Welcome to the awesome 94th 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
Top spot this week has been smashed by two great post from the StEmylns team!
- First up we have Simon as he prepares us for the ever dreaded Perimortem C-section - what other procedure can deliver a 200% mortality? This post is brilliant, in depth and covers both the metacompetence required and the technical skills required to complete this life saving procedure! Hat Tip: some great pearls in the comments section as well, be sure to check them out.
- Next up is Richard with an insightful look at Teamwork in Resus: Just Like Football? Yes there is plenty of similarities comparing the resus room to the football field team, and our goals is about winning and saving the the patient…Its how we get there is what this post is all about.
The LITFL Review Top Picks
- Ketamine & cardiovascular stability - remember to tailor your dose to the patients physiology and you generally want run into trouble.
Great pearl from Michael Winters on post intubation hypotension:
- It is clear that preintubation hypotension is associated with increased mortality in critically ill patients who require mechanical ventilation.
- Unfortunatley, the literature is less clear on the frequency and impact of hypotension that develops after intubation.
- Two recent publications in the Journal of Intensive Care provide valuable information on postintubation hypotension. Some highlights of the studies include:
- Retrospective cohorts of over 300 patients who developed postintubation hypotension, defined as a SBP < 90 mm Hg within 60 min of intubation.
- Postintubation hypotension occurred in almost 25% of patients.
- Median time to hypotension was 11 minutes.
- Patients with postintubation hypotension had a higher inhospital mortality (33% vs. 23%).
- A preintubation Shock Index > 0.8 was the strongest predictor of cardiovascular collapse after intubation.
- Take Home Point: Postintubation hypotension occurs frequently and may be associated with worse outcomes.
- What’s in your emergency airway kit ? What’s your GOTO Gear!? Minh wants to know!
- How do you hold your laryngoscope? Caveman style? Ming teams up with Jim DuCanto to discuss how holding the laryngoscope may actually improve glottic view.
- The Vortex – management of the unexpected difficult airway. Minh has a chat to two airway gurus on their approach to emergency airway management using simple cognitive aid to assist in the unexpected difficult airway case. Its called VORTEX!
- Two great paediatric procedural videos on Bag Mask Ventilation and IO Insertion – Two critical procedures, one blog post - Worth a gander at!
- NSAIDs Part 1: Which one is best? - Take home point: “Although some agents have been advocated for specific indications (eg, indomethacin for gout), there is no compelling evidence that any one NSAID is superior to any other—for any indication. Consequently, NSAIDS should be selected based on convenience, cost, and availability rather than on theoretical efficacy advantages.”
- Battle Preparation: Getting Ready for Your First Shift in the ER - Great guest post by Damian Tedford- are you prepared?
- Just another wrist fracture? Great case highlights some limitations of X-rays and how the use of CT change the management of this case.
- ICE 004- Ian puts us through our paces with an evolving ECG- what would you do?
- Rob not only owns the anus but now also owns the Butt Pus, for more check out the vodcast below from USC Essentials:
- ECT4Health. Ian gives a shout-out to ED nursing Education guru Robert Timmings and his new trauma nursing blog ECT4Health, great to see more nurses joining the FOAMed world.
- Tip: how to collect a baby’s urine on demand. A new approach thats still fun and frustrating to watch but delivers results!
- Is it Pyloric stenosis? - Can you pick it like Casey can? Great case!
- Anatomy for Emergency Medicine 025: PK SMACC talk - Brilliant!
- Excellent lectures giving introduction to medical toxicology - and there full of common sense toxicological advice, something we dont alway see!
- The toxic trio: what’s the number needed to test? - As Leon say’s This small study leaves many questions unanswered. I would have to agree.
- Nebulized naloxone in opiate intoxication- Were are we at? A must read study and Leon as always is right on the money when its come to using a rational logical approach to these patients@
- Right Bundle Branch Block with ST Elevation in V1? Is it MI vs psuedoinfarction?
- Heart rate of 230 beats per minute - Its ok its just a infant with a fever and dehydration – not too much to worry about right?
- Dexmedetomidine (Precedex) as an Adjunct to Benzodiazepines for Ethanol Withdrawal. Dexmedetomidine may be a useful adjunct to benzodiazepines for ethanol withdrawal patients (in the ED or ICU).
- Trick of the Trade: Needle foreign body removal - Probe it the pull it- its that easy!
- VBG versus ABG - Nice Paucis Verbis card on correlating the VBG vs the ABG.
- Mandible fracture - a nice guide to reading facial CT scans.
- Papa Don’t Preach - When the condom breaks…Do you know what is the best method of emergency contraception!
- Want to get up-to-date on paediatric DKA? Check out….sweet & sour…
- What’s Your Trigger? To transfuse some red stuff into your patients, nice summary by Lauren highlighting the pro’s and con’s of the debate.
- What to know when and why of when to transfuse that low HB in certain circumstances? Lauren has put together an excellent review on it here in: Special (Medical) Transfusion Situations
- Etomidate associated with increased mortality in sepsis: meta-analysis (Crit Care Med). Clinical Takeaway: Etomidate as an anesthesia induction agent for intubation was associated with increased mortality among septic patients in this meta-analysis, which was flawed by study heterogeneity and possible publication bias.
- Forget “embolic burden” of pulmonary embolism: location is everything (Chest). Take home point: In hemodynamically stable patients, PEs in the main pulmonary arteries seem to confer a higher risk of dying or deteriorating, so these patients might warrant higher levels of care and longer observation periods compared to lower risk segmental and subsegmental PEs.
- Sumesh Arora on Dysbarism - Great podcast on managing your patients that are going around the bend!
- A Review of Systematic Reviews - The ins and outs of systematic reviews and how FOAMed fits into all this- great post!
- Code Brown: Crashing Trauma Patient - Brilliant case on manning the bleeding trauma patient. Remember In life vs limb, life wins.
- IVC Diameter and Hypovolaemic Shock. Take-home message: It is is not too impressive but at least there is some evidence demonstrating how IVC diameter is lower in patients presenting with hypovolemia. Also, It confirms what we know about the significant variation in IVC diameter between individuals.
- We’ve seen the checklist, now Scott walks us through how to use it EMCrit Intubation Checklist.
- Does ondansetron affect the gag reflex? Turns out it does…..Ondanestron for Awake Intubation - the power of FOAMed keeping us educated again.
- Join Scott on Google+ for more EMCC goodness! Check out video for more:
- Toddler’s Fracture - Nice pearl: little kidos are more likely to fracture a bone than strain a ligament.
- Lidocaine for Renal Colic - Just when you think you’ve heard it all – something new and different, and it seemed to be just as effective as IV fentanyl!
- MOPETT – Half-Dose tPA for PE - Seems to be a game changer, and most of the experts are liking this study! Are you doing it yet?
The LITFL Review Shout Out of the Week
Great new FOAMed resources this week by EM CapeTown - provides us with a stella collection of EM procedural videos for our learning pleasure. Check out their YouTube channel for more.
The GMEP Cases of the week
Twee Dee and Twitical Care
News from the Fastlane
- The FOAMed world is taking off and two recent prominent articles have paid respect to two of the founders of EM Foam Mike and Chris, for more check out:
- Another great summary of EMA February 2013 is out!
The Final Words
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 —boringem—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 — EM CapeTown — EMDutch — Emergency Medical Abstracts —EMERJENCYWEBB –EmergencyLondon — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Tutorials—Emergency Medicine Updates —Emergucate — emimdoc — EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMProcedures — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — EM REMS — ER CAST — EXPENSIVECARE — Free Emergency Medicine Talks — GMEP — Gmergency!—Got Resuscitation— Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network — iTeachEM — IVLine — 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 —PEMTweets Blog — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — Resus.com.au — Resus.ME — RESUS Room — Resus Room Management — Richard Winters’ Physician Leadership —ruralflyingdoc — SCANCRIT — SCCM Blogs — SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SOCMOB — 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 Podcast — Ultrasound Village