Welcome to the glorious 41st 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!
Top spot is dominated by Casey Parker at Broome Docs this week, with brilliant posts that simplify the evidence and provide us with inspiration for doing what we do — remember Casey does what we do with only a fraction of what we have access to!!! Casey starts of with a case in Big transfusion, Little Hospital = big trouble — what would you do to manage the massive transfusion requirements of this patient out in the bush? Next up is a hard-hitting review of managing traumatic bleeding: how can we apply the evidence in smaller hospitals? — don’t be fooled by the title of this post, it is just as useful in the big hospitals as well. Meanwhile ‘promiscuous’ blogger Minh Le Cong is also featured with part 2 of his case on No Airplane, no airway! and Casey gives you his nickel on how he would approach this case.
The Usual Suspects
- Want to get that SCAPE (sympathetic crashing acute pulmonary edema) patient off the NIV — Scott gives a guide on how to to wean the CPAP in SCAPE — bottom line get the BP down and the patient looking good before even considering it.
- Chemical suicide by the slaughterhouse sledgehammer effect — sniff for the characteristic smell of rotten eggs, remove and bag the patients clothing and give excellent supportive care.
- FDA warns about linezolid, methylene blue association with serotonin syndrome — Leon also highlights some other drugs placing your patient at risk of serotonin syndrome.
- Just when you thought it was safe to go back to Malaysia . . . lethal box jellyfish stings strike again!!
- No pressure immobilization in U.S. pit viper bites — it may increase the risk of developing local pressure necrosis.
- David shares with us his presentation to ACEP 11 looking at all of the Numbers Needed for Badness (NNBs) to happen and how to document this in the patients notes.
- Ian has taken the deep dive into the world of podcasting with a look at veinipuncture: audio walk-thru, this short handy little podcast is an excellent resource for your new students, doctors and nurses that are preparing for their emergency department rotation.
- Message from Dr Doug Lynch — a follower shares his inspired views on what web 2.0 has done for him and his career…Thanks for sharing Cliff.
- ‘Cryptic shock’ important but not always very cryptic — the bottom line according to Cliff: “This paper makes an important contribution to the sepsis literature by warning against the dismissal of an elevated serum lactate in the setting of apparent haemodynamic stability as being a less acutely ill patient than one presenting with overt hypotension. It provides a reminder to check the lactate in patients with infection and signs of systemic inflammatory response, since this may provide the only early evidence of hypo-perfusion.”
Academic Life of Emergency Medicine
- Paucis Verbis: Ventilator settings for obstructive lung disease another brilliant little card for dominating the ventilator.
- Joe’s podcast of the week gets a little bit controversial with a talk by David Nelson on Should we being doing subcutaneous rehydration?
- The Nuts & Bolts of Finger Amputation – an excellent step by step approach to managing these devastating injuries.
Time to put on your ECG caps chaps (and chap-esses) and tackle these cases’ from Dr Smith:
The Rest Of The Best
- Colin and Kate team up with Dr James Rippey “The man who proved that emergency medicine can be practiced in the dark” to talk about UltraSound uses in Paediatric Emergency Medicine from its current use and role, and a brief look at the new and crazy direction it’s heading.
- US Scalene Block for Shoulder Reduction — time to forget procedural sedation and reduce your patients length of stay by half.
- Andy gives us a handy pictorial guide to Anatomy for EM – The Cervical Spine.
- Your Next Patient: A 76 year old man with abdominal pain — what is the diagnosis and what are your goals for managing this case.
- David shares with us some lesson learned on the paediatric rotation — the biggest take home point: “Even the paediatricians are not really sure where to draw a line between bronchiolotis and bronchitis.”
Keeping Up with Emergency Medicine
- This weeks highlights some Aussie literature looking at the DORM study a randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance:
- Twitter is really starting to take off at conferences. It’s an awesome way for people who attend conferences to share the pearls from the speakers so that people who aren’t there can keep up with the new research, tips, tricks and concepts. GruntDoc hasn’t disappointed after attending ACEP 2011 conferences he has put together a Best of my ACEP 2011 Twitter feed post — well worth checking out.
Emergency Medicine Literature of Note
- Hypertonic Saline In Cardiac Arrest — no change in survival, but may cause more neurological demise.
- Preventing Mechanical Ventilation in Newborns — Simple takeaway message — surfactant isn’t just useful after intubation, but may also prevent mechanical ventilation.
- Ultrasound In Undifferentiated Infant Vomiting — it’s nearly time to say there is nothing ultrasound can’t do!!
- A Third of tPA Patients dont have Strokes — and luckily that didn’t go on to have ICH.
- EMS Blood Pressures Aren’t Unreliable — maybe it’s time to trust our pre-hospital colleagues.
- avR- ‘the little lead that ‘ is a very important lead as it can give us information on potential ischaemia in the LMCA, but may also indicate three vessel disease and LAD disease. This is important as most of these lesions will require CABG.
- Clearing the cervical spine often its comes down to doing more, instead of less and ordering that CT neck!
Michael Winters delivers this weeks pearl on SAH and Electrolyte Disorders:
- Hyponatremia can be seen in up to 40% of patients with a SAH.
- Most often, hyponatremia in patients with an SAH is due to SIADH or the cerebral salt wasting syndrome.
- To date, hyponatremia has not been associated with poor outcome.
- Treatment should focus on the underlying cause and often includes volume replacement with isotonic crystalloids (0.9% NaCl).
The Trauma Professional’s Blog
Michael gives us the ultimate guide to performing emergency resuscitative thoracotomy, in this 4 part series:
A Life at Risk: the Emergency Physician
- Acute dyspnoea and X-Ray — Take home point: approximately 1 of every 5 patients with decompensated heart failure had no signs of congestion on ED chest X-ray.
- Acute appendicitis and Symptoms — what is the likelihood ratio that this patients has appendicitis? It may surprise you were the number lie?
Twee-D and Twitcal Care
@impactednurse redefines some of the buzz words we use everyday.
and
News from the Fastlane
- Ed Burns is back again with another ECG masterpiece added to the LITFL ECG library; check out Lateral STEMI.
- Meanwhile, Mike is fluctuating between levels 5,6 and 7 of lecture preparation as he gears up for the Essentials of Emergency Medicine in San Francisco.
- And Chris asks Do you use Web 2.0 in clinical decision making?… and gets plenty of replies.
The Final Words
- ”Purpose of a lecture is not to transmit information, but to change behavior.”
— Amal Mattu
- “Critical Care is a level of treatment, NOT a location!”
— Cliff Reid
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
Just a note about fingertip amputations: in Australia, it is generally accepted practice to have these managed by a hand surgery service (either a hand surgeons, plastic surgeons, or orthopaedic surgeons). This is mainly because some of these will benefit from flap reconstruction acutely (and there are a wealth of flaps described for the reconstruction of fingertip injuries -- see http://rlbatesmd.blogspot.com/2008/10/soft-tissue-injuries-of-fingertip.html).