Welcome to the post-Essentials 44th 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 taken out by Haney Mallemat with this awesome pearl on “The risks of intubation with pericardial tamponade!” – not something we do every day, but important to know when we do.
- Positive-pressure ventilation (e.g., mechanical ventilation) increases intrathoracic pressure potentially reducing venous return, right-ventricular filling, and cardiac output.
- Pericardial tamponade similarly causes haemodynamic compromise through increased pericardial pressure which reduces right-ventricular filling and cardiac output.
- When mechanically ventilating a patient with known or suspected pericardial tamponade the mechanisms above may be additive, causing cardiovascular collapse and possibly PEA arrest.
- For the patient with known or suspected pericardial tamponade consider draining the pericardial effusion prior to intubation or delaying intubation until absolutely necessary.
- If intubation is unavoidable, consider maintaining the intrathoracic pressure as low as possible (by keeping the PEEP and tidal volumes to a minimum) to ensure adequate cardiac filling and cardiac output.
The Usual Suspects
- Joe’s pick of the week is by Ingrid Lim on Troubleshooting AICDs.
- Scott provides us with a short, sharp and straight to the point podcast on managing and restraining the patient suffering from an acute behavioural emergency in: On Human Bondage and the Art of the Chemical Takedown.
- Also if you’re depressed enough like me because you couldn’t attend EssentialsofEM this year, Scott provides us with a wrap up and highlights of his trip Essentials of EM 2011 with special mention to LITFL own Dr Mike “Crocodile Dundee’ Cadogan.
- BromodragonFLY mislabeled as 2C-E caused two deaths in Oklahoma — and Leon provides us with some excellent links for you to learn everything you wanted to know about BromodragonFLY.
- Cliff provides us with an update on the 2011 Asthma Guidelines from the British Thoracic Society — although not a lot has changed since the 2009 version, it’s a good refresher for us all.
- Preoxygenation and Prevention of Desaturation — Cliff gives us a summary of this brilliant article by the man behind EMCrit.
- Trick of the Trade: Ultrasound-guided injection for shoulder dislocation — Great trick and it takes away the risk of procedural sedation.
- Paucis Verbis: Methotrexate for ectopic pregnancy — a nice guide to who is eligible, which patients are contraindicated, and what does to give.
- Stuart Swadron gives us The Low Down on Ano-Rectal Disorders featuring perianal abscess and check out Mel’s video below.
- The Pain Problem — When managing acute and chronic pain in the emergency department, EPs struggle to walk the line between being cold-hearted cynics and becoming sugar daddies.
- Coordinating Care for Athletes with Possible Concussions — as we head back into football season, do you know which players with a ding to their head need a CT scan? This article answers that question nicely.
- Unusual Paediatric Cases are Rarely Slam Dunks — time to put on your detective hats and crack the diagnosis in these three paediatric cases.
- Atrial Repolarization Wave Mimicking ST Depression — Learning point: Beware diagnosing ST depression before considering the atrial repolarization wave as the etiology.
- Hyperacute T-waves, with a Twist — This post illustrates nicely how hyperacute T-waves are present not only shortly after occlusion, but also shortly after spontaneous reperfusion, or, as Dr Smith says: “both as the ST segments are on the way up, and on the way down.”
- We have brought the concepts of “upstairs care, downstairs”, but now look like we are bringing the drugs as well; Dexmedetomidine has found its home in the ED: Pediatric painless procedures.
The Rest Of The Best
- The November Sharp End Newsletter is out, covering the big topics from the Sgarbossa’s criteria, to using ultrasound to identify paediatric abscesses and highlights the UCEM waiting room.
- The how and what to do when approaching the paediatric patient with a Traumatic Pneumothorax.
- Anyone want to go on Retrieval? — David teams up with Tim Harraway for having this discussion about the ins and outs on retrieval care.
- VBG to diagnose DKA — Andy gives us the heads up on this lovely observational study showing that a VBG is equally good for diagnosing a DKA as sending a formal serum electrolytes.
- Heparin v LMWH for STEMI with PCI — we still don’t know if either of therapy work well in ACS treatment.
- Computers – Probably Better Doctors for UTI — It seems computers are better at detecting and treating UTI than doctors!!
- When Parents Refuse a Septic Workup — what would you do in this situation? — this article provides food for thought.
- Ethanol – Miracle Drug (For Stroke) — forget the tPA in stroke — now its time to get your patients tipsy!!
- Conflict of Interest in TPA Literature — Ryan share’s with us a publication written by him looking at the ECASS-III trial and noting that 12 of the 14 investigators were paid, sponsored, or employed by the manufacturers of alteplase – which muddied my estimation of the reliability of the conclusions.
- Casey sets the bar high for us to crack this Paediatric Puzzler case!
- Disaster strikes — what would you do, and would you approach this scene if you were sent to it.
- Sexual Healing — Casey shares with us a video made by some medical students tackling astonishingly high rates of STIs. Warning: there are some seriously tasteless and adult themes in this video.
- Sudden visual loss — Peter gives us a quick guided approach to managing this difficult presentation.
- If A Tree Falls In A Forest… — Bottom line always consider the benefits vs the risk when ordering diagnostic tests.
Twee-D and Twitcal Care
Minh Le Cong has joined the Twitter universe follow him @rfdsdoc
And check out this pearl from EssentialsofEM
News from the Fastlane
- Chris is preparing to launch R&R In The FASTLANE and has lined up some amazing contributors check out who’s in (here).
- Mike is on his way back from EssentialsofEM — check out all the Twitter action from the conference in Essentials Of EM Day 1 Twitter Stream and Essentials Of Emergency Medicine 2011 Final.
- Rumor has it a new author is joining the team over the coming days… Stay tuned to find out who it is!!!
The Final Words
- “I was permitted by my medical badge to follow the poor, defeated body into those gulfs and grottos.”
— William Carlos
- “…if you don’t read the nursing triage notes at the bedside — be prepared to read it on the stand… in court”
— Greg Henry
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