Welcome to the resuscitated 63rd 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
- Wow! The ScanCrit boys have got a post that will knock your socks off on…. Avalanche Survival - something we don’t really see down here in the land of the OZ! This post is packed full of some amazing stats, insight, pictures and videos .The concept of the patient receiving a free airway or air pocket is fascinating and really does decide who lives and who dies. A must read (& watch) post that is as clear a ‘ripper beaut’ as there ever has been.
The LITFL Review Top 20 of the Week
- Nitrate bolus in acute heart failure – are you doing it? Well you should be and the studies support it. This great post Cliff guides and supports your practice – especiallyuseful as were coming up to the APO season here down-under.
- Rob’s newest podcast (featuring Ryan Radecki) on Pulmonary Embolus Outpatient Treatment answers these big questions: Do we need to hospitalize all patients diagnosed with pulmonary embolism in the ED? Can some be discharged and managed as outpatients? Plus many more questions around the management of low risk PE in the ED!
- Joe’s pick of the week goes to Michael Winters, an engaging and inspirational speaker on all things ED critical care. Listen in for take on: What are the New Sepsis Biomarkers? Can they help in ED?
- High-Risk Orthopedic Injuries: Tibial Plateau Fracture - A must read article so you don’t get “tripped up” from this complex often missed injury.
- Nasal Pharyngeal Oxygen - a different way of delivering oxygen and its sure to impress the nurses in ED.. .not sure about ICU!
- Is use of flumazenil in poisoned pediatric patients safe?- Yes – because children are virtually never addicted to benzodiazepines, do not typically present after overdosing on multiple medications, and often have a medical history that can be supplied by their parents or caregivers. If they respond to flumazenil, an extensive diagnostic evaluation including multiple laboratory tests and a head CT may be avoided. Thus, in young children, the risk/benefit calculation of using flumazenil becomes much more favorable.
This weeks Pearl provided by Dr. Semhar Tewelde on the Athlete’s Heart and ECG Abnormalities:
- Up to 80% of athletes have common training related ECG changes/abnormalities including: sinus bradycardia, asymptomatic sinus pause, sinus arrhythmia, first degree AV block, incomplete right bundle branch block, benign early repolarization (BER), and isolated QRS voltage criteria for left ventricular (LV) hypertrophy.
- Approximately 5% athletes exhibit uncommon training unrelated ECG changes/abnormalities including: T-wave inversions, ST-depression, pathological Q-waves, left axis deviation/left anterior fasicular block, right axis deviation/left posterior fasicular block, right ventricular hypertrophy, complete left or right bundle branch block, long or short QT interval, ventricular pre-excitation/WPW, Brugada pattern, and arrhythmogenic right ventricular dysplasia (ARVD).
- Scott really does “open the book” and shares with us in the ins and out’ of managing Severe Pelvic Trauma in this podcast, also check out the posts Chris has done on assessing and managing pelvic trauma that are linked from EMCrit.
- Nursing: the incomplete ‘how-to’ guide. Ian shares with us a collection of post on different clinical topics he has written over the years – packed full of pearls, pitfalls, advice and some laughs!
- Steve really is becoming a force to be reckoned with in the world of podcasts. He recently published two excellent podcast on trauma evaluation and management, guaranteed to benefit medical students and juniors doctors alike. Listen to part 1 Trauma Resuscitation Part 1- the evaluation and part 2 Trauma Resuscitation Part 2- Interventions.
- My ICD presentation to a Hospice and Palliative Care Group in this post John shares with us a talk he gave to palliative care doctors on ICD in the terminally ill, some great pearls and wisdom can be taken from this talk to benefit the humble ED doctor or nurse.
- Dr Smith provides us with a peek at a peer reviewed presentation he has done for the journal Academic Emergency Medicine. This is the second one they have published, and the publishers have allowed us all to have free access – check out Dr Smith talking on ECG Diagnosis of STEMI-equivalent in Left Bundle Branch Block (20 minutes) below.
- Out-of hospital traumatic paediatric cardiac arrest - This small study on traumatic arrests in children refutes the “100% mortality from traumatic arrest” dogma that people still spout and gives information on the mechanisms associated with survival: drowning and strangulation were associated with greater rates of survival to hospital admission compared with blunt, penetrating, and other traumas. Overall, drowning had the greatest rate of survival to discharge (19.1%).
- Codeine, Potentially Unpredictably Lethal - The short summary – whenever possible, avoid medications that are unpredictably metabolized - such as codeine. This is especially important in paediatrics and patients with liver or renal impairment.
- Scott Weingart’s new podcast reviews the ACEP 2012 Management of Early Pregnancy - a short, simple in depth look at what you need to know in the ED for that first trimester presentation.
- Ultrasound for Epidurals… I ask an expert: Dr Mitch - Casey provides some excellent advice from an expert on getting epidurals in the right spot with the aid of a probe!
- Aussie simulation enthusiast Luke shares with us how you can create an ultrasound simulator for under $100 in The Australian EDUS2 Project - we look forward to hearing more from Luke about simulation in the LITFL Review.
- Trick of the Trade: Bend the IV angiocatheter to cannulate the external jugular.
- This week’s podcast Stoking the fire – Inotropes in the ICU features Dr John Myburgh, who has a PhD in catecholamine physiology in critically ill patients. In this exciting podcast, he chats to Todd about the evidence for their use in ICU, why good research is hard to do and where the future will take us
The LITFL Review Shout Out of the Week
- Finally emergency medicine’s most promiscuous blogger has settled down and started a new relationship with himself. That’s right folks, Minh Le Cong, retrievalist & prehospitalist extraordinaire, has created his own blog called PHARM; Prehospital and Retrieval Medicine. The blog is packed full of posts and podcasts on emergency airway management and the big hard hitting topics surrounding pre-hospital and retrieval medicine. Check out some of the work Minh has already published on there:
- Emergency Airway 101 with Dr Jim Du Canto - A must listen to episode covering some very pertinent topics around airway management and were we are heading in the future.
- BLOODY AIRWAY TRAINING..LITERALLY!! Highlights how to simulate blood and vomit in the airway during training – will really have you putting the pressure on your trainees.
- Minh’s Airway Slides - these are gold Minh!
Twee-D and Twitical Care
News from the Fastlane
- Firstly my apologies for the lapse in LITFL Reviews – hopefully will all good intentions we can keep bringing you the LITFL review regularly from now on.
- There’s been a few changes to LITFL RSS feed, and we now have a Vimeo account! To find out more read LITFL RSS Feeds.
- Come to Perth in June - not only get to meet some of the awesome LITFL team but also get too listen to some fine speakers at ACEM scientific meeting.
- Who thinks physiology is boring? Well, prepare to be proven world.Michelle Johnston @Eleytherius -one of the most hip hop and happening emergency physicians now brings us the Physiology Philes - see for yourself below:
The Final Words
- We’ve reached the point, as doctors where we can’t do it all by ourselves. We can’t know it all.
- Atul Gawande
- ”There is no use for the term costochondritis.”
- Judd Hollander
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