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’ top spot goes to Keeping Up With Emergency Medicine thanks to a great collection of short, sharp reviews this month. In this 21 Minute Version Must-Read Articles Sept 2012 Clay covers everything from STEMI in LBBB, vasopressin vs norepinephrine, ECMO in the ED, and much, much more…..This is great for those of us that don’t have the attention span to read a whole article, Clay sums them up in a high yield 1-2mins each, WIN WIN! Clay, you rock!
The LITFL Review Top Picks
- A Confirmation of Prejudices: Chloride and Pressure Poisoning – Scott puts some evidence behind his prejudice and will make you think twice before charting another bag of saline for your next sick dying patient. He also emphasises why we need to use lung protective ventilation strategies for all our tubed patients, not just those with ARDS. Put another way, if you’re tubed, you are an ARDS patient in the making.
- Antidote Research Center — unbiased fountain of information, or marketing tool for big pharma?
- Hyperbaric oxygen for carbon monoxide poisoning? — eminence-based recommendations not evidence-based!
- Orthopaedics for ED - Nice simple, tips and tricks for managing common orthopaedic presentations in the ED.
- Video laryngoscopy should be “standard of care” - EM tutor jumps on board with Ron Walls, backing video laryngoscopy as the soon to be “standard of care” for airway management.
- Subtle Signs of Pediatric Heart Failure - its not as easy to pick up in the paed patients as it is in the adult…
- Ultrasound-Guided Intubation - EtCo2 not working to confirm ETT placement? No problem just probe them!
- The Silver Book — Helping us dealing with the geriatric tsunami, one page at a time!
- Cartner on Dialysis — Michaela Cartner, an ED physician and intensivist, gives a down-to-earth fast-paced low down on renal replacement therapy in ICU: IHD vs SLEDD vs CVVHF.
- Lane on Airways — Stuart Lane, an intensivist from Nepean hospital, pulls no punches in a 10 minute discussion on the management of difficult airways in ICU, mainly focusing on video layngoscopy. As always, Stuart serves up a lot of food for thought!
- Sedation vacations don’t improve outcomes in large trial — Take home point: Minimizing critically ill, mechanically ventilated patients’ sedation to the minimum required is good. Exactly how their doctors and nurses do it probably doesn’t matter much.
- Diagnostic panacea? USS that paeds abscess?? — Bottom line: Ultrasound is good. And this is a great idea – by using ultrasound we can actually see whether there’s an abscess needing incision and drainage, rather than relying on external look & feel alone. Why would we not use ultrasound?
- Oh, Sugar! Paediatric Hypoglycaemia - Do all paediatric hypo’s need investigation? Natalie provides an excellent in depth review to help guide our practice downstairs.
- Smoke without fire — Great review on managing CO poisoning! Definitely worth a read!
- Joe Lex talks on Hanging and Strangulation Injuries pure FOAM goodness, Joe provides a fantastic insight into managing these often devastating injuries.
- Marcus Ong on Predicting which ED patients will Crash - A great talk on the future and how technology is going to be used to assist us in finding that truly crook, deteriorating patient.
- Jeanmarie Perrone talks on ’The slippery Slope from percocet to heroin.” — what every ED Doc needs to know about opioid prescribing.
- Still Overpromising Benefit of PCI After Cardiac Arrest — PCI following cardiac arrest should not be considered to be “routine” and probably isn’t for everyone. We have a role in ED to advocate for those that need it however.
- PCA in the ED is Brilliant and Horrible — Take home message: Patient-controlled analgesia may yet have a role in the ED – and studies like this help keep the flame alive – but significant hurdles remain.
- Awesome review by Kent on the basic approach to Mechanical Ventilation — Brilliant FOAM!
- Teaching Reflection — Reflection is a skill which has been demonstrated to improve learning. Despite it’s importance, little weight has been given to it in traditional medical education.
- Have you ever had to promise the radiologist that you would arrange emergent dialysis for your end-stage renal disease (ESRD) patient after receiving IV contrast? Time for a mythbuster: Urgent dialysis following IV contrast?
- Is this ACS? Look at the previous ECG!! — serial ECG’s always help!
- ST depression, pulmonary edema, and severe hypertension — is this demand ischemia or acute coronary syndrome?
- Videolaryngoscopy Versus Direct Laryngoscopy in Simulated Paediatric Intubation — The paper suggests that the use of a video laryngoscope in the simulation setting does not significantly reduce intubation success in neonate and infant mannequins, and may improve performance in adult mannequins when used by skilled PEM clinicians.
- Double Gloving It – Hands-on Defibrillation — Who’s doing it? Great discussion Lauren!
- Sorting out the RIF raff — Casey probes out the appendix!
- The Easiest Blood Draw — The old trusty femoral stab - guaranteed to deliver blood every time!
- Minh has a Multinational PHARM panel discussion on emergency procedural sedation discussing the finer points on Ketamine, Fentanyl and even the intranasal route.
- GET FOAMEd rural masterclass session : Spotting the Crook! — Awesome discussion by 4 FOAMed experts on finding and recognising that sick patient hiding in your ED. Great discussion about recognizing vital signs, clinicians gestalt, and identifying the seriously septic patient.
- Can we fight against Pulmonary Embolism using the LR’s arrows? — Bottom line: Using Wells Score in this setting, the PE pretest probability is intermediate (around 30%).
The LITFL Review Shout Out of the Week
- Rural Medicine Australia is nearly here! Tim shares some of his latest research on managing the difficult airway in the rural setting.
- Is the medical conference dead? — No, not quite yet, but those that don’t evolve will die… Enter SMACC.
Twee Dee and Twitical Care
News from the Fastlane
- LITFL has got behind and supported the The Intern Crisis.
- Chris is in Vegas for USC Essentials, stay tuned for the tweets and the reviews!
The Final Words
- “The mark of the true professional is their ability constantly question their competence.”— Minh Le Cong
- “The effort invested in ‘getting it right’ should be commensurate with the importance of the decision.”
— Daniel Kahneman
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