Welcome to the mind boggling 60th 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 the brilliant and inspiring duo Rob Orman and Scott Weingart with a discussion of Cardiac Arrest. This is one of the best podcasts I have listened too on the subject and the lads really do tackle the controversies in this podcast – from do they need an ETT straight away in the ED? When to cool and when not to, and which patients need to go to the cath lab post arrest? This is recommended as a must listen to podcast all for all emergency providers!!!
The LITFL Review Top 20 of the Week
- Top End Infectious Diseases – Darwin Experience & Melioidosis - Why is it important to know about Melioidosis? - Without correct treatment, case-fatality ratio as high as 90% within 2 days of presentation, crikey!!!
- Mechanical Thrombectomy – Promising, But Still Unsafe – The take home point from this study: ”Clinical efficacy of this approach compared with standard medical therapy remains to be demonstrated in prospective, randomized controlled trials.”
- Are Femoral Traction Splints Okay In Open Fractures? - Michael shares some tips and tricks for this evidence poor area of trauma management. Remember the bottom line: Treat traction splints with respect.
- Andy runs us through the anatomy and physiology of the herniating brain!!
- C-spine Trauma: in a town with no CT - What the! Most of us would be shocked that there are still hospital with-out a CT scanner – This is what Casey is faced with every day, find out how he clears the C-spine, and manages the one that do need imaging – we take our hats of to you Casey!
- Does Antibotic Choice in Sepsis Change Outcomes – Evie Marcolini – takes us on a journey through looking at which antibiotic is the best in sepsis, some of the history of antibiotic resistance, and how do we we actually change outcomes – here’s a tip “timing is everything!!”
- ED RSI – Rocuronium Vs Suxamethonium (Succinylcholine) - Amit echos the LITFL post Does Sux suck? Does Roc rock? and has made the change from Sux to Roc. He shares with us his take on the evidence to support his change.
- Wide Complex Tachycardia after Ingestion and Seizure - remember supportive care rules in toxicology even in the overdose patient with a wide complex ECG!!
- This month’s podcast targets the chief complaint we see every day Shortness of breath - and Steve certainly doesn’t disappoint with pearls on vital signs, to the ins and out of asthma and pneumonia.
- Cervical Spine Injury and Submersion Injuries – nice short, sharp morsel on the evidence for when to be concerned about cervical spine injuries in our paediatric population following being submerged!
- What to you get when you put a microphone in front of two of Australia’s premier retrieval docs? A podcast on Prehospital and Retrieval Medicine 001 – thats right Minh Le Cong takes over EMCrit and sits down with Cliff Read to discuss the nuts and bolts of pre-hospital airway management .
- Methoxetamine: a designer ketamine analogue - Leon highlights a new drug with similar properties to Ketamine with a very similar side effect profile – be on the look out, it’s coming to an ED near you soon.
- Magnesium Sulfate for Women with Preeclampsia - not as good as i thought it was!
- Airway expert/author Darren Broude highlights The Best Airway Articles of 2011 from preoxygenation and prevention of desaturation all the way through to blind tracheal intubation – short, sharp and sweet – worth reading.
- Simple emergency haemorrhage control - Cliff highlights an approach to stemming the bleeding in penetrating neck trauma, using an IDC – no he’s not taking the p!ss – it actually works!!!
- Graham Walker share his thoughts on the expectation’s of both patients and staff in the ED Emergentology: Expecting the Expected - I like the concept of “Under-promise and over-deliver’- anyone else out there using this approach?
- Ketamine + Propofol = Ketofol - Combining propofol, a beloved agent for procedural sedation for its rapid onset, quick recovery times, and titratable levels of sedation with ketamine, the world’s safest agent for unmonitored anesthesia, has been shown in case series to be as safe and effective as expected.
- Awake video laryngoscopy -A nice study reminds us of the option of awake video laryngoscopy as an alternative to fibreoptic instrumentation of the airway.
- Michael Winters shares with us some pearls on preventing VAP.
- Ventilator-associated pneumonia (VAP) occurs in 9-27% of patients receiving mechanical ventilation (MV).
- VAP increases the duration of MV and increases the ICU length of stay.
- VAP is primarily caused by aspiration of oropharyngeal secretions either during intubation or while receiving MV.
- While there are many interventions that may potentially reduce the incidence of VAP (aspiration of subglottic secretions, selective digestive decontamination, monitoring endotracheal cuff pressure), a simple, no cost intervention is patient positioning.
- Placing intubated patients in the semirecumbent position is associated with a lower risk of VAP.
- Weak, SOB, “DKA”, Chest Pain, and Wide Complex Tachycardia: Is there STEMI? - Wow, an interesting but tough case – and yes the ‘K’ was normal!
The LITFL Review Shout Out of the Week
Shout-out of the week heads over to new EM blog RAHUL’S EM BLOG – described as “an experiment in EM education” has started out with an excellent video series on performing and interpreting ECG’s all the way through to a comprehensive series on ACLS management with a few post thrown in along the way on recent research reviews. Worth checking out – and stay tuned for the highlights from this blog in the LITFL review.
Twee-D and Twitical Care
News from the Fastlane
- Mike shares with us some of his trail and tribulations after succumbing to a recent dislocate elbow in Beat Up And Pent Up.
- This weeks Funtabulously Frivolous Friday Five 080- gets cool and hip with some cool tunes from tox tunes!
The Final Words
- ”We see only what we know”
- Greg Henry
- “Saving lives is easy. It’s changing lives that’s hard.”
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