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
- The Ripper of the week title is taken out by Reuben over at Emergency Medicine Updates with his mind blowing post on The Usual State of Readiness. In this Rueben discusses the concept of having cognitive readiness in critical situations, and says most of this can achieved through practicing invisible simulation. Remember: Memory fails when catecholamines are high; planning for emergency scenarios involves the development and deployment of emergency references.
The LITFL Review Top Picks
- David Newman provides us with two great examples on how to understand the NNT & NNH in NIPPV for CHF Works, ACLS Algorithms Do Not.
This weeks pearl is from EMCC guru Michael Winters on The Lung Transplant Patient in Your ED:
- The number of lung transplant recipients is increasing. With improved immunosuppressant medications, pts are living longer. In fact, the 5-yr survival rate is now approximately 60%.
- When evaluating a lung transplant pt who is < 1 yr following transplant, think about acute rejection and infection
- Acute rejection occurs in up to 40% of pts, can present with cough, SOB, malaise, or hypoxia, and is treated with high-dose corticosteroids.
- Bacterial infections usually occur in the early stages following transplant, with Pseudomonas the predominant organism
- CMV is the most common organism affecting up to 33% of pts during the first year after transplant
- Kind of Blue: skin discoloration caused by minocycline - Causes of blue discoloration of the skin can be divided into those due to cyanosis (presence of low oxygen tension with increased amounts of deoxyhemoglobin) and those of noncyanotic etiology.
- Case series: four patients with dabigatran-associated bleeding. Remember patients over 75 on this drug are at a greater risk of bad stuff happening to them…Be aware!
- Adding “Spice”: synthetic cannabinoids in St. Paul, MN - Seizures, hyperreflexia, and tachycardia seems common in these patients, with symptoms resolving over 2-4 hours with just good old supportive care.
This weeks grand round is by Ryan Arbeau presenting on The Disabled Athlete…
- Subacute subdural haematoma - can be difficult to identify on non-contrast CT as the blood is isodense to brain parenchyma (the same density).
- Ankle ABC’s. A nice neat approach to reducing ankle fractures. Do you X-ray before or after reduction?
- Organophosphate and Cyanide Poisoning – making life easier. With the aid of an IO!
- Kent shares with us two recent presentations he given on Abdominal Aortic Aneurysm and Aortic Dissection.
- What does A Bad Haircut and emergency medicine have in common? A lot actually…Worth reading especially junior doctors and nurses!
- Steve provides us with a great introductory podcast into Non-invasive Ventilation, from when to, how to, and when not to use NIV!
- Interesting Case: The Answer- The dang factor strikes again!
- The Chest Tube Autotransfuser - Bottom line: Although shed blood from the chest looks like whole blood, it’s missing key coagulation factors and will not clot. Reinfusing it will boost oxygen carrying capacity, but it won’t help with clotting.
- That funny ketamine breathing thing - Some people just don’t behave as they should with ketamine. How do manage the patient that is agitated with ketamine sedation?
- Scott shares with us some pearls of wisdom on interpreting the Rule-Out Criteria and Screening tests.
- Intensive glucose control probably kills, says NICE-SUGAR post-hoc (NEJM) - remember don’t aim too low when trying to control the sugar in critically ill patients.
- Beta Blockers give survival advantage in sepsis? Although the jury is still out…chronic β-blocker prescription may result in increased survival in patients with sepsis.
- Where’s the fun in fungi? The UK approach to treating mushroom poisoning.
- Chill man, it’s only a pneumothorax. Great clinical case, putting the spotlight on an interesting secondary cause of PTX.
- V & A in the ED – blood gases. Is there still a role for ABGs? Simon serves up some excellent ”food for thought” on this topic.
- The dangers of chopping trees down.- Brilliant case – highlights that clinical exam still plays a huge role in clinical medicine over diagnostic imaging.
- Acute Dyspnea in a Middle Aged Male - beware of the Wenckebach, which is common in inferior MI.
- awake intubation procrastination. How would you manage this case? Share with Casey your tips and tricks of the trade.
The LITFL Review Shout Out of the Week
This weeks shout-out goes to new Aussie blogging sensation- Chris Partyka over at thebluntdissection. Chris is a training ED Doctor with a passion for resuscitation, ultrasound and education. Check some of Chris’ post below;
Twee Dee and Twitical Care
News from the Fastlane
- Michelle put us on our toes and challenges us ethically in Household Words Chapter 1.
- Chris provides us with a fascinating video from Ben Goldacre on Bad Pharma - A must watch!
- Unfortunately no LITFL Review next week as I will be busy over at ICEN 2012.
The Final Words
- “A true leader has the confidence to stand alone, the courage to make tough decisions and the compassion to listen to the needs of others. He does not set out to be a leader but becomes one by the quality of his actions and the integrity of his intent.”
- “Patients don’t come to us for judgement. They come to us for care.”
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