Welcome to the tumultuous 12th 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!
- Bonus – Is Kayexalate Useless? — Here’s an idea, why don’t we poor liquid concrete up that critically ill renal patient’s backside? If its in the the NEJM it must be true… right? Resonium for hyperkalemia gets debunked.
The Usual Suspects
- Ketamine abuse scars and damages the lower urinary tract — ketamine’s a great drug, but is not to be abused!
- Methemoglobinemia in aluminum phosphide ingestion: an effect of toxin or treatment? In other words, what about the potassium permanganate?
- Does dextromethorphan toxicity cause seizures? Or is that seizure and episode of dystonia?
- Cliff auto-reviews his case in the EMJ demonstrating the effectiveness of Intranasal ketamine analgesia in a child with scalds.
- Suspension syncope — what’s that, you ask? Well read this and find out.
- ECLS on Japanese, in Japanese — early indications are that extracorporeal cardiopulmonary resuscitation is lookin’ good.
- CVT guideline — cerebral venous thrombosis is one of those bad boy diagnoses that gives most critical care physicians the willies. Cliff, with a hat tip to LITFL team member Oli Flower’s neuro-icu.com, gives the run down on the latest AHA/ASA diagnostic and management guidelines.
- LBBB with acute STEMI due to ruptured obtuse marginal, diagnosed with bedside ultrasound, another awesome case demonstrating the effectiveness of bedside ultrasound.
- This week’s Paucis Verbis: Need rapid sedation for that violent and aggressive patient? Unable to get an IV, can’t find the IO? Find out which IM drugs work best for chemical sedation for severe agitation.
- Search for PubMed articles on the go, this app provides you with full free text and review articles from PubMed.
- Want instant audience feedback at your next grand rounds? Try PollEverywhere: A cool real-time tool for lectures.
- Need to look under that swollen eyelid? This Trick of the Trade has it covered; Benzoin for opening traumatic, swollen eyelids.
- Do ROMI Patients Really Need Telemetry?…Find out the answer in Joe’s pick of the week.
- Dangerous Medications for Kids, do you know which ones they are? Find out in this clinical pearl.
- Where Did Sellick’s Maneuver Come From? But is it here to stay?
- It’s time to test your orthopaedic clinical acumen in this diagnostic dilemma… Pain in Left Wrist.
The Rest of the Best
- Minor Head Injury covers it all, from the definition of concussion to the correct use of the ‘vomitometer’.
- We learned about some cool stuff from Movin’ Meat this week. In I want to be a cyborg we discovered that a whole lotta people may soon be saying goodbye to their wheelchairs:
- Also we got the Movin’ Meat take on bongi’s soul searching post, The Graveyard — a reminder that, perhaps, ‘you’re not a real doctor until you’ve killed someone’…
Amal Mattu pearl of the week is on rib fractures in the elderly:
- Rib fractures are associated with significant morbidity and mortality in the elderly, and the risk increases dramatically with each successive rib fractured.
- An elderly patient with 3 rib fractures has a mortality of 20% and risk of pneumonia is 31%.
- As a general rule, you should really think twice about discharging home any elderly patients with rib fractures.
Bulger EM, et al. Rib fractures in the elderly. J Trauma 2000;48:1040-1046.
- Do Motorcycle Helmets reduce Cervical Spine Injury? Yes and they decrease traumatic brain injuries too.
- Look how far we’ve come: Trauma 20 Years Ago: ED Intubation For Head Injury Is Safe!
Twee-D and Twitical Care
News from the Fastlane
- Look out for some insanely brilliant posts from one of LITFL’s newest team members, ‘Junior’, in the next couple of days… Tomorrow’s ‘Choose Your Own Resus Adventure!‘ will be followed up by ‘The Ballad of Eric’s Prostate‘ — they’re not to be missed!
The Final Words
“To thrive in Emergency Medicine you must recognise what the specialty is, the provision of medicine to anyone and anytime – emergency has little to do with it most of the time!”
— Greg Henry
“Beware of patients who call you “Doc.” They rarely pay their bills.”
—William Osler, 1849-1919.
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