The tenth edition of our weekly series of eminence-based evidence:

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 11 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer

• Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med. 2010 Oct;56(4):392-401.e1. PMID: 20868907.

The DORM study is an important step towards rehabilitating the reputation of droperidol in the sedation of agitated patients. Droperidol is an (almost) essential emergency drug that we should not be afraid to use when required.

Recommended by Chris Nickson

• Solomon RC. Coffers brimming, ethically bankrupt. Ann Emerg Med. 2012 Feb;59(2):101-2. Epub 2011 Nov 10. PMID: 22078890.

A brilliantly written piece outlining our culpability as physicians and our responsibility to make a stand and pay the moral and financial cost of our involvement with big pharma.

Recommended by Andy Neill

This week’s R&R recommendations

Critical Care

Emergency Medicine

Quirky, Weird and Wonderful

Toxicology

Trauma

Ultrasound and Imaging

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The ninth edition of our weekly series of eminence-based evidence:

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 8 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer

• Batchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace. 2007 Nov;9(11):1081-90. Epub 2007 Oct 10. Review. PMID: 17932025.

This paper is a thing of beauty for the ECG nerd – all the ways incorrect lead placement can play havoc with an ECG.

Recommended by Chris Nickson
Fulltext

This week’s R&R recommendations

Critical Care

• Batchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace. 2007 Nov;9(11):1081-90. Epub 2007 Oct 10. Review. PMID: 17932025.

This paper is a thing of beauty for the ECG nerd – all the ways incorrect lead placement can play havoc with an ECG.

Recommended by Chris Nickson
Fulltext

• Beck LH. Should the actual or the corrected serum sodium be used to calculate the anion gap in diabetic ketoacidosis? Cleve Clin J Med. 2001 Aug;68(8):673-4. PMID: 11510523.

If only I had a dollar for every time someone has asked me the question this little paper succinctly answers…

Recommended by Chris Nickson
Fulltext

International and Tropical Medicine

Pediatrics

Quirky, Weird and Wonderful

Toxicology

Trauma

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Welcome to the splendid 55th 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 will cast 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.

The Most Fair Dinkum Ripper Beaut of the Week

SMART EM

• The uber geek’s of emergency medicine are back with a lengthy look at Stress Testing: A Moment of Clarity - the SMARTEM team dives down through 40,000 leagues of medical literature on the utility of using the exercise stress testing in the emergency department. Congratulations David and Ashley on taking out top spot!

The Usual Suspects

Academic Life in Emergency Medicine

• Trick of the Trade: Minimizing propofol injection pain - great tips inspired by Andy Neill’s recent contribution to R&R In The FASTLANE.
• Paucis Verbis: Pediatric fever without a source (Birth-28 days) - A nice approach guaranteed to come in handy!

Free Emergency Medicine Talks

• Joe’s pick of the week is by Karl Nibbelink on the difficult topic of I Suspect My Colleague Is Using Drugs: What should I do?

The Poison Review

• “Legal Highs”: new psychoactive drugs - not the greatest article on new psychoactive drugs – but provides some useful facts.
• Honey Don’t: grayanotoxins, sex, and affairs of the heart - this honey is most probably not something to spread on your toast. This is an amazing pair of cases.
• Bath salts and necrotizing fasciitis: a case report -  you have been warned!

Dr Smith’s ECG Blog

• Left ventricular Aneurysm Morphology Distorted by Right Bundle Branch Block – Mimicking Acute STEMI with RBBB.
• Chest pain and hypotension in a patient who is 3 weeks post STEMI - is the patient having ongoing ischaemia or a complication post-STEMI?

Emergency Physicians Monthly.

• 11 Benchmarks That Should Matter to EPs. Take home point: Benchmarks serve no purpose if they do not reflect the needs and perceptions of all the stakeholders.
• Sickle Cell: 10 Things Every EP Should Know about SCD.

Impactednurse

• You are twice as likely to die when flying on this aircraft – You wouldn’t fly on this plane with that risk- but patients that attend the emergency department are exposed to the same risk.
• 53 secrets the ED staff won’t tell you – What there is only 53??
• Ian gives a tribute in praise of our wardsmen (and women).

The Rest Of The Best

CLIC-EM

• Some excellent little pearls and pitfalls on a common ED resus medication - Know Before You Push — Adenosine - remember help your electrophysiologist out get a good ECG before giving.

Intensive Care Network

• Craig Hore shares with us an interesting case in Emergency Pacing - and shares with us some excellent pitfalls in for transcutaneous pacing.

Emergency Medicine Literature of Note

• Further Harms of IV Contrast - Just in case you needed another reason to not order a contrast CT.
• The Harmful Rush To Hypothermia - Hard to know what to actually do with data.  Is early hypothermia truly harmful?

Broome Docs

• Consult Skills 2: When Agendas Collide or “Physician Know Thyself” – Casey shares his approach to the difficult patient or the difficult conversation.

UMEM Educational Pearls

Michael  Winters pearl of the week - SAH and Pulmonary Edema – Think Twice About Diuresis!

• Delayed cerebral ischemia (DCI) is the most common cause of secondary neurologic injury in patients with aneurysmal subarachnoid hemorrhage (SAH).
• Intravascular volume depletion is one of several factors thought to cause, or worsen, DCI.
• Pulmonary edema frequently occurs in patients with SAH.
• A recent study in patients with SAH and pulmonary edema demonstrated that many were not volume overloaded.  In fact, many were intravascularlyvolume depleted.
• Think twice about aggressive diuresis in patients with SAH and pulmonary edema, as this may exacerbate volume depletion and may worsen DCI.

Emergency in the Shed

• David smashes out another brilliant podcast episode when he teams up with anaesthetic consultant Simon Pattullo to provides us with an approach to the ‘Can’t Intubate – Can’t Ventilate” scenario – check out Airway-Preparing to Fail.

Emergency Medicine Ireland

• Revitalising Professionalism - “The fact that medicine rarely cures many of the diseases that we attend to makes it even more morally significant.”
• Anatomy for Emergency Medicine – #5 CSF Circulation

Anatomy for Emergency Medicine – #5 CSF Circulation from Andy Neill on Vimeo.

EmergSource.com

• Learning to learn - The secret to life long learning is simple. Everyday, and every patient ask yourself ‘Could I have done that better?’

ED Trauma and Critical Care

• Amit shares with us some of his revision notes on Radiation Illness and High Altitude Illness.
• Management of The Mangled Extremity - a new algorithm approach from some recently published literature.
• As Australian’s continue to have a love affair with Bali – ED doc’s and nurses need a good understanding on Saturday Night Dengue Fever & Staying Alive - Worth reading!
• Bleeding Hell! Dabigatran is Here. Forget the Vit K or prothrombinex its straight of to dialysis for these patients!

Pediatric Emergency Medicine Morsels

• This weeks morsel is on how to rotate back the Malrotation.

EMdose

• Vasopressors in Neurogenic Shock - Remember: shock in a trauma patient should be presumed to be secondary to hemorrhage until proven otherwise.  If you’re certain it’s neurogenic shock, then optimize BP with crystalloid fluids, followed by a pressor as above to increase your MAPs and increase spinal perfusion.
• Hypothermia in Trauma - Until further word, preventing and correcting hypothermia is recommended.

The Trauma Professional’s Blog

• The Societal Cost of ED Thoracotomy - Bottom line:  use the guidelines and save your own health, safety and hospital resources. Is it really worth it if you know the patient will not survive?
• Can Lead Poisoning Occur After A Gunshot? -  Not something you come across every day, but some important pearls and pitfalls here on treatment options.
• A Cool Way To Remove Embedded Foreign Bodies - This is a very slick technique that promises to dramatically increase the success rate and decrease complications from removing foreign bodies.

A Life at Risk: the Emergency Physician

• Septic Arthritis and Arthrocentesis - Although arthrocentesis is not a risk-free procedure, synovial fluid analysis is essential for the diagnosis.

More Musings (of a Distractible Kind)

• Good Things in Medicine #2: Puzzles – Problem solving is central to being a good diagnostician. The quirky and insightful Rob Lambert tells us why diagnosis is cool, and how to get good at it.

 Twee-D and Twitcal Care

A holistic orthopaedic surgeon is one who cares for the whole bone and not just the fracture.

January 24, 2012 2:58 pm via Twitter for iPhoneReplyRetweetFavorite

@otorhinolarydoc

Trainee ENT Surgeon

News from the Fastlane

• Yosef Liebman’s Emergency Medicine Update January 2012 - is out…so check it out!
• There is still time to go into the draw to win in the Test The Textbook Trilogy.

The Final Words

• ‘Accept ignorance, accept that you just don’t know, once you get that into your head you’ll start to learn.’

 - Jim Ducharme

• “One of the major biases in risky decision making is optimism. Optimism is a source of high-risk thinking.”

- 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 our roving reporter:  kane AT lifeinthefastlane.com

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The eighth edition of our weekly series of eminence-based evidence:

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 14 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famers’

• Abd-el-Maeboud KH, el-Naggar T, el-Hawi EM, Mahmoud SA, Abd-el-Hay S. Rectal suppository: commonsense and mode of insertion. Lancet. 1991 Sep 28;338(8770):798-800. PMID: 1681170

Recommended by Rob Orman
Learn more: ERCAST – The Suppository Conundrum

• Hudson ML, Moore GP. Defenses to Malpractice: What Every Emergency Physician Should Know. J Emerg Med 2011;41:598-606. PMID: 21094012

Recommended by Leon Gussow

This week’s R&R recommendations

Airway

Critical care

Emergency medicine

Pediatrics

Quirky, weird and wonderful

Retrieval, prehospital and disaster

Toxicology

Trauma

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Welcome to the mind-boggling  54th 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 will cast 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.

The Most Fair Dinkum Ripper Beaut of the Week

EM Basic

Top spot this week is taken out by someone new on the podcasting/blogging scene… Steve Carroll over at the simple yet extremely informative podcast EM Basic. This podcast covers all the pertinent topics in EM in a simplified, easy to follow format. To take out top spot this week Steve provied a nuts and bolts simplified approach to the patient presenting with syncope. He covers what tests need doing, all the way through to who needs to stay for further work-up and who can be discharged. Also check out the bonus section on rehydrating the dehydrate patient in the ED.

The Usual Suspects

RESUS.ME

• β-2 agonists could worsen ARDS outcome - the search continues for what actually works and provides benefits in ARDS.
• Caution with intraosseous adenosine. Interesting case series – but was the dose and IO position correct?
• Adjacent haemofiltration catheters can remove CVC drugs - An important consideration when siting your lines in your critical care patients who require renal replacement therapy.
• FIRST: Fluids in Resuscitation of Severe Trauma. Cliffs take on this study: “I’m sure the FIRST trial is going to be quoted for some time to come, including, I suspect, by the manufacturers of certain colloids”.

Emergency Medicine News

• Leon Gussow highlights The Best Toxicology Articles of 2011 and finishes by taking a swipe at the black box warnings.
• Hernia with Acute Pain and Swelling - time to reduced the irreducible.

Academic Life in Emergency Medicine

• Paucis Verbis: this week gives us the heads up on what and when to give Antibiotics for open fractures.
• Trick of the Trade: A handy approach to managing the often challenging Dental Avulsion/Subluxation.

Free Emergency Medicine Talks

• Larry Raney gets Joe’s pick of the week with a presentation on Should We Be Using More Agonist / Antagonist Pain Medicines in the ER?

ER CAST

• Rob is back with another awesome podcast this time teaming up with Ryan Radecki the literature guru from Emergency Medicine Literature of Note to tackle and discuss the ins and outs on Decision Tools: PERC, NEXUS and CURB-65 - they also get some commentary from Scott Weingart from EMCrit, and give LITFL editor Chris Nickson numerous shout-outs.

The Poison Review

• Prehospital naloxone given by nebulized inhaler - time to start considering that nebulized naloxone is safe and effective treatment in patients with suspected opiate overdose and spontaneous respiration.
• Caffeinated energy drinks: do they cause significant acute toxicity? – Are these drinks causing a problem? Leon isn’t convinced what about you?
• Carnitine and valproic acid overdose - is it a reasonable approach? The jury is still out – but Leon thinks so.

Dr Smith’s ECG Blog

• Subtle Anterior Transient Injury Pattern, Not Appreciated -Looks like the LAD occlusion spontaneously reperfused.

Emergency Physicians Monthly.

• Greg Henry promotes a new must read book for emergency doctors and nurses in It is OK to Die. - anybody out there read this book yet? Do you share the same sentiments as Dr Henry? Let us know. 
• Rick Bukata shares with us some new literature focusing on With Discharge Instructions, Less is More - worth a read!

The Rest Of The Best

Intensive Care Network

• Oli is back with another great case-based podcast in An interesting case. Can you try to work out what your differential would be and how you would investigate and manage this case.

PEM + ED

• This months podcast is on Clearing The Pediatric C-spine - remember “Your pediatric patient doesn’t need a decision instrument as much as they need a good doctor.”

Emergency Medicine Literature of Note

• Lies, Damned Lies, and Tamiflu (oseltamivir) -  it doesn’t decrease hospitalisations and only reduces symptoms by about 21 hours – is it worth it??
• 100,000 Incorrect TIA Diagnoses Every Year – a very disappointing study that made its way into the Annals – how??
• Observation For Anticoagulated Head Trauma - will the absence of evidence change our practice in this patient group – be interested to see what others think of this paper

Broome Docs

• Casey introduces us to the art Consultation Skills: Intro and highlights the two different approach he takes towards his consultations – looking forward to reading other post in this series.
• Consult Skills 1: The “normal” strategy: Understand the patient’s point-of-view and prosper. Biggest take home point – “every patient has a story to tell, let them tell it.”
• Irukandji syndrome – the swarm hits Broome-  a nice review on one of the LITFL team’s favourite topics.

UMEM Educational Pearls

Amal Mattu is back again with more brilliant cardiology pearls. This week looks at  coronary risk factors and AMI mortality.

• We’ve noted studies in recent years indicating that cardiac risk factors are ineffective at predicting the likelihood of ACS in patients with acute chest pain (in other words, it’s all about the HPI and EKG!).
• Now there’s evidence also that cardiac risk factors are ineffective at predicting in-hospital mortality in patients that rule in for acute MI. [1]  In fact, this study actually demonstrated that in-hospital mortality is inversely related to the number of cardiac risk factors!
• The bottom line is simple: cardiac risk factors are useful at predicting long-term risk for development of coronary artery disease, but they are NOT useful at in the acute setting.
• Canto JG, Kiefe CI, Rogers WJ, et al. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. JAMA2011;306:2120-2127

Emergency Medicine Ireland

• NAC for alcoholic hepatitis - the research is looking promising for this intervention – nice find Andy.

EmergSource.com

• Your Next Patient: A 62 Year Old Man With Advanced Lung Cancer- Brilliant case,  something different for a change, a look towards palliative care in the ED. Palliative care seems on face as far out of the realm of emergency medicine as can be – what do you think?

ED Trauma and Critical Care

• Posterior Sterno-clavicular Dislocation - check out the key points on identifying and managing this rare and diagnostically challenging presentation.
• Dysbarism Made Easy…. A nice revision list of the key terms and points surrounding this topic.

Pediatric Emergency Medicine Morsels

• This weeks Morsel is huge with a review on Pediatric Obesity – just when you thought your job was difficult enough.

EMdose

• Steroids in Acute Spinal Cord Injury - its not the standard of care – and does the evidence even make it a treatment option?
• A nice review and some suggestion on why you attempt to clear patients of the Long Spine Boards asap.
• Catheter Size and Fluid Resus -A review on why short and fat is a good attribute for intravenous catheters and some other things about flow.
• Needle thoracostomy - looks like its time for a new approach.
• Heart rate in hemorrhage - what is the magic heart rate number?

EMpills-pills of Emergency Medicine

• Anterior nasal tamponade anchored - a new approach to packing that bleeding nose.

The Trauma Professional’s Blog

• Pet Peeve: “High Index of Suspicion” - interesting, food for thought!!!
• Does Initial Hematocrit Predict Shock? - Bottom line: Starling was right! Fluid shifts occur rapidly, and initial hematocrit or hemoglobin may very well reflect the volume status of patients who are bleeding rapidly. If the blood counts you obtain in the resuscitation room come back low, believe it! You must presume your patient is bleeding to death until proven otherwise- a must read post!!!

A Life at Risk: the Emergency Physician

• Septic Arthritis in patient with HIV- what is the LR give you on the test you order.

 Twee-D and Twitcal Care

Anaesthetic's ABCDE. Arrive, blame, criticize, depart, everyone else's problem. #joking #iloveanaesthetistsreally

January 21, 2012 6:09 pm via Twitter for iPhoneReplyRetweetFavorite

@4hrEmergencyDoc

ED Doc

News from the Fastlane

• R&R In The FASTLANE 007 is back from its festive break – find out what the experts in EM have been reading lately.
• Want to win one of 3 awesome textbooks? Find out how in Test The Textbook Trilogy!!

The Final Words

• “Seriousness is the only refuge of the shallow.”

- Oscar Wilde

• “There can be as much value in the blink of an eye as in months of rational analysis.”

-Malcolm Gladwell

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 our roving reporter:  kane AT lifeinthefastlane.com

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Late last year we completed a trilogy of textbooks relating to emergency medicine, toxicology and medical education.

We are now looking for ‘volunteers’ to read and review these texts…and have 15 textbooks (5 of each book) to give away for FREE.

Rules for reviewers

• Be subscribed to Life in the Fast Lane by email or RSS feed
• Send me an email letting me know which of the texts you would like to review, and why
• Enhance your chances by leaving a comment at the end of this post, sending me a Tweet on twitter or a Comment on Facebook or a Comment on Google Plus
• Cross your fingers
• The lucky winners will be drawn out of the proverbial hat on February 1st 2012…

Emergency Medicine Diagnosis and Management

Authors: Anthony F. T. Brown, Mike Cadogan
Edition: 6th Edition
Chapters: Additional reference material, clinical images and extended tables
Overview: Handbook of emergency and acute medical care. Utilises a standardised approach to the diagnosis and management of common conditions encountered in the emergency setting. Suited to a wide range of health and medical professionals

Publisher: Hodder (Order UK – Order Australia)

On Call Principles and Protocols

Authors: Mike Cadogan, Anthony F. T. Brown, Antonio Celenza
Edition: 2nd Edition
Chapters: Additional reference material, clinical images and extended tables
Overview: Handbook of acute medical care. This revised handbook based on Marshall and Ruedy’s original text is designed to assist medical students, nurses and junior doctors deal with common calls, the interpretation of medical investigations and managing patient-related problems with a symptom based approach
Publisher: Elsevier (Order Australia)

Toxicology Handbook

Authors: Lindsay Murray, Frank Daly, Mark Little, Mike Cadogan
Edition: 2nd Edition
Chapters: Additional reference material, clinical images and extended tables
Overview: Handbook of toxicology. Utilises a standardised approach to the diagnosis and management of common conditions encountered in the emergency setting. Covering the common toxicological emergencies and highlighting some of the more important elapid and marine envenomings.
Publisher: Elsevier

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

The seventh edition of our weekly series of eminence-based evidence (back after the festive season hiatus):

A free weekly resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 18 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer’

• Croskerry P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Academic Medicine 2003;78:775-780. PMID: 12915363.

You won’t be able to avoid cognitive errors such as anchoring, confirmation bias, psych-out error, and Yin-Yang out unless you’re aware of them. Pat Croskerry gives suggestions on tuning up your medical decision-making.

Recommended by Leon Gussow

This week’s R&R recommendations

Critical Care

The R&R iconoclastic sneak peek icon key

	The list of contributors		The R&R ARCHIVE
	R&R Hall of fame You simply MUST READ this!		R&R Hot stuff! Everyone ‘s going to be talking about this
	R&R Landmark paper A paper that made a difference		R&R Game Changer? Might change your clinical practice
	R&R Eureka! Revolutionary idea or concept		R&R WTF! Weird, transcendent or funtabulous!
	R&R Boffintastic High quality research		R&R Trash Must read, because it is so wrong!
	R&R Mona Lisa Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Dr Newman helps us to tackle hyperbole and fear-mongering media head on by understanding the value of data in the age of information…

As health care professionals we all have a responsibility to help curate and deliver the most accurate information and help define the ‘truth that lasts” – we should not take this responsibility lightly

http://www.youtube.com/watch?v=TDB6iBOhuq0

Dr. Newman is the Director of Clinical Research in the Emergency Department at the Mt. Sinai School of Medicine. For the past ten years he has concentrated his work in medical evidence translation and appraisal. He is also the editor-in-chief for TheNNT.com, a resource for health care evidence summaries, and SMART-EM, a monthly audio review.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Welcome to the awe-inspiring 53rd 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 will cast 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.

The Most Fair Dinkum Ripper Beaut of the Week

EMCrit

• Top spot this week is taken out by Scott over at  EMCrit when he teams up with Dr Paul Marik to try and answer one of the toughest questions in critical care on assessing fluid responsiveness in the critical ill patients. Check out Podcast 64 – Fluid Responsiveness with Dr. Paul Marik.

The Usual Suspects

Emergency Medicine Updates

• Reuben shares with us a new approach to bag-valve mask ventilation  11 minute screencast: emergency ventilation. This screen-cast is pure gold and is a must watch for everyone that is involved with airway management.

Emergency Ventilation in 11 Minutes from reuben strayer on Vimeo.

RESUS.ME

• Emergency percutaneous airway - Cliff provides us with an excellent review and pearls from a recent article focuses on emergency needle and surgical cricothyroidotomy.
• Prehospital fluids for head injury – keep it simple - Take home point from  a team from Melbourne that has reviewed the literature and concluded isotonic crystalloids (Ringer’s or Saline) are as good as anything else.
• Ultrasound for pneumonia -Bedside chest ultrasound is a reliable tool for the diagnosis of pneumonia in the ED, probably being superior to CXR in this setting.
• Steroid replacement after etomidate: no benefit - is it time we brought this drug to the land down under or forget about it all together?
• Vasopressin – what it does and doesn’t do - Cliff sums it all up in a nice review.
• Potassium levels and AMI death - time to start aiming for serum potassium levels between 3.5 and <4.5 mEq/L in AMI patients.

Emergency Medicine News

• Graham Walker shares with us his frustrations On My Emergency Medicine Boards.
• Only Mostly Dead- An interesting case!

Academic Life in Emergency Medicine

• Paucis Verbis: Interpretation of intraosseous blood- another nifty little card to print of and have handy in your trauma bay.
• Trick of the Trade: A removable guidewire - the MacGyver approach making something out of nothing.

Free Emergency Medicine Talks

• Joe’s podcast of the week is by Chandra Aubin with the in’s and out’s on diagnosing Idiopathic Intracranial Hypertension in the emergency department.

ER CAST

• Zen and the Art of Shoulder Reduction- Rob gives us an awesome screen-cast and walks us through the Cunningham approach to shoulder relocation.

The Poison Review

• Potent stimulant PMMA associated with ecstasy deaths - cheaper, gives you an enhanced drug effect- but also results in more fatalities, need to be on the look out for PMMA presentations.
• Methadone induces hearing loss- an unusual side effect!
• Pick Your Poison- Leon put’s us up to the Q & A challenge.

Dr Smith’s ECG Blog

• Serial ECGs confirm initial suspicion of anterior STEMI (LAD occlusion) - Take home point – if the suspicion is there, get your nurses doing serial ECG’s.

Impactednurse  

• Ian provides us with a quirky look at how to collect a mid-stream urine specimen.

empem.org

• Dr Colin and Dr Rachel share with us some Well Baby Oddities! Covering everything from periodic breathing through to hormonal withdrawal.

The Rest Of The Best

Emergency in the Shed

• David and Jeff are back with part 2 of Avoiding the Pitfalls of Trauma Part 2, after taking out top spot with part 1, part 2 certainly doesn’t disappoint- pack full of amazing pearls that will have you dominating and improving outcomes for your next trauma patient. Worth listening to.

HQmeded.com

Does my patient have measles?

Does my patient have measles? from hqmeded.com on Vimeo.

 DrGDH

• Scaring the SHO’s or “Can we be sure discharge is safe?” - Take home point: we have to be comfortable accepting a certain level of uncertainty, when discharging patients from the emergency department.

CLIC-EM

• Reversal of Novel Anticoagulants in the Bleeding Patient - nice guide to help you face the challenge of reversing these new novel anticoagulants.

Emergency Medicine Literature of Note

• PERC – Still (Mostly) Useless - don’t think too many ED docs would disagree with that title Ryan!!
• Can We Stop Placing NG Tubes? Bottom line: So, yes, if you wanted to stop placing NG tubes because they’re uncomfortable for patients and apparently don’t change ultimate outcomes – certainly, that may be reasonable.

Broome Docs

• SUSS IT: Secondary UltraSonographic Survey In Trauma - This post is a must read! Casey provides us with a excellent guide to using ultrasound as part of your primary and secondary assessment of trauma patients.
• Dr JRs last week in training before he goes bush. A look back at the lesson’s learned from a year of GP anaesthetic training.
• Quit QID? Is Casey just a bad parent? Or is he onto something here? Makes a lot of sense and practicality by changing to BD dosing!!

UMEM Educational Pearls

Amal Mattu shares this week pearl on the painless ACS:

• As many as 1/3 of patients with proven ACS have no chest pain at presentation.
• Among the more common alternative presentations (anginal equivalents) are dyspnea, diaphoresis, nausea/vomiting, and syncope/near-syncope.
• Note also that the absence of pain does not confer a better prognosis.
• The overall in-hospital mortality rate for patients with painless presentations is 13% vs. 4.3% for patients with chest pain.

Emergency Medicine Ireland

• IV Paracetamol vs morphine for pain - a bigger study is needed – but some results look promising for IV paracetamol in acute limb trauma.

EmergSource.com

• The time and action specific consultation - some great pearls and pitfalls from Aaron on dealing with interactions with other consultants.

ED Trauma and Critical Care

• Military Abdominal Aortic Tourniquet  - how times change with research, the recent wars have shown that limb tourniquets aren’t such a bad thing after all, know we have a whole new concept of the abdominal aortic tourniquet – I’m sure we will all be watching were this device takes us closely!!!
• More on Human Factors in Trauma Scenarios - interesting research- worth having a read of this paper!
• Myth Buster Episode 4 – the Case of the Stone Heart - nice review on the literature surrounding giving calcium to the hyperkalemic digoxin toxic patient!!
• Utility of Chest Radiography in Blunt Trauma- Is it time to change our practise, and individualise our care and tailor it to the patient in front of us?

Annals of Emergency Medicine Podcast

• David and Ashley are back with the January 2012 podcast highlight the latest and greatest published research from a look at Dengue fever through to the effectiveness for steroids in treating Bell’s palsy.

Pediatric Emergency Medicine Morsles

• This week’s morsel is on Gradenigo’s Syndrome and Otitis Media.

EMdose

• A take on Factor VII -Bottom line:  We still need a lot more data before we can officially make a stance on this issue, but for now, it’s probably better to stay away from a medication with no mortality benefit and a possibly bad side effect profile.
• Perimortem C-section - the facts on when to, and a short summary on how to!
• A little reminder of some important neonatal resuscitation points. Check out - Neonatal Resus!

EMpills-pills of Emergency Medicine

• A chest pain resistant to treatment - remember chest pain in young adults isn’t always benign.

Crit-IQ

• This week Associate Professor Andrew Davies shares his expert knowledge of Total Parenteral Nutrition – when to start, what to add and how much to give. Have a listen to TPN – Getting it right.

The Trauma Professional’s Blog

• High Inspired O2 Is Not An Effective Pneumothorax Treatment- although the good evidence is lacking, this approach seems to be more of an urban legend.

A Life at Risk: the Emergency Physician

• Soft tissue abscess: clinical plus ultrasound evaluation. Bottom line - Ultrasonography is a useful adjunct to clinical evaluation of soft tissue infection, it increases diagnostic accuracy and guides treatment decision.

 Twee-D and Twitcal Care

Anxiety mediated spontaneous cardioversion following suggestion of DC cardioversion. A case report. Chump et al 2012.

January 14, 2012 12:54 am via EchofonReplyRetweetFavorite

@bungeechump

Chump

News from the Fastlane

• Chris highlights the Best Of The LITFL Review 2011 - and the LITFL team wishes him well as he takes up his new post in Alice Springs.
• Ed drums out another brilliant tox conundrum in Brain Dead? and Rick Abbott is back with a take on Emergency Imaging In Tassie.

The Final Words

• “The real purpose of books is to trap the mind into doing its own thinking.”

-Christopher Morley.

• “If we are to learn to improve the quality of the decisions we make, we need to accept the mysterious nature of our snap judgments.”

-Malcolm Gladwell

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 our roving reporter:  kane AT lifeinthefastlane.com

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

If you were to ask me:

‘How do I find out about web 2.0 and social media education resources for emergency medicine and critical care?”

I’d reply:

“Easy, spend 10 minutes checking out The LITFL Review.”

Just over a year ago it became clear to me that keeping track of all the fantastic free education resources in our field was becoming near impossible for even the most assiduous insomniacal social media savvy technophilic medicos among us. Recognition of this need led to the creation of The LITFL Review – a ‘one stop shop’ that brings together a week’s worth of new educational material from the very best blogs, podcasts, tweets and online multimedia from around the world.

Kane Guthrie has been the furnace in the engine room of The LITFL Review, and we can all be thankful for his weekly Herculean efforts in bringing this all together. Great work, Kane!

Now that a year has passed, it’s time to reflect on just how incredible the free resources that are being shared in the social mediasphere actually are. In doing so, we give you our twenty favourite ‘Most Fair Dinkum Ripper Beauts!’ from the first 52 editions of The LITFL Review:

20. Big Transfusion, Little Hospital = Big Trouble

Casey Parker is one of those MacGyvers of medicine we prosaically call ‘GP Proceduralists’. His enthralling blog, Broome Docs, has rapidly become a staple of The LITFL Review. In this post he highlights the issues facing a small remote centre when facing patients with massive haemorrhage. The post must be read with its follow up: ‘Managing Traumatic bleeding: how can we apply the evidence in smaller hospitals?’.

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• Big Transfusion, Little Hospital = Big Trouble
• Managing Traumatic Managing traumatic bleeding: how can we apply the evidence in smaller hospitals?

19. Meningococcal Disease: Pearls and Pitfalls

I was lucky enough to work with Colin Parker in 2010 and picked up plenty of paediatric pearls along the way. Even luckier, his EMPEM podcast keeps getting better and the pearls keep on coming. Colin and team recruited Paediatric Infectious Disease specialist Chris Blythe for this succinct and informative review of the menace of meningococcal disease.

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• Meningococcal disease: Pearls and Pitfalls

18. The First Resus.ME! Podcast

Cliff Reid’s first podcast is a tantalising taste of what he can do. His insights into resuscitation education and practice are always on the money. Fingers crossed we hear more audio offerings from this great educator in the future.

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• First Resus.ME! Podcast

17. Podcasting in Emergency Medicine

Rob Rogers is the man when it comes to the practicalities of how to educate in emergency medicine. For this episode of EMRAP: Educator’s Edition he brought together two of the shining lights of EM/CC social media learning, Rob Orman and Scott Weingart. What follows is an entertaining nuts-and-bolts discussion of how to make a podcast… which is also, indirectly, a call to educators everywhere to join the social media revolution.

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• Podcasting in Emergency Medicine

16. Distracting injury in c-spine injuries?

Michelle Lin is to blogging what Rob Rogers is to podcasting. She is an emergency physician with a passion for education and has a social media presence dedicated to the academic aspects of emergency medicine. Her blog, Academic Life in Emergency Medicine, has two core offerings: the Tricks of the Trade and the Paucis Verbis cards. This post is an example of the latter – all you need to know about a topic to make clinical decisions is presented on a card that can be printed out or stored electronically for instant access.

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• Distracting injury in c-spine injuries?

15. IV Spike Cric

CLIC-EM is fairly recent edition to the emergency medicine blogging scene, coming out of Chicago. The blog focuses on brief reviews of interesting and important papers from the emergency medicine literature. We liked this practical do-it-yourself approach to an emergency cric… Handy if you find yourself without your standard kit.

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• IV Spike Cric

14. Weaning from Mechanical Ventilation

Serious conflict of interest with this one – Oliver Flower is one of my best friends in intensive care and is a LITFL contributor. His ICU Podcasts feature on the Intensive Care Network, a free to registrar social network for anyone interested in intensive care. Oli gives an intensivist’s perspective on how to liberate a patient from the machine.

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• Weaning from Mechanical Ventilation

13. Instinct versus Expertise

I consider Movin’ Meat, along with GruntDoc and Blogborygmi, to be the foundation stones upon which the emergency medicine social media colossus of today is built. Even before LITFL, these guys were bringing emergency medicine to the blogosphere. Movin’ Meat is not strictly an educational resource – though there have been some great educational posts over the years – yet, anyone who consults specialists from the ‘pit’ will learn from this post based on real life experience.

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• Instinct versus Experience

12. Patrick Croskerry: Clinical Decision Making in Emergency Medicine

Free Emergency Medicine Talks is one of the great treasures of the Internet Age for anyone interested in emergency medicine and critical care. Which is no surprise, as it is, in turn, the website of one of emergency medicine’s great treasures, Joe Lex. My eyes lit up when I saw this listed as Joe’s pick of the week… Both myself and EMCrit’s Scott Weingart (and I’d suspect TPR’s Leon Gussow is in the same boat) are starstruck cheerleaders for the work of Patrick Croskerry in bringing insights from cognitive psychology to the ‘perfect storm’ of emergency medicine decision making. Thanks to social media you get hear the gospel from the man himself.

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• Patrick Croskerry: Clinical Decision Making in Emergency Medicine

11. ‘Peer Review is dead, long live Peer Review!’

Graham Walker epitomises the tech savvy emergency physician of tomorrow… or perhaps the day after tomorrow. Everyone should know him from MDCalc and his work on TheNNT.com, but he also writes elsewhere, including The Central Line. This post – the oldest entry to make the Top 20 – looks into the future of peer review, a subject close to our LITFL hearts.

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• ‘ Peer Review is dead, long live Peer Review!’

10. Venlafaxine bezoar causing intestinal necrosis

The Poison Review is, in my opinion, the most under-rated medical blog out there. It’s author, Leon Gussow, has the perfect mix of intelligence, experience and diverse interests to make this the perfect poisons blog… after all, everything is poison… it just depends on the dose. Blogs tend to lack the high impact bedazzlement of a slickly produced podcast or vodcast, but the best blogs are unrivalled in their scope, detail and collation of useful resources – TPR does this well. The staple of TPR is telling us why we should, or (usually) should not, believe the new additions to the tox literature. Leon scores them with his notorious ‘skull and cross bones’ rating system. This post is just an example of the consistently top notch work Leon produces week in, week out.

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• Venlafaxine bezoar causing intestinal necrosis

9. Dr. Rivers on Severe Sepsis – Part I

Imagine if you could create a podcast that feature the likes of Emmanuel Rivers (that’s right, of ‘Early Goal Directed Therapy’ fame) talking about the latest developments in the assessment and management of severe sepsis. In other words, imagine you’re EMCrit’s Scott Weingart… Few could do what he does and then give it away for free. By the way, there’s also Parts II and III…

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• Dr. Rivers on Severe Sepsis – Part I

8. Chest Pain Risk

The SMARTEM podcast is mind blowing. David Newman and Ashley Shreeves get together on a monthly basis to dissect out the whys and wherefores that underlie what we do. Let’s not kid ourselves, listening to each podcast is an exercise in mental stamina – David and Ashley even advise taking it in bite-sized parcels. Yet the listener’s efforts are invariably rewarded, and there are often big surprises in store. My favourites so far have been the Subarachnoid Hemorrhage and Pediatric UTI podcasts, but neither of those were “Most Fair Dinkum Ripper Beauts”… In this one David tells us how he assesses the risk of badness happening to emergency patients presenting with chest pain.

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• Chest Pain Risk

7. Anatomy for Emergency Medicine video series – #1 Cervical Spine

Andy Neill is a LITFL reader from way back, and has gone on to create his own blog called ‘Emergency Medicine Ireland‘. Andy is a bit of an evidence boffin and likes to give his take on recent papers from the EM literature, but he has also started putting his skills as an anatomy tutor extraordinaire to use for ER docs. This is his first video on applied clinical anatomy for emergency medicine.

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• Anatomy for Emergency Medicine video series – #1 Cervical Spine

6. Atrial Fibrillation

If anyone was ever meant to podcast, it was Rob Orman. I may be misremembering, but I think Rob Rogers once likened him to the Barry White of EM podcasting. His curbside consult audio episodes have a captivating conversational style that allows him to really get into the ‘nitty gritty’ with an expert from another specialty. This one gets into the ins-and-outs of AF management with a likeable and knowledgeable electrophysiologist. Its worth listening to for the description of Rob’s first ‘hands on’ cardioversion if nothing else…

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• Atrial Fibrillation

5. Haemostatic Resuscitation

This video lecture by Richard Dutton, who we first met on a previous EMCrit podcast on resuscitation of the haemorrhagic shock patient, is one of the best lectures I’ve seen. Dutton really knows his stuff, and is actually one of the pioneers of the modern haemostatic resuscitation approach. What’s more, we get a few glimpses of Baltimore’s Shock trauma Center, which looks like one heck of a place to do medicine. Actually, this lecture shared the top spot of the 23rd LITFL Review with Scott Weingart’s take on The Mind of the Resus Doc: Logistics over Strategy… So check that out too.

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• Hemostatic Resuscitation

4. Bum crack fluid pump

After TPR, Resus.ME is the next most under-rated blog on the planet. Cliff Reid is a reliable source of new ideas and cutting edge insights in resuscitation. As for this post, how could you go past it with a title like that? Need to give fluids fast in a pre-hospital environment, but don’t have a pump? Here’s what to do.

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• Bum crack fluid pump

3. Paediatric airway for emergency physicians who are not also paediatricians

One thing I’ve learnt from the past few years of trawling through educational social media, is that if EMUpdates‘ Reuben Strayer makes a screencast you are being irresponsible if you don’t check it out immediately. In this one Reuben tackles the paediatric airway… the words “who are not also paediatricians’ shouldn’t be there – paediatricians will want to check this out too.

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• Paediatric airway for emergency physicians who are not also paediatricians

2. ERCAST Rant-Off

This episode of ERCast is a classic. Rob invited the world to send him their best rants on an emergency medicine topic. Put together, this makes for riotous listening. For me, Cliff Reid’s effort ensures him a place in the ranter’s Valhalla. Can’t wait for the next ERCast rant off…

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• ERCAST Rant-Off

1. Delayed sequence intubation

Perhaps more so than anyone, Scott Weingart sets the standard for what can be achieved with educational social media in emergency medicine and critical care. I’ve listened to Scott’s work from its inception, and later discovered that I was already a fan of his thanks to his book on emergency medicine decision making. Make no mistake, if you work in the emergency medicine and critical care fields you need to listen to every single one of the EMCrit podcasts – IT REALLY IS THAT GOOD. Scott’s post on delayed sequence intubation inspired me to adopt this approach in my own practice, and the outcomes have been near magical so far.

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• Delayed sequence intubation

I’m sure you’ll agree, that’s a pretty amazing selection of free educational offerings.
But it is only the tip of the iceberg, check out The LITFL Review each week to make sure you don’t miss anything…

Life in the Fast Lane Medical Blog - Emergency Medicine education blog