Welcome to the 4th edition!
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.
We’ve introduced a new feature this week — what the LITFL team considers the most indispensable, highest yield, most flagrantly brilliant educational gem we’ve unearthed over the past week. It’s called:
The Most Fair Dinkum Ripper Beaut of the Week!
- The Newman and Shreves tag-team take on Paediatric UTIs in this month’s podcast. They confirm the LITFL team’s suspicions with a deep dive into the murky depths of the literature underpinning (or should that be undermining?) how we approach urinary tract infections in children. The bonus section features their dismantling of the recent NEJM paper by Hoberman et al, which claims that antibiotics should be given for otitis media — it is not to be missed.
The Usual Suspects
- This week the fantastic ERCAST celebrates it’s first birthday — congratulations Rob! Dr Orman is clearly pretty excited about his recent induction as a Fellow of UCEM, which entitles him to use the F.UCEM post-nominals and proudly wear the yet-to-be created UCEM budgie smugglers. The meat of the podcast is a return to Rob’s anal fixation (he covered rectal foreign bodies in his very first podcast) with perianal abscess as the subject.
- Scott has finally got to the bottom of a mystery that has been gnawing away at him since his 16th podcast: the origins of the DOPE mnemonic. Amazingly, thanks to a letter from Ahad in Saudi Arabia, it seems that this handy heuristic for identifying the causes of post-intubation desaturation comes from oil workers in the 1950s…!
- This week Leon gives his take on the recent study study its OK to give IV calcium in patietns with digoxin toxicity in Heart of Stone?: calcium and digoxin toxicity. He also asks, Hyperbaric oxygen therapy for carbon monoxide poisoning: do we know the answer? No, it seems we do not.
Academic Life in Emergency Medicine
- Michele Lin gives us a quick and easy guide to the the shoulder exam, the latest addition to her Paucis Verbis card series. She also reviews the NEJM iphone app, and presents an inspiring talk from TEDx that shows how education is changing, from the old and outdated classrooms to the new virtual classrooms of social media and online learning, in From Knowledgeable to Knowledge-Able.
- As always, Cliff Reid has been busy ferreting his way through the morass of new resuscitation literature this week. As well as highlighting the work of Rich Levitan, who we featured in last week’s review, in Paediatric airway gems, he finds out that helicopters probably do save lives in Helicopters and trauma: systematic review and reveals that RV involved in AMI more often than you think… the right ventricle is involved in up to a third of anterior MIs.
- LITFL readers well know that the LITFL team likes to celebrate, and even participate, in the advancement of clinical toxinology through self-experimentation. However, as we find out in Diamondback bite, emergency physician envenomings don’t always end happily…
- There’s plenty of advice to live by in Joe Lex’s pick of the week from Free Emergency Medicine Talks: Don’t Drink Your Drive by Toby Carroll. It covers all the nasty toxic fluids that can be found in your car.
The Rest of the Best
- An irrational fear of ketamine’s “bite” makes it one of the most under-rated drugs in the ED doc’s arsenal. Taming the Ketamine Tiger is a useful update on how to use the drug safely and effectively, and is a great adjunct to LITFL’s case-based Q&A on on the use of ketamine sedation: Nasal foreign body, ketamine and laryngospasm.
- “An 8 yr old girl presented with 24 hours central abdo pain which had shifted to the right of her umbilicus. She had vomited 3 times since the onset.” Can you make the diagnosis based on Adrian Goudie’s ultrasound video images? Here’s the case in ‘test yourself’ mode. And, no, it ain’t appendicitis…
- Some kids get tummy aches all the time… usually from eating too many ‘tiny teddies’. But when might it be something more sinister? Colin and co address this, and many other questions, in the latest empem.org podcast: abdominal pain in children.
- The violent and aggressive patient is often a daily encounter in the emergency department. David shares some tips and tricks of the trade in managing these difficult patient’s effectively in his latest podcast. Professor Staghorn has suggested that the Billy Mallon F.UCEM receptor-based approach to difficult patients deserves further emphasis: “we have the drugs… they have the receptors. We just have to put the two together”.
- Teaching Residents Soft Skills: soft skills relating to professionalism, communication and empathy lie at the hidden center of our profession. This week Robert Cooney looks at 52 precepts the doctors should regularly consider… That’s one a week for a year! This post follows on nicely from Rob’s two-part discussion on mindful practice: part 1 and part 2.
- Prophylactic Antibiotics for Reducing ICU Respiratory Tract Infections and Mortality in Adults: what’s the bottom line from this, the most recent entry in the NNT database? For those who received both topical and systemic antibiotics 1 in 18 lives are saved and 1 in 4 had one respiratory tract infection prevented. Harm is not quantified. Be sure to explore this growing resource.
- Charlene present us with a case of an alcoholic patient, who’s sustains a small subdural haematoma that’s initially gets managed conservatively, however 3 weeks later after getting rejected from the rehab clinic due to some slight neurological symptoms he gets another CT scan find out what its shows here.
- “Witch” doctor are you destined to become? ….Maybe it’s Dr Maverick or Dr Buzz-kill. A beatboxing blast from the past from Dr Harry And The ZDoggMD.
Twee-D and Twitical Care
- This week from Twitter, we feature Tacoma-based emergency resident Aaron Grey. Keep on tweeting mate!
News from the Fast Lane
- Following the post on A Motorcyclist’s Irreparable Injury the LITFL team received news from emergency medicine legend Billy Mallon F.UCEM, of an outbreak of another condition affecting iPhone users in Los Angeles:
“Certainly this is tragic, but nowhere near as bad as the “i-phone up the assicus” phenomena encountered in LA. In the i-phono-recto-sigmoid FB situation the hapless victim is often still trying to reach the phone to see if they have an “app” that will help, and find themselves scrolling across the prostate…….. all while contorted like a Russian acrobat.”
A Word from our Sponsors
- From the UCEM Facebook page:
The Final Words
“Pus is like the truth — you have to let it out.”
Gareth Morris-Stiff
“One finger in the throat and one in the rectum makes a good diagnostician.”
William Osler
That’s it for now… Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps you to deal with anyone, anything, anywhere at anytime for at least another week!
If you’d like to suggest something for inclusion in the next edition of The LITFL Review, email our roving reporter: kane AT lifeinthefastlane.com
About Kane Guthrie
