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
Ripper of the week is taken out by Greater Sydney Area HEMS, with their guest author, and new recruit David Anderson (@expensivecare) who normally blogs over at his own site expensivecare.com. David shares with us the two great post, as he smashes out all the dogma that surrounds spinal care management in the trauma patient, this is a massive issue that we need to confront and reconceptualise the way we approach suspected spinal cord injuries in the emergency department. Don’t believe me have a read in Spinal Dogma Part 1 and Spinal Dogma Part 2 and see for yourself! Looking forward to what part 3 has install for us!
The LITFL Review Top Picks
- What do you do when a child presents with an Apparent Life-Threatening Event? That’s easy, read this great summary from Sean!
- Not Pregnant, Vaginal Bleeding for Two Weeks, eeek this is not what we trained for…..Joelle Burhart gets us into shape on on managing this common and daunting presentation.
- Guidelines for the management of paracetamol (US: acetaminophen) poisoning. Superb and refreshing review on managing paracetamol toxicity.
- When a patient leaves with cannula in-situ. Not a big issue right? Nah wrong again…Check out the case Ian highlights, will have you checking your patients for retained IVC for sure before discharging them in the future.
- Cliff get’s us up-to-date with the latest and greatest in trauma management…In A whole bunch of trauma guidelines.
- Etomidate & sepsis - Not the greatest drug….Best to avoid at all cost in the septic patient!
- Aeromedical retrieval: invasive vs noninvasive blood pressure - Nothing ground-breaking here, but the sicker they are, head towards invasive BP measurements.
- Echo for cardiac arrest outcome prediction - Bottom line: Echocardiography performed during cardiac arrest that demonstrates an absence of cardiac activity harbors a significantly lower (but not zero) likelihood that a patient will experience ROSC.
- Best Of: IV Contrast. Bottom line: If you are considering contrast CT, try to get a history to see if the patient is at risk for nephrotoxicity. Also consider all of the studies that will be needed and try to consolidate your contrast dosing. For example, you can get CT chest/abdomen/pelvis and CT angio of the neck with one contrast bolus.
- Subdural Hematoma: How Well Do They Really Do? Bottom line: Patients with subdural hematoma do better these days than they used to. This is probably due to better imaging (CT), which leads to earlier and more accurate management.
- Clearing up Sodium and Hyperglycaemia Roger Harris follows up a twitter conversation with @MDaware to explain the biochemistry of sodium in the context of hyperglycaemia.
- LITFL awesome editor provides us with two fascination talks, updating us on all things Snakebite and SPIDERS and STINGERS - remember redback antivenom is the knee arthroscopy of the tox world – quote of the year!
- Case of the week: Feeling Blue at St.Emlyn’s and its a challenging one from Simon, 30 male collapsed and looking a bit blue in the nightclub….What is the cause?
- Intranasal Ketamine: Mum “Nose” Best - Geez is there nothing that ketamine isn’t useful for.
- Emergency Medicine: A risky business Part 4 Simon provides us with a fascinating insight into how diagnostic test work in practice….A must read, pure brilliance Simon!
- An Emergency Physician Texted Me This ECG, Asking for Help in Interpretation and for Advice in Management. Lesson learnt: 25-30% of “NonSTEMIs” have an occluded infarct-related artery at 24 hours after presentation.
- Was the “Pain as a 5th Vital Sign” campaign in part a marketing ploy? Have we been had by this marketing campaign that has lead to extreme levels of prescription drug abuse.
- All Elevated Troponins Are Not MI - Positive troponins need to be evaluated properly in their clinical context, and this is a lovely (if very, very long) reference document for describing it.
- Although we all love and dominate the resus room, in fact the Waiting room medicine is what we do most. Nice insights and points from Andy on tackling these waiting room patients.
- Anatomy for Emergency Medicine #21 – shoulder: subacromial space and labrum
- Butterflies in the stomach - The ingested foreign body is a common dilemma we face in the paed ED, however most pass with-out too much intervention, but be aware for those little disc batteries, that cause us the most concern!
- Discharge a PE? that’s crazy talk! - nope not anymore, literature supports low-risk PE patients (PESI score below 85) are safe to be discharged home from the ED with appropriate follow up. Great discussion piece by Movin Meat, even worth checking out the comments at the bottom for the patients perspective on this.
- a poison puzzler… A great toxicology conundrum from Chris on a case of methylxanthine overdose! Not something you see very often these days.
- headache for all… the challenges and complexities of diagnosing and managing the post-partum preeclamsia patient with a sore head!
- Do you need to see at all? -the art of blind intubation, a forgotten technique these days with the advantage of video laryngoscopes.
- Paediatric Cannot Intubate ,Cannot Ventilate & Cannot Oxygenate – a case report. Remember: “Everyone has a plan until you get punched in the face ” – Mike Tyson
- Clinical Case 074: the discussion - Minh, myself and Casey hangout and discuss the challenges and complexes we would face in case 74, from how we would manage our resources to what techniques we would try.
- Brilliant review by Casey on Hypercalcemia in a nutshell - great post on a difficult and often poorly understood electrolyte disorder.
- Early Lactate Testing in Undifferentiated Paediatric SIRS - Lactate is just as important in the septic kid as it is in adults, if your taking blood from a febrile kid- might as well check the lactate while your there.
- Orbital Cellulitis - How to detect it on CT!
- Charcoal: Reserved For Grilling? Excellent review by Lauren on the use of charcoal in poisonings. Remember it does have a role, just a limited role in a limited number of poisonings.
- Updates in fluid resuscitation in trauma - short, sharp summary on were we are today with fluid resuscitation in the haemorrhaging trauma patient…Nice review Kent, worth a gander!
The LITFL Review Shout Out of the Week
Shout-out this week is taken out by new and exciting emergency ultrasound blog The Sono Cave, headed up by Aussie ED ultrasound guru James Rippey and his team of clinicians promise to take probing to a whole new level, and its already of to a great start with these posts:
- Two catheter balloons in a patient that had a major post partum haemorrhage (PPH), and had a Bakri ballon inserted to stem the bleeding- but did it, the probes gives us the answer.
- A big stone causing RIF pain- This is a case of acute appendicitis where an appendicolith obstructs the lumen of the appendix causing distention and inflammation of the distal appendix.
- To see, or not to see - forget the slit lamp now for detecting retinal detachments, just need some gel and a probe!
Twee Dee and Twitical Care
News from the Fastlane
- Michelle provides us with an in-depth, energetic wrap of #ACEM2012 In Perspective, can’t wait for the videos and podcasts to be released so we can listen to all the talks!
- Tessa reviews Keeping Up With Emergency Medicine, new app in TechTool Thursday 007.
- Cheers to Mike for giving the review a freshen up, personally I like the new image, hope the rest of you do to!
The Final Words
- “Don’t raise your voice. Improve your argument.”
- Desmond Tutu
- “better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”-Atul Gawande
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 —ED-Nurse— 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