Welcome to the awe-inspiring 53rd 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 this week is taken out by Scott over at EMCrit when he teams up with Dr Paul Marik to try and answer one of the toughest questions in critical care on assessing fluid responsiveness in the critical ill patients. Check out Podcast 64 – Fluid Responsiveness with Dr. Paul Marik.
The Usual Suspects
- Reuben shares with us a new approach to bag-valve mask ventilation 11 minute screencast: emergency ventilation. This screen-cast is pure gold and is a must watch for everyone that is involved with airway management.
- Emergency percutaneous airway - Cliff provides us with an excellent review and pearls from a recent article focuses on emergency needle and surgical cricothyroidotomy.
- Prehospital fluids for head injury – keep it simple - Take home point from a team from Melbourne that has reviewed the literature and concluded isotonic crystalloids (Ringer’s or Saline) are as good as anything else.
- Ultrasound for pneumonia -Bedside chest ultrasound is a reliable tool for the diagnosis of pneumonia in the ED, probably being superior to CXR in this setting.
- Steroid replacement after etomidate: no benefit - is it time we brought this drug to the land down under or forget about it all together?
- Vasopressin – what it does and doesn’t do - Cliff sums it all up in a nice review.
- Potassium levels and AMI death - time to start aiming for serum potassium levels between 3.5 and <4.5 mEq/L in AMI patients.
- Graham Walker shares with us his frustrations On My Emergency Medicine Boards.
- Only Mostly Dead- An interesting case!
- Paucis Verbis: Interpretation of intraosseous blood- another nifty little card to print of and have handy in your trauma bay.
- Trick of the Trade: A removable guidewire - the MacGyver approach making something out of nothing.
- Joe’s podcast of the week is by Chandra Aubin with the in’s and out’s on diagnosing Idiopathic Intracranial Hypertension in the emergency department.
- Zen and the Art of Shoulder Reduction- Rob gives us an awesome screen-cast and walks us through the Cunningham approach to shoulder relocation.
- Potent stimulant PMMA associated with ecstasy deaths - cheaper, gives you an enhanced drug effect- but also results in more fatalities, need to be on the look out for PMMA presentations.
- Methadone induces hearing loss- an unusual side effect!
- Pick Your Poison- Leon put’s us up to the Q & A challenge.
- Serial ECGs confirm initial suspicion of anterior STEMI (LAD occlusion) - Take home point – if the suspicion is there, get your nurses doing serial ECG’s.
- Ian provides us with a quirky look at how to collect a mid-stream urine specimen.
- Dr Colin and Dr Rachel share with us some Well Baby Oddities! Covering everything from periodic breathing through to hormonal withdrawal.
The Rest Of The Best
- David and Jeff are back with part 2 of Avoiding the Pitfalls of Trauma Part 2, after taking out top spot with part 1, part 2 certainly doesn’t disappoint- pack full of amazing pearls that will have you dominating and improving outcomes for your next trauma patient. Worth listening to.
Does my patient have measles?
- Scaring the SHO’s or “Can we be sure discharge is safe?” - Take home point: we have to be comfortable accepting a certain level of uncertainty, when discharging patients from the emergency department.
- Reversal of Novel Anticoagulants in the Bleeding Patient - nice guide to help you face the challenge of reversing these new novel anticoagulants.
- PERC – Still (Mostly) Useless - don’t think too many ED docs would disagree with that title Ryan!!
- Can We Stop Placing NG Tubes? Bottom line: So, yes, if you wanted to stop placing NG tubes because they’re uncomfortable for patients and apparently don’t change ultimate outcomes – certainly, that may be reasonable.
- SUSS IT: Secondary UltraSonographic Survey In Trauma - This post is a must read! Casey provides us with a excellent guide to using ultrasound as part of your primary and secondary assessment of trauma patients.
- Dr JRs last week in training before he goes bush. A look back at the lesson’s learned from a year of GP anaesthetic training.
- Quit QID? Is Casey just a bad parent? Or is he onto something here? Makes a lot of sense and practicality by changing to BD dosing!!
Amal Mattu shares this week pearl on the painless ACS:
- As many as 1/3 of patients with proven ACS have no chest pain at presentation.
- Among the more common alternative presentations (anginal equivalents) are dyspnea, diaphoresis, nausea/vomiting, and syncope/near-syncope.
- Note also that the absence of pain does not confer a better prognosis.
- The overall in-hospital mortality rate for patients with painless presentations is 13% vs. 4.3% for patients with chest pain.
- IV Paracetamol vs morphine for pain - a bigger study is needed – but some results look promising for IV paracetamol in acute limb trauma.
- The time and action specific consultation - some great pearls and pitfalls from Aaron on dealing with interactions with other consultants.
- Military Abdominal Aortic Tourniquet - how times change with research, the recent wars have shown that limb tourniquets aren’t such a bad thing after all, know we have a whole new concept of the abdominal aortic tourniquet – I’m sure we will all be watching were this device takes us closely!!!
- More on Human Factors in Trauma Scenarios - interesting research- worth having a read of this paper!
- Myth Buster Episode 4 – the Case of the Stone Heart - nice review on the literature surrounding giving calcium to the hyperkalemic digoxin toxic patient!!
- Utility of Chest Radiography in Blunt Trauma- Is it time to change our practise, and individualise our care and tailor it to the patient in front of us?
- David and Ashley are back with the January 2012 podcast highlight the latest and greatest published research from a look at Dengue fever through to the effectiveness for steroids in treating Bell’s palsy.
- This week’s morsel is on Gradenigo’s Syndrome and Otitis Media.
- A take on Factor VII -Bottom line: We still need a lot more data before we can officially make a stance on this issue, but for now, it’s probably better to stay away from a medication with no mortality benefit and a possibly bad side effect profile.
- Perimortem C-section - the facts on when to, and a short summary on how to!
- A little reminder of some important neonatal resuscitation points. Check out - Neonatal Resus!
- A chest pain resistant to treatment - remember chest pain in young adults isn’t always benign.
- This week Associate Professor Andrew Davies shares his expert knowledge of Total Parenteral Nutrition – when to start, what to add and how much to give. Have a listen to TPN – Getting it right.
- High Inspired O2 Is Not An Effective Pneumothorax Treatment- although the good evidence is lacking, this approach seems to be more of an urban legend.
- Soft tissue abscess: clinical plus ultrasound evaluation. Bottom line - Ultrasonography is a useful adjunct to clinical evaluation of soft tissue infection, it increases diagnostic accuracy and guides treatment decision.
Twee-D and Twitcal Care
News from the Fastlane
- Chris highlights the Best Of The LITFL Review 2011 - and the LITFL team wishes him well as he takes up his new post in Alice Springs.
- Ed drums out another brilliant tox conundrum in Brain Dead? and Rick Abbott is back with a take on Emergency Imaging In Tassie.
The Final Words
- “The real purpose of books is to trap the mind into doing its own thinking.”
- “If we are to learn to improve the quality of the decisions we make, we need to accept the mysterious nature of our snap judgments.”
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