is The LITFL Review?

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 Usual Suspects

EMCrit Blog

• This week Scott Weingart F.UCEM presents his ED Critical Care Dirty Dozen for 2010. Scott provides a nice review of the top online resources in emergency medicine/critical care for 2010, though it looked like his meds were wearing off by the time he got to No.2 on the list…

Emergency Physicians Monthly

• Stuart Swadron F.UCEM provides a simplified approach to vertigo. The article gives you key points on diagnosing peripheral vertigo, and provides you with pearls and pitfalls to minimize your risk of sending a patient home with a cerebellar stroke. The article goes nicely with the EMCrit podcast on diagnosing posterior stroke.

The Poison Review

• Leon Gussow F.UCEM features a case from Paul Gee and colleagues on DMAA-related intracranial hemorrhage titled DMAA; A new party pill. Mike has previously tackled DMAA (also know as methylhexanamine) from the sports medicine perspective on LITFL here. Leon’s post on the clinical significance of serum lactate on acetaminophen toxicity is also worth reading as it highlights the prognostic implications of paracetamol’s direct and indirect effects on lactate in the overdose setting.

EMRAP: Educators Edition:

• This month’s podcast looks at Educational Resources in Emergency Medicine. Rob Rogers F.UCEM highlights his favourite  blogs, podcasts, and educational sites  in emergency medicine, and gives us the heads up on what will be coming up in 2011 on EMRAP: Educators Edition.

ERCAST

• Rob Orman F.UCEM overcomes his obsession with budgie smugglers (it’s a long story…) to talk to the above mentioned education podcast gurus Scott Weingart and Rob Rogers in a podcast about the divide between academic and non-academic careers in emergency medicine.

Resus.ME

• Cliff Reid F.UCEM this week has a look at all things tracheostomy. The post tracheostomy bleeder can be a death sentence for the patient of the unwitting critical care practitioner, whether in the ED or the ICU. Cliff has a must-read post on this disaster waiting to happen. In another post, Cliff also provides a link to the excellent National Tracheostomy Safety Project — check out the useful flowcharts.

Academic Life in Emergency Medicine

• Michelle Lin F.UCEM and the team this week crank out another great paucis verbis card looking at sutures, which details the in-and-outs on on different materials and the optimal suture removal times. They also take a look at diagnoses that sound alike with some interesting comments on the post by LITFL’s own @precordialthump.

MicroGnome

• This week Tim Inglis F.UCEM gives a shout-out to his best of the rest in a look at his favourite micro and infectious disease blogs.

Impactednurse

• Ian Miller gets all alternative with a post looking at Mindfulness Based Stress Reduction, a program that teaches doctors and nurses a set of tools and techniques for meditation and yoga to help reduce stress. He also gets all warm and fuzzy by setting the new standard in thank-you cards.

The Central Line

• Graham Walker F.UCEM gnashes his teeth as he blogs about one of his pet-hates: The Blood Test Lavage in GI bleeding. He also takes a swipe at cranial crockpots, with a post on Pain and Prompting.

EM:RAP.TV

• Mel Herbert and the EMRAP team present a short case by trauma surgeon Kenji Inada on vascular neck trauma. The case highlights and demonstrates the important points of applying pin-point pressure over the site of maximal bleeding in vascular neck trauma.

The Rest of the Best

Critical Insight

• This blog was brought to our attention by Neuro-ICU.com‘s Oli Flower, who is also part of the LITFL team. Dan Harvey has created a hybrid blog/ journal club providing post publication peer review of the intensive care literature. Readers can register and submit their own posts. The blog most recently featured the provocative topic of NMB in Early ARDS.

Free Emergency Medicine Talks

• A great talk by Mervyn Singer called “Less is More in Sepsis” discusses why blanketed measures may not work in severe sepsis (or may even cause harm) and why there is a need for individualized targets and treatments.

Educational Pearls

• If you subscribe to the monthly email update from the UMEM Department of Emergency Medicine you will have seen these useful tips from Fermin Barrueto on the use of naloxone

1. Naloxone is the epitomy of an antidote with complete reversal of opioid toxicity within 60 seconds of administration. Remember your clinical endpoint should be respiratory effort. If you utilize “the vial” of either 0.4mg or 2mg and there is a higher probability of withdrawal and for acute lung injury.
2. Here are some tips for administration:IV Access: Try 0.1 mg or even 0.05 mg – anesthesiology typically doses naloxone in micrograms. Reversal is slower so you have to be patient. It is also not as dramatic so closely monitor respirations to see if you have improvement, that may be all that you get.
3. These are probably patients that you don’t want that awake anyways.No IV Access: advantage of naloxone is it is bioavailable IV, intranasal and even by nebulizer.  Here you want the dose to be 0.4mg to start for intranasal. Nebulizer is difficult to measure and probably safe to start with 2mg in the nebulizer container.
4. There is a difference when you know it is an opioid overdose and are reversing apnea versus a diagnostic administration to determine if it is opioid toxicity. In the former instance you can rationalize the large dose – just be ready and be sure you are not in line of the possible projectile vomiting.

Clinical Cases and Images: Casesblog

• Dr Ves F.UCEM takes a look at why you should start blogging in 2011:
  “Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.”

Movin’ Meat

• Kidney stones are rarely if ever life threatening,  however this fascinating story by Movin’ Meat shows how a kidney stone can be life saving.

Biting The Dust

• Our favourite bush pharmacist Robbo features Soil Transmitted Helminth Infections on his blog. The post raises awareness of the health problems posed by intestinal worms, and provides us with an insight into this neglected disease.

ZDoggMD

• ZDoggMD gives you his New Year resolution to improve the American health care system, check-out OsamaCare.

hqmeded

• Hqmeded was one of the best new emergency medicine education sites in 2010, and its look like it’s only going to keep getting better in 2011. R. Pete Thompson presents the case of a 65 year old female with  out of hospital cardiac arrest, and emphasizes use of emergency department ultrasound to diagnosis pericardial effusion and tamponade. Also worth watching is Jon B Cole’s talk on Body Packing and Stuffing. Stay up to date with all things hqmeded.com by following them here on Twitter.

empem.org

• Colin Parker takes a look at croup in  this month’s podcast. The podcast comprehensively deals with the topic of croup, including conditions that mimic it, through to assessment and management of this potentially (but rarely) life threatening respiratory condition.

The Trauma Professionals Blog

• This blog  features trauma topics for trauma professionals. This weeks post shows you how to read a stab wound. Sherlock Holmes eat your heart out.

Twitter Meducation News

• Colin Parker from the paediatric emergency medicine podcast EMPEM is now a tweeter — welcome to the club @empemorg! Also the LITFL team has rediscovered that Rob Orman from ERCAST is on Twitter… Follow him at @emergencypdx.
• While looking for resources to help with writing blog posts, @precordialthump tweeted this:

• Finally our very own @sandnsurf features in the BMJ Careers article “Twitter going global” — yet another must read.

News from the Fast Lane

Life in the Fast Lane:

• Among the big news at LITFL recently was the announcement of UCEM’s 2011 New Years Day Honours List. The first Fifty F.UCEM’s are Grandfather awards for the fifty fondling members who have demonstrated the excellence in their respected fields and uphold the ideals of the Utopian College – supremus totus vindicatum haud officium. Many of of the shining lights of EM/CC blogging and podcasts made the list, as you may have noticed from the large number of F.UCEMs featured in this post.
• LITFL’s online podcast database is now well and truly up and running. Searches are superfast and it is amazing to have over 1400 high quality, free talks, videos and podcasts right at your fingertips! Take it for a spin here.

A Word from our Sponsors

Resus.ME recently advocated the use of Crunchie Bars for teaching how obtain intraosseous access. EgertonYDavisIV, speaking on behalf of UCEM, made the following announcement:

The Final Word

“You are the patient’s advocate. You work for no one else.”
— Clifton K. Meador

*****

That’s it for now… Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps to you deal with anyone, anything, anywhere at anytime for at least another week!

If you’d like to suggest something for inclusion in the next weeks edition of The LITFL Review email our roving reporter: kane AT lifeinthefastlane.com