Welcome to the sensational 7th 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.
The Most Fair Dinkum Ripper Beaut of the Week!
The ripper of the week is undoubtedly RESUS.ME’s post on the effectiveness of the bum crack fluid pump.
But that’s not all Cliff’s been up to this week:
- What’s the best position for LP in kids? Some clever people have used ultrasound to tell us.
- A ‘case-control meta-analysis’ (if there is such a thing) found no factors that predict when laryngospasm will occur during ketamine sedation. It is very rare, but be prepared.
- Have you, like the LITFL team, been lying awake all night wondering what the normal SaO2 for neonates is? Wonder no longer as What’s a neonates normal newborn O2 sat? has the answers. By 8 mins only half all newborns reach an SaO2 of 90%.
- Lastly, in a monster week of resuscitation meducation from Cliff, if you’re going to do CPR, why not do it Hollywood-style? Turns out the works The Sichuan Straddle well.
The Usual Suspects
- In the bonus add-on to their last podcast, the SMARTEM team punched some gaping holes in the recent NEJM paper suggesting that antibiotics are beneficial for acute otitis media (as highlighted in the comment on this Pediatrics and Medicine blogpost. So this month, they plumb the murky depths of ear infections in Antibiotics for Otits Media: Feeling Better? Indeed, there is something for everything… including some old fashioned deceit.
- Scott interviews Cliff Reid from the blog RESUS.ME (see above,) a prehospital-retrieval specialist and director of training for the New South Wales ambulance service. Cliff is popping like a shaken bottle of champagne as he talks about pre-hospital airway management, gives insight into his blog, and has a rant about scoop-and-run vs stay-and-play in the prehospital setting. The LITFL team look forward to the promised follow up episode.
- Leon tells us about a unique case report in Atomoxetine-associated myocardial infarction: case report, and provides an interpretation of the meaning of such a unicorn (rarer than a zebra) with reference to an essay by EM legend Jerome Hoffman.
- In other posts we learn about Energy Drinks: Pediatric effects and a mystery is solved in Why does this normal-appearing infant have a high carboxyhemoglobin level?
Academic Life in Emergency Medicine
- Michelle teams up with Rob Orman (the dude from ERCAST) to produce a Paucis verbis card on Suicide Risk Stratification, although assessment is primarily based on physician judgment, using the TRAPPED SILO SAFE mnemonic will assist you greatly during your risk assessment of the suicidal patient.
- The Trick of the Trade focuses on the use of serial lactate in sepsis, touching on a recent article in JAMA that published a landmark study showing that lactate clearance of ≥10% over the first 2 hours is “not a worse measurement” than ScvO2≥70% in septic patients requiring EGDT.
- Do you routinely leave patients immobilised on back boards during your trauma assessment and imaging? This case report highlights a rare injury and a common complication of imaging through the backboard.
- Hmmm… the title of Joe Lex’s pick of the week certainly caught our attention: Do Intensivists Matter? – a talk by Don Chalfin. Of course they do… Or do they?
The Rest of the Best
- Nathaniel L. Scott discusses the use of Tranexamic acid in Haemorrhagic Shock.
- New LBBB and ST elevation sounds like a STEMI, ECG looks like a STEMI, but when is it not a STEMI? Dr Smith gives you the answer.
- This post highlights the need to always check out the pre-hospital ECG, not just the baseline arrival ECG on chest pain patients that arrive pain free after pre-hospital treatment.
Bradydysrhythmia Pearl; By Jeff Tabas
3 causes of bradycardia to consider when the rhythm is not clearly sinus bradycardia:
- Junctional bradycardia
- Hyperkalaemia
- Digoxin toxicity
- Two highly effective therapies added to the NNT database this week. Yep, ‘roids work for croup (NNT 5 for respiratory improvement).
- And therapeutic hypothermia after cardiac arrest has an immpressive NNT of 6 for mortality.
- Dr John is a cardiac electrophysiologist. His post, The first 4 months of a new era is a nice insight into his experience with dabigatran, the direct thrombin inhibitor that may make warfarin a thing of the past. Read it for a useful insight into the pros and cons of this drug and ‘life without levels’.
- Emergency departments are full of machines that go beep, we tend to think of them as the bane of our ED existence and the silence button as our best friend. Maybe Ian’s post on alarm fatigue, will change the way we look and feel about that annoying beep.
- ‘Cut it out you fool!’… It seems tobacco advertising what was quite different back in 1915, as this Anti-Smoking Sign shows:
- These day’s there are multiple ways of disseminating information to emergency physicians, from blogs, to Twitter, and Facebook pages however some avoid these for fear of privacy, and confidentiality issues. Could discussion forums be the answer to these issues? PEA takes a look at discussion forums and has even set one up through Google groups for emergency physicians to discuss, collaborate and share information over a secure moderated setting.
Twee-D and Twitical Care
Ed Burns’ magicianly work on the LITFL ECG Library is reaping the Twitter love. But you don’t need to tell us, @DavidThorisson!
@grahamwalker re-tweets about the difficulty some doctors have understanding Twitter addiction.
As always the ‘best’ is saved till last… Who could go past the humorous savagery of Dr @bungeechump:
Ouch!
News from the Fast Lane
- All present at Dr Mike’s debut run out as the Western Force team doc were seeking treatment for UV keratitis 12 hours later — apparently his over-developed cranium is highly reflective!
A Word from our Sponsors
- No word from UCEM this week… Their decision on whether to stick with LITFL sure is taking a long time…
The Final Words
“Hard work is a talent”
— Garry Kasparov
“Medicines heal doubts as well as diseases”— Karl Marx
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
Brilliant Work Kane
I am finding these reviews a great source of information, and keeping me up to date
Thanks for all the hard work!
Mike
Cheers Mike
Can’t take all the credit, had excellent support and guidance from Chris.
Kane