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!
- Scott’s podcast on delayed sequence intubation would have to be one of his best yet. Scott presents his concept of how to maintain oxygenation in the lead up to intubation in true Weingart fashion: it sounds so simple and easy and by the end of the podcast you’re so excited that you find yourself trying to convince family members to volunteer for a practice run… Scott provides a link to his lucid article on Preoxygenation, Deoxygenation, & Reoxygenation as well as his excellent video on NIV Preoxygenation.
The Usual Suspects
- Cognitive errors are part of being human, unfortunately. Being aware of the inherent flaws in our decision-making processes may help limit the risks to our patients. the February podcast by Dr. Doug Sinclair and Dr. Chris Hicks provides a much needed overview Diagnostic Decision Making & Medical Error.
- Leon again demonstrates his obsession with cleanliness with another post on “Bath Salts”, which highlights the toxicity caused by MDPV. TPR also reviews an article that presents 3 cases of opioid toxicity from the use and misuse of fentanyl patches. Finally there is the clash of the superbug and the super-spider in brown recluse spider vs MRSA: an 11 year old boy has a large, violaceous, tender area of induration in the right axilla with erythema extending across his body. What is the culprit?
- Cliff starts off with a paper suggesting we shouldn’t give up on conventional CPR all together just yet… and then tells us that there may be some benefit from uber-invasive Extracorporeal CPR, at least in Korea. Finally, Cliff finds a paper that supports his position of vehement opposition to the injudicious use of Propofol for RSI in critically ill patients.
Academic Life in Emergency Medicine
- A lot can happen in a week in the academic life of an emergency doctor. This week features a handy new ‘paucis verbis’ card on the management of accidental hypothermia. There is also a great tip of the trade for getting an ECG on a Wookie… No razor needed! Finally, what can EM educators learn from a physicist? Find out in ‘School Sucks: Building a new culture of teaching and learning’, featuring the key insight that the secret to learning is to “work your ass off until you figure it out”.
- Mel turns out two awesome new videos this week. The first looks at peripheral vascular CT in the patient with a vascular injury, and the second shows the use of ultrasound to perform a radial nerve block.
- Do you know what to do when turtles attack? What if the attack is in progress inside the ED? EPM wants to know how you would manage this extra-ordinary case. Almost as difficult is the drunk and disorderly patient with a challenging laceration combined with the difficult and domineering surgeon… could ultrasound be the solution?
- ‘Vital Signs for the 21st Century: Moving Beyond Heart Rate and Blood Pressure’ is Joe Lex’s talk of the week this time round, and comes from esteemed critical care educator Dr Peter DeBlieux.
The Rest of the Best
- Ian shows us how to remove a fish hook like a pro:
- Every emergency department around the world is trying to improve it’s door to balloon times for STEMI patients, however even with an excellent system and DTB time some patients can still go on to develop large myocardial infarctions. Dr Smith presents an interesting case where this occurred.
- Morbidity and mortality is at the forefront of emergency medicine and critical care practice, but how do we learn from it? More importantly, how can we reduce it? One way might be by using the healthcare matrix. This tool is designed as a framework for improving patient care by providing a method to investigate errors and suggest potential solutions when bad outcomes occur.
Emergency Medicine Forum
- Consider the patient who gives a good story for subarachnoid haemorrhage but doesn’t want to stay around for further testing. This post covers the grading scales for SAH, the sensitivity of tests for xanthochromia, whether asymptomatic patients need to be admitted under neurosurgery, and more? “I don’t want to stay” provides some ammo to help you convince such difficult patients to stay around for further investigation.
Recognizing True Stroke versus Seizure, by Aisha Liferidge:
- Seizure is very rarely associated with true ischaemic stroke; the presence of seizure is, in fact, a contraindication for administering t-PA in patients thought to have had a stroke.
- Thus, when patients present with an alleged stroke in the setting of seizure, be skeptical as to whether there truly was an ischemic stroke and do more investigating to ascertain a satisfactory conclusion. In these cases, perhaps the patient suffered a hemorrhagic stroke, which is associated with seizure more often than is ischaemic stroke.
- Post-seizure sequelae can present as focal neurologic deficit that mimics stroke (i.e. Todd’s Paralysis), but note that these are generally associated with partial, not generalized, seizures.
- Finally, remember that patients who have had strokes in the past are at increased risk for having future strokes AND for developing a seizure disorder secondary to the focal area of brain tissue damaged by their prior stroke. These patients, therefore, may present with a combination of true, new OR exacerbated, old stroke symptoms, with or without seizure.
- Which patients with a Cervical Spinal Cord Injury: Need A Tracheostomy?, Michael gives a great summary of the research on this topic from the trauma group at LAC + USC Medical Center.
- Hospital-based general medicine is the prostitute of medical specialties… they take accommodate all comers… no matter how insoluble the problem. For that, all us non-hospitalists are truly thankful. The ZDoggMD shows us just how hard the life of a hip-hopping hospitalist really is in Hard Doc’s Life (Hospitalist’s Anthem). Oh yeah, before we forget, nice cap mate!
- If you speak — or even better read — Italian be sure to check out this Italian emergency medicine website, MedEmIt. Feel free to send us a brief review and we’ll post it on LITFL.
Twee-D and Twitical Care
We’ve got a feeling the next Emcrit podcast is gonna be a goodie:
In other Twitter news, let’s see what Dr Bungeechump has been up to:
News from the Fast Lane
- Yes, the finalists for the Medgadget Medical Blog Awards 2010 are out, and, no, there is no LITFL this year. The ramifications are huge, what with an ongoing emergency meeting (about 4 days so far…) to decide if UCEM will leave the Sinking LITFL Ship?… But don’t wallow in our self-pity… Get out there and cast votes for your (other) favourite emergency medicine blogs: vote for EMCrit in Best Weblog Category, ZDoggMD in Best New Weblog, and when it comes to Best Clinical Weblog Category, it’s time to to start pulling names out of a hat to choose between Academic Life in Emergency Medicine, EMCrit, and Aussie-based blog Resus.ME.
- Our main man Scott Weingart is giving everyone a chance to win LITFL’s favourite medical book, the Toxicology Handbook by Murray, Daly, Little, Cadogan and co.
A Word from our Sponsors
There seems to be some confusion, do you know who Chris Nickson is?
The Final Words
“We now call Intensive Care ‘Normal Care’ and the Wards ‘No Care’”.
— Stephen Clifforth
“Save the fleeting minute; learn gracefully to dodge the bore.”
— William Osler
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