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
- This weeks ripper of week is The Short Coat - where Lauren really does get down to the deep of it with two fascinating post. The first Anchors Aweigh! Cognitive Bias – Where IS This Ship Headed? tackles the big issue of cognitive errors and biases, and follows it up with Thinking About Thinking a look at the emergency physician and metacognition. The future of emergency medicine and FOAM looks bright, with medical students like Lauren around!
The LITFL Review Top Picks
- Paucis Verbis of the week is: Delayed sequence intubation An excellent summary of this controversial new approach to airway management.
- The 3-minute EM student presentation - A must read for all junior docs and medical students, as featured on LITFL a few years ago in ED Case Presentation for Medical Students.
- Trick of the Trade: Oral naloxone for opioid-induced constipation - Treats the constipation well without causing systemic opioid withdrawal effects = WIN WIN!
- Clinical Case 065: Sternum vs. seatbelt – Once again Casey shows how the the probe dominates this chest X-ray this time in identifying sternal fractures. Also links to a great review article on sternal fractures by one of LITFL esteemed Editors.
- Check out this fantastic talk on Haemodynamics, ECMO and the physiology of circulation in the critical intensive care patient, by one of Australia’s leading experts in this field Vin Pellegrino.
- Joe’s pick of the week is Update on DKA in Children by Nathan Kupperman. This talk is great because it focuses on what we all worry about in kids with DKA…that nasty complication of cerebral oedema….Great talk!
- Rob gives us an introduction to the new iTeachEM Podcast- Can’t wait – can you?
- Storyboarding without bullet points!- Rob shares with us a bit of Garr Reynolds magic on how to prepare and deliver your next keynote or powerpoint presentation, without those troubling bullet points.
- Are you wrong about learning? - Chris provides us with four major misconceptions put in the context of meducation to help us learn and solidify information.
- Rob sits down with emergency cardiology master Dr. Amal Mattu and gives the low down on EKGs: ST elevation, Wide Complex Tachycardia and PE. This offers a smooth, straightforward approach to managing these common cardiology presentations you are confronted with each shift.
- From BURP to BILP: backwards internal laryngeal pressure - Cliff highlights a new concept: the ‘backwards internal laryngeal pressure’ manoeuvre. The authorsrecommend that during difficult intubation an inadvertently placed oesophageal tube should be left in place to allow a BILP maneuver, but removed if it impedes the passage of the tracheal tube.
- Vertigo, “Answers” — Nice Q&A on how to diagnose and how to fix it.
- PCA in the ED - Bottom Line: PCAs provide less labour-intensive analgesia, with slightly better pain scores in the first two hours of an ED stay, at the cost of slightly more adverse events – nausea, vomiting and pruritis. They are probably worth it if the patient has a truly painful ongoing condition.
- The same but different - OK something different, we’re used to the really tricky ECG, but can you pick whats going on with this X-ray? Great case Simon!
This weeks pearl by EMCC guru Michael Winters on AKI and Fluid balance:
- Up to 70% of critically ill patients develop acute kidney injury (AKI), with 5-6% of ICU patients requiring renal replacement therapy (RRT).
- Maintaining adequate renal perfusion is central to the management of AKI in the critically ill patient. As such, fluids are frequently administered.
- As we’ve highlighted in previous pearls, there is mounting evidence to indicate that a positive fluid balance may be detrimental for select critically ill patients.
- Results from a recent publication suggest a positive fluid balance in patients with AKI may be harmful.
- Bellomo, et al analyzed data from the RENAL trial to determine the association between daily fluid balance and outcomes.
- Investigators found a 70% reduction in 90-day mortality for critically ill patients who had a negative mean daily fluid balance compared to those that had a positive balance.
- A negative fluid balance was also associated with decreased ICU length of stay and the need for RRT.
- Take Home Point: Once critically ill patients with AKI are resuscitated, maintaining a slightly negative daily fluid balance may be beneficial.
- Thomas Dalton provides us with a short-sharp vodcast review on paediatric cervical spine injuries:
- Angiography can have bleeding complications – be more sure of your STEMI diagnosis in high risk patients. Tip from Dr Smith: Acute STEMI usually has large T-waves and, unless anterior, does not develop Q-waves rapidly. When you see inferior or lateral QR-waves, think of old MI with persistent ST elevation.
- Tintinalli Tuesday: A nice guided approach on how to identify and treat Pelvic Inflammatory Disease!
- This weeks tute concerns the case of an obese chap who is agitated and not tolerating BiPAP. He has difficult IV access. The IO needles leaked. He got Ketamine then Roc…. 45 minutes to intubate! Want to know more about this case have a listen to Mr Blobby very DSI.
- Minh looks like he had a massive week organising the 2012 Aeromedical Conference in Cairns! Check out all the new, reviews and cool pics from the conference in DAY ONE REPORT and DAY TWO REPORT … Great work Minh!!!!
- Sudden sniffing death syndrome - occurs when sudden death after sniffing an inhalant, due to cathecolamine surge (patient startled or being caught in the act).
- Lethargy and Nausea in an Elderly Patient- First thing to be checking with the patient- What cardiac meds are they on!
- Pop & Suture Abscesses Closed -Is it reasonable to perform some sort of abscess closure? I think it probably is – depending on the amount of potential disfigurement, there’s probably a discussion of risk/benefit that can be had.
- The End of IABP? - In the end, the authors rather grimly state that, despite some surrogate markers appearing to be improved in the IABP group, there is no evidence to support routine use of IABP in cardiogenic shock secondary to acute myocardial infarction.
- Blackouts and syncope – Andy tackles this colossal topic and focuses on the ECG in syncope and falls assessment in the elderly. Great talk Andy!
- Guidelines for reversing overdose of dabigatran (Pradaxa) and other new anticoagulants. Follow these four steps and basically hope for the best:
- supportive care (fluids, RBCs, control of bleeding source)
- discontinuation of anticoagulant
- activated charcoal if ingestion is “recent” (several hours)
- How To Remove An Impaling Object - some pearls from the trauma expert!
- The ultimate guide on how to dominate the Visual Aid Questions in Emergency Medicine by TJ!
- NIV for infant Bronchiolitis – Good study from Australia that showed a decrease in intubation rate, respiratory support days, and PICU length of stay for bronchiolitis when non-invasive ventilation is used.
The LITFL Review Shout Out of the Week
-Want something new, something different and something? Then check out Adventure Medicine a great new exciting blog by two Aussie EM adventure gurus Dr Sean Rothwell & Dr David Rosengren
- Interested in a nice bush walk? Then why not try the Kokoda Trek, Sean gets you ready for it in Kokoda part 1 – Preparation and how to deal with the extremeness of the trail in Kokoda part 2 – On the Trail.
Twee Dee and Twitical Care
News from the Fastlane
- Another excellent collection of articles in this weeks R&R In The FASTLANE 025, and if you want even more literature to review check out Yosef Leibman’s Emergency Medicine Update August 2012.
- Paul Young serves up another challenging blood gas in Pregnant And Metabolic Acidosis?
- Congratulations to Seth Trueger for cracking the ETT Cuff Pressure Puzzle Solved!
The Final Words
- “In the middle of difficulty lies opportunity”- Albert Einstein
- ”He who learns medicine without having practicing mentors does not really learn medicine.”- Joe Lex
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
123Sonography.com — Academic Life in Emergency Medicine — Adventure Medicine— A Life at Risk — All LA Conference — Al Sacchetti’s Youtube — Bedside Ultrasound — Better in Emergency Medicine — Broome Docs — CCM-L.org — CLIC-EM — Critical Care Perspectives in EM — Dave on Airways —DrGDH — Dr Smith’s ECG Blog — ECG Academy — ECG Guru — ECG of the Week—ED Exam — EDTCC — EKG Videos — EM Basic — EM Core Content — EMCrit — Emergency Medical Abstracts —EMERJENCYWEBB –EmergencyLondon — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Tutorials—Emergency Medicine Updates —Emergucate —EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMProcedures — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — EM REMS — ER CAST — Free Emergency Medicine Talks — GMEP — Gmergency! — Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network —iTeachEM - keepcaring — Keeping Up With Emergency Medicine — KeeWeeDoc — KI Docs — 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 — PEMLit — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — Resus.com.au — Resus.ME — RESUS Room — Richard Winters’ Physician Leadership —ruralflyingdoc — SCANCRIT — SCCM Blogs — SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SonoSpot — StEmylns — Takeokun — thebluntdissection—The Central Line — The Ember Project —The Emergency Medicine Resident Blog — The NNT — The Poison Review — The Sharp End — The Short Coat —The Skeptics Guide to Emergency Medicine — The Sono Cave - The Trauma Professional’s Blog — underneathEM.com — ToxTalk — TJdogma — Twin Cities Toxicology — Ultrarounds — UMEM Educational Pearls — Ultrasound Village