Welcome to the traumatised 65th 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
- Patients presenting to the ED with high blood pressure can be the bain of our lives, with only specific cases and circumstances that need treating. Reuben has written the ultimate post on managing hypertension in the ED. Check out Hypertension and the Emergency Physician as he shares with us some excellent pearls and pitfalls and offers some sound take home advice that we should share with all patients: Lastly, tell your patients who check their blood pressure at home and then come in for hypertension that checking blood pressure at home causes cancer.
- Acute agitation management in Retrieval medicine with Dr Casey Parker - Minh really does serve up a difficult case to Casey on an agitated minor in a rural ED. Casey then shares some excellent pearls and pitfalls for dealing with the agitated patient from verbal de-escalation techniques to when is the right time and the right way to sedate these individuals in a rural isolated environment.
- End of life care in the emergency department. A topic that we get lots of exposure to, but that we have little discussion about. This article challenges some of the thoughts and emotions that we have around end of life care in the ED.
- Over in the United States, they are in the midst of a pertussis epidemic. Rob has put out a brilliant short-sharp podcast on Whooping cough from do antibiotics work? through to which antibiotic is best.
- Andy shares his thoughts on a recent paper looking at The LMA as a murder weapon? See the video below:
- Selling Ice Cream in the Desert-Brilliant post by Seth on how to coach your patient that is receiving NIV.
- Tachycardia followed by bradycardia after smoking the synthetic cannabinoid “K9″. Leon highlights an important point: Synthetic cannabinoids often have more marked effects than cannabis itself, perhaps because they have far greater affinity for the cannabinoid receptors than does tetrahydrocannabinol itself.
- If it wasn’t stressful enough contemplating doing a surgical airway! This study shows if often difficult to Find the Cricoid especially in in females and the obese patient…. Don’t worry like everything in EM these days it all becomes easier with the aid of ultrasound.
- Fever and neutropenia after chemotherapy: do - A nice reminder on managing febrile neutropenia in the ED!
- Emergency Burr Holes - how to relive the pressure on those time critical extra-axial intracranial hematomas – Thomas provide some excellent commentary and “food for thought” on a recently published article.
- Phenylephrine vs. Catecholamines and the (rodent) heart. Take home point from Cliff on this study: It supports my view that pure alpha-agonists might fix the numbers on the chart, but are not necessarily helpful in terms of cardiac output and potentially organ perfusion, whereas catecholamines might be more fit for purpose in many shock states including septic shock.
- Despite advances in pharmacology and endoscopy, placement of a balloon tamponade device is occasionally required to stabilize a patient with acute variceal bleeding.
- Currently, there are 3 devices available: the Linton-Nachlas (gastric balloon only), the Blakemore (gastric and esophageal balloons), and the Minnesota (gastric and esophageal balloons) tubes.
- The tube should initially be passed at least to the 50-cm mark and preferably to the maximum depth allowed by the length of the tube.
- Once the gastric balloon is inflated and correct position confirmed, traction must be applied to keep the gastric balloon engaged in the cardia and fundus of the stomach.
- An overhead pulley system is the preferred method to deliver traction. If you don’t have weights for the pulley system, a 1-liter bag of crystalloid provides the desired 1.0 kg of traction.
- Keeping up is back with more summaries and excellent podcasts – This week they tackle the latest controversy on Darn – Azithromycin Kills People.
- Lamotrigine and Ketamine - A great case on trying to sedate a patient with ketamine- that just want go to sleep.
- Stroke thrombolysis and IST-3 – is it another false dawn? -IST-3 seemed poised to answer the question once and for all regarding rtPA benefit in ischaemic stroke. But does it? – Domhnall shares his thoughts.
- Just a sip - Help Casey crack this tough paediatric toxicology conundrum.
- What is the rhythm? And is there new left bundle branch block (LBBB)? -Another great ECG case. What caused it ACS, reperfusion arrhythmia or a postural hypotensive event?
- Sepsis: Unbundling the Bundle - Often what we do today is proved wrong tomorrow. The surviving sepsis bundle is most probably one of those things as Kevin Klauer points out in this article. He does make some important points on sepsis, we do need early recognition and early antibiotics in all patients that present to ED with signs of septic shock.
- Trick of the Trade:A neat and nifty trick for removing an Ear foreign body.
The LITFL Review Shout Out of the Week
This weeks shout-out goes to the blog section of the Greater Sydney Area HEMS - a site dedicated to the pre-hospital retrieval physicians of NSW. Each week they put out a blog post from their coffee and case discussion’s for our educational enjoyment. Check out some of their recent cases:
- ‘Tourner sur une nouvelle feuille de route…’ Is the tourniquet hero or villain?
- ‘That tricky fella, human error…’ To acknowledge that we will all suffer from human error, and think about ways to reduce this leading to patient harm
Twee-D and Twitical Care
News from the Fastlane
- If you missed this article by Guest Author Tobby Fogg on Do You Know If You Really Own The Airway? - you have missed out on some wise words on managing the airway.
- Yosef Leibman Emergency Medicine Update May 2012 is out… so check it out!
The Final Words
Got an upcoming presentation coming up? Remember these 4 pearls of wisdom:
- Tell me something new.
- Don’t read from a script.
- Don’t read from your slides.
- Speak from your heart.
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