Welcome to the serpinginous 69th 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 casts 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 to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
- On Evidence, Education, Errors, Ego and Expert intuition — Casey discusses our thirst for certainty, the fallaciousness of intuition and ‘expertise’ in clinical practice, and how we should do what we do. A must read little post.
- Clinical Case 061: Colle’s sans Xray — Casey presents a compelling case advocating for the use of ultrasound to assist in the diagnosis and reduction of Colles fractures in EDs without 24 hour on-site radiography services.
The LITFL Review Top Picks
- Trick of the Trade: Photograph slit lamp findings — how to use your mobile phone camera to take quality slit lamp photographs.
- Goodbye nasogastric lavage! — nasogastric lavage doesn’t rule out an upper GI bleed… So, if it’s positive the “? upper GI bleeder” needs a scope, and if it’s negative the patient still needs a scope… Goodbye!
- Right Bundle Branch Block after Blunt Trauma: A Tragic Case — A case where RBBB is not reassuring… Steve Smith tells us why. This post is a must read — I just hope the case is sufficiently rare that I never get to see one similar!
- Thrombolysis in Stroke – Are We Done Yet? — Amit seems to agree with the rest of the EM/CC FOAM community — the authors of the IST-3 trial may well suffer from FITH syndrome based on their diabolical conclusion…
- Podcast 78 – Increased Intra-Cranial Pressure (ICP) and Herniation, aka Brain Code — The first of Scott’s podcasts on topics from the soon to be released ENLS (emergency neurological life support) course. Having worked on the acute non-traumatic weakness topic with my LITFL buddies Oli Flower and Mike Cadogan I know that this ENLS project is awesome.
- Emergentology: The Right Care in the Right Place at the Right Time — Graham Walker talks to SMARTEM’s Ashley Shreeve about the interface between emergency medicine and palliative care. This is such an important topic – whatever else we do, our job is to always reduce suffering.
- The Science of Safe Handoffs — A quick look at the science (what little there is) of the handover, a troublingly critical episode of patient care.
- Making an ET tube — Kenneth Iserson recently saw the publication of his book Improvised Medicine: Providing Care in Extreme Environments; this article shows how to make an ETT tube for children if you don’t have one small enough.
- Ovarian Torsion, “Answers” — tough questions on an often tough diagnosis answered!
- Joe’s Pick of the Week is Ed Oakley’s talk on Evidence-Based Pediatric Fractures.
- OXY’s LOG – ‘Between shock and a hard place…’ — The GSA HEMS take on cardiogenic shock.
- Clay Smith’s take on Ped ED Survival Skills to help docs knew to EM keep the truly sick kid alive.
- Show me a PICTURE and let me LISTEN to your words — a neat pragmatic approach to giving a great slideshow-assisted talk.
- 3 Simple Rules to Avoid Torture — always give your intubated patients analgesia/ sedation.
- Nanofiltered C1 Inhibitor Concentrate for Treatment of Hereditary Angioedema — a treatment you need to know about.
- Pancytopenia and Malaria — neither are good, but both? Beats having cancer!
- Ketofol & Shah — a discussion with the author of an RCT on ketafol for pediatric procedural sedation.
- PHARM Podcast 29 : Dr Seth Trueger takes Washington — Seth is back an talking about being a new attending, capnography withdrawal, stopping the post-intubation torture, and human factors in airway management.
- Adherence with low tidal volumes for ARDS is poor at top centers; reduces survival (BMJ) — 6 mL/kg tidal volumes saves lives. This paper suggests the way we translate life-saving research into clinical practice needs to improve.
- The Bleeding Trauma Patient — Peter Sherren’s run down on the lethal triad and bleeding in trauma, and the management thereof.
- Head injury was not predictive for cervical spine injury — Cliff presents a nice table summarising risk factors for cervical injury — head injury per se is not one of them.
- A better way to tilt pregnant patients? — It may be more effective to tilt the patient into the full left lateral position first before returning them to the left lateral tilt position.
- EMERGENCY ECMO — science fiction or fact? This IS coming…
- CODE BROWN: DYSFUNCTIONAL TEAM AMBUSH — lessons learned from a retrieval team’s patient being hijacked in the ED without a handover.
- SonoCase: 57 yr old with acute chest pain, light-headed…. — is that a pneumothorax? The importance of knowing what’s not normal and the role of the RUSH exam in identifying life-threatening emergencies.
- Kiddy pills, syrup, compliance and cost — which antibiotic syrus will kids actually swallow and which will they spit out? Imagine if it it turns kids can actually swallow pills just as well…
- Rapid atropinization in organophosphate overdose — if only the people writing the FACEM exam MCQs had read this a couple of years ago… Serial dose doubling is the way to go when giving atropine for OP poisoning.
- Flumazenil-induced seizures — if you didn’t give the benzo’s, you don’t give the flumazenil.
- Superb review of atypical antipsychotic overdose — I will have to get a copy of this paper. You must know these overdoses inside out. Quetiapine and olanzepine overdoses account for the bulk of toxicological ICU admissions in Australia.
Subdural Hematomas and Hygromas Simplified — basic but good!
- More on Rib Fractures in the Elderly — ask and you shall receive! Thanks for the response Michael.
CT Scans And Rib Fractures — So, should we be doing CTs to count rib fractures? Michael McGonigal explains why not (in most cases).
- Chest imaging challenge — Keep an open mind when reading these CT and CXR images.
- Brian Corwell has some great facts about Jet lag in athletes, but Mike Winters’ pearls on Steroids and Septic Shock appeals most to us critical care junkies:
- Do low-dose steroids improve mortality or shock reversal in patients with septic shock?
- A recent systematic review published in the Journal of Emergency Medicinefound:
- A statistically significant improvement in shock reversal (RR 1.17)
- A favorable, but not statistically significant, mortality benefit for patients with refractory septic shock (RR 0.92; CI 0.79-1.07)
- Most guidelines recommend against steroids for septic patients that are responding to fluid resuscitation and vasopressor therapy.
- Updated guidelines from the Surviving Sepsis Campaign (soon to be published) will continue to recommend low-dose IV corticosteroids (200 mg over 24hrs) for those who are refractory to fluids/vasopressors.
The LITFL Review Shout Out of the Week
- EMCHATTER — Imagine if The LITFL Review was an entire website with even more detailed summarises of blog content. Then you’d have something like Jon Schonert’s EMCHATTER website, which filters out blogposts focussing on emergency medicine education and organises them in a systematic fashion.
Twee Dee and Twitical Care
- To our man in the Intwensive Tweetment Unit, Bungeechump: I’m sure you’re not the first, and won’t be the last…
News from the Fastlane
- @antidoped is finally back connected to the the Internet and overcoming his delirium tweemuns. Welcome back Kane!
- The Critical Care Compendium is continuing to explode — over 170 pages and counting!
The Final Words
- “The thing about looking after patients who were stabbed, is that by the time you’ve finished looking after them you can usually understand why they were stabbed.”
— Anonymous Intensivist
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 kane AT lifeinthefastlane.com
LITFL Review EM/CC Educational Social Media Round Up
Academic Life in Emergency Medicine — A Life at Risk — All LA Conference — Al Sacchetti’s Youtube — Broome Docs — CCM-L.org — CLIC-EM — Critical Care Perspectives in EM — DrGDH — Dr Smith’s ECG Blog — ED Exam — EDTCC — EM Basic — EM Core Content — EMCrit — Emergency Medical Abstracts — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Updates — EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — ER CAST — Free Emergency Medicine Talks — GMEP — Gmergency! — Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network — Keeping Up With Emergency Medicine — KeeWeeDoc — LipheLongLurnERdok — MDaware — MD+ CALC — MedEDMasters — Medical Education Videos — Medicina d’urgenza — Medicine for the Outdoors — Micrognome — Movin’ Meat — Neurointensive Care — Pediatric EM Morsels — PEM ED — PHARM — Priceless Electrical Activity — PulmCCM.org — Resus.com.au — Resus.ME — RESUS Room — Richard Winters’ Physician Leadership — SCANCRIT — SCCM Blogs — SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SonoSpot — StEmylns — Takeokun — The Central Line — The NNT — The Poison Review — The Sharp End — The Short Coat — The Trauma Professional’s Blog — The Underneaths of EM — ToxTalk — TJdogma — Twin Cities Toxicology — Ultrasound Podcast — UMEM Educational Pearls — Ultrasound Village