Welcome to the stimulating 28th 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!
- Andy over at Emergency Medicine Ireland has taken top spot this week with an excellent review on Why methaemoglobinaemia is a bad thing, its generally a mind numbing and neuro depleting task trying to get your head around methaemoglobinaemia, but Andy post is simple, easy to follow and highlights the important points surrounding this topic.
- Andy also has a look at and rants a little bit about in procedural sedation for abscess drainage.
The Usual Suspects
- Crike rate 1 in 500 in Scottish ED, are these low rates of surgical airways going to affect the way we train for the difficult airway in the future, or are we getting better at securing the difficult airway now without resulting to the knife??
- Effect of physician specialty on pre-hospital intubation success. Take home point: looks like experience counts.
- Prehospital resuscitative hysterotomy , although the outcome wasn’t good, the authors should be commended for attempting this in the pre-hospital arena and disseminating the lessons that have been learnt from this case. Looking forward to reading this case in full, should anyone have a copy they could email me?
- It’s up to you…. when you have nothing to loose, its better to have a crack than wondering about the what if’s -most of time. So start practice simulating these in your mind now, and make these experiences more positive than negative in the future.
- Verapamil vs adenosine for SVT. The bottom line, “Adenosine and verapamil have similar efficacy in treating PSVT. Adenosine has a higher rate of minor adverse effects, and of overall adverse effects, whereas verapamil has a higher rate of causing hypotension. A decision between the two agents should be made on a case-by-case basis and ideally involve informed discussion with the patient where appropriate.” Glad to see some excellent research coming out of Australia!
Emergency Physicians Monthly
- Are you routinely faced with the problem of To Aspirate Or Not To Aspirate? in patients that present with ? peritonsillar abscess. The answer could be in the probe…Yes that right they have found another awesome use for ultrasound in the emergency department.
- David and Ashley dive into the literature surrounding the use of PPIs in Upper GI Bleeds, seems the literature is more messy and offensive than the haematemesis.
- Despite Known Risks, EPs Not Prepared to Treat Hemorrhagic Complications of Thrombolysis, i had never thought of this, but something we all need to read before we administer thrombolysis to our next stroke patient.
- Joe’s pick of the week is by Kevin Reed on Chief Complaint- Foot Sticking out of the Vagina.
Academic Life in Emergency Medicine
- Paucis Verbis: Diagnostic testing tips for acute abdominal pain. This is one of the best Paucis Verbis cards of late, packed full of excellent pearls giving you a simplified approach to approaching imaging in common abdominal complaints.
- Trick of the Trade: I know our emergency ultrasound specialist have proved that they can practice emergency medicine in the dark, however now its looks like they can do it Underwater ultrasonography.
- Article Review: Redesigning a Powerpoint lecture using multimedia design principles,nice points on reshaping our slides to give better presentations.
The Poison Review
- How to avoid rare but devastating N-acetylcysteine overdose . As Leon sums it up “Although these cases are rare, they can be — as in this instance — devastating, and this paper is worth reading as a cautionary lesson.” Check out the LITFL Critical Care Drug Manual for all your tips and tricks for administering NAC.
The Rest Of The Best
- What to you get when you have an elderly female patient thats hypotensive, pale and complaining of central abdo pain? A ruptured AAA of course-nope not this case!! Time to probe for the other causes, that can present simliar to a ruptured AAA.
Aisha Liferidge supplies us with weeks pearl on ‘What is PRES”.
- Posterior Reversible Encephalopathy Syndrome (PRES) is a relatively newly-recognized condition characterized by headache, convulsions, confusion, and vision loss(i.e.“CCCV,” ”Cephalgia,Convulsions, Confusion, Vision loss.”)
- Risk factors include: severe hypertension, eclampsia, renal failure, and use of immunosuppressive medications such as tacrolimus and cyclosporine; low magnesium levels may exacerbate PRES.
- PRES may be under-recognized because its diagnosis is based on both clinical and radiographic findings. Brain MRI findings classically show bilateral hyperintensedensities in the parieto-occipital regions on T2 weighted images (see attached image).
- Treatment of PRES consists of managing the underlying cause such as lowering blood pressure and discontinuing offending medications, which typically results in resolution of symptoms.
- Take Home Point: Consider PRES as the etiology of unexplained constellations of symptoms including headache, seizure, confusion, and vision loss in the setting of severe hypertension, particularly amongst patients with renal failure and on immunosuppressants.
Annals of Emergency Medicine Podcast
- This months podcast David and Ashley review the following topics looking at radiation exposure from CTs, the true ‘discriminatory zone’ for beta-HCG when an IUP is not visible, a randomised trial of an oral chelating agent for iron ingestion and much more.
- Picking Up the Subtle Right Ventricular MI. Right ventricular myocardial infarction (RVMI) is thought to occur in up to 50% of inferior wall infarcts. Its early recognition and treatment is important because it retains a unique haemodynamic response profile with high risk for decompensated cardiogenic shock.
- Some Lessons Learned From ACEM 2011 Bangkok focuses on the emergency drugs of abuse in Asia, and the medical complications of riot control agents.
- Casey reviews and makes some excellent point on the newest drug in the anticoagulation range - Dabigatran – Clexane you can swallow.
- Kid’s coconuts and CTs. Paediatric head injury, who to scan who not to scan? Does it all come down to the PEACAN, Casey provides us with a new approach on when to order a CT scan in minor blunt head trauma.
The Trauma Professional’s Blog
- Rib Fracture Management the big 3 keys things are:
- Pain management
- Respiratory hygiene
- Activity Management
- And if the above fail Fixation of Rib Fractures can sometimes be of benefit.
- Hopefully we can now stop doing LP’s to rule out SAH if CT scan performed within 6 hours of onset, and you have access to experienced radiologist!!
Twee-D and Twitcal Care
Some sound advice finally from @bungeechump:
News from the Fastlane
- Dont forget only a couple of days left for our Jeans for Genes Double-helix tongue twister challenge.
The Final Words
- 90 percent of success is showing up.
-Woody Allen
- Patient geography should not determine the level of care they receive.
-Scott Weingart
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
For a view into an area previously ignored but now emerging as a bonafide public heath epidemic due to the survival rate of those who previous would have succumbed http://www.icudelirium.org Vanderbilt university School of Medicine US
Hi Bruce.
Thanks for the heads up on the site. Agree its an area that has previously been ignored, but now getting the attention it deserves.
Regards
Kane