Welcome to the bumper 23rd 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!
- Well it has been a huge week in the emergency medicine/ intensive care blogging-podcast world and made the task of selecting the top dog for the top spot the most difficult to date. However there can be only one and this week its Scott Weingart post on Haemostatic Resuscitation by Richard Dutton was the stand-out post. Richard Dutton was one of the primary formulators behind the concept of 1.1.1. in massive transfusion resuscitation, his talk covers the history of haemostatic resuscitation from the early days through to the current concepts that are being employed today.
- It’s been a busy week for Scott not only taking out top spot he also put out a second podcast on The Mind of a Resus Doc: Logistics over Strategy. This podcast which looks to be part 1 in a series that delve’s into the philosophies that make a good resuscitationist.
The Usual Suspects
- What do you get when you combine an Internal Medicine Rock Doc with a Emergency “Budgie Smuggling” Medicine guru? A podcast on Hypertension Rocks! Zdoggmd returns to ERCAST to discuss the ins and outs of HTN, personally it was more like listening to a comedy show. Caution: this podcast should be watched with caution as has the potential to induce laughter associated stress incontinence!!!
- Tap That Belly a nice summary of the pearls and pitfalls on spontaneous bacterial peritonitis.
- Dr. Perfect. Take home point be careful you don’t dislocate your shoulder when patting yourself on the back!!
- Nasal Intubation no its not in retirement according to Rick Levitan in his featured article looking at a technique that has suffered an overall general demise in recent years, but still remains a valuable technique for securing the airway when the mouth is off limits.
- ACEP policy on PE, Cliff provides the full free text link to this extensive guidelines on managing the patient with suspected PE.
- FAST in kids has low sensitivity. In other words excellent at ruling in, poor for ruling out free fluid in the belly!
- Neurologic complications in infective endocarditis. Take home point from the study “more than half of patients admitted to ICU with left-sided infective endocarditis developed neurologic complications”.
- Steroids for trauma although this study shows promise that steroids may reduce hospital acquired pneumonia in trauma patients, the numbers in this study are small and further research is needed before widespread adoption of this practice is recommended.
- Erythropoietin for STEMI. Does this study mean professional cyclist will have worse outcomes if they have a STEMI???
- Hypovolaemic shock and pre-hospital hypertonic saline = no benefit when compared to normal saline!
- AV Dissociation. Is there AV block?
- Chest pain and LBBB. LBBB resolves and there is V1-V3 T-wave inversion. Bottom line; only 5-13% of patients with chest pain and LBBB have MI; many fewer have coronary occlusion.
- Trick of the Trade: Fingertip Injuries this is pure awesomeness for killing two-birds with one stone, analgesia and haemostasis of the bleeding digit.
- How great would it be if you could give patients concrete numbers when you are talking about cancer risk and CT? Well now you can in a nifty little table created by Dr. Hans Rosenberg Lifetime attributable risk of cancer from CT in this weeks Paucis Verbis.
- Social media in academia: Why do it? Because the cool kids are doing it… Also you learn, share and disseminate information amongst some brilliant minds in medicine!!!
- Leon was being generous giving this article a 2 skull review!!!Lipid emulsion therapy in lamotrigine overdose: rescue from what?
- Whole bowel irrigation for venlafaxine overdose? Give me a break! and the nurse’s who have to manage the WBI.
- Did you know that the extremely toxic box jellyfish has a 24 eyes — including 2 that, like human organs, have a cornea, lens, and retina…find out more in Leon’s review The 24 eyes of the box jellyfish.
- Extraglottic Airway Devices: Buy One, Use One, Change Your Practice the ins and outs on EAD’s, which one are you using in your practice, or are you still relying on the trusty old ETT??
- Toxicological Anecdotes, Oddities, and Amazements Leon gives a look at some fun and interesting toxicological oddities.
- Dabigatran’s Potential to Replace Warfarin… You’re going to start getting sick of hearing about this drug soon.
- The explosive growth of ultrasound imaging, and increasingly limited access to specialty care have combined to make first trimester bleeding a disease for emergency and primary care docs. This months podcast see’s David and Ashley take a deep dive look at Threatened Ab: Knowledge is Power.
- Oli really is taking off as a dominate force in the medical podcast world with his third podcast looking at The acute management of spinal cord injury.
- Mel apart from wearing another stupid hat, gives us a quick review on the utility of New LBBB and MI.
The Rest Of The Best
- Not something we think about too much downstairs, but worth knowing about if your working upstairs in ICU, Propofol Related Infusion Syndrome.
- Horner’s Syndrome Andy gives us the ins and outs in a simple way on this condition which is more than just impaling the thumb on a cooked piece of fruit.
- Tasty Morsels of EM 4 a quick touch on some ENT morsels.
- Medicine as virtue formation
- What’s the diagnosis? in this sick patient with a bizarre looking ECG?
Pearl of the week is from Mike Winters with a brief look at the cardiovascular complications of End-Stage Liver Disease.
- Patients with end-stage liver disease (ESLD) can develop a number of complications that lead to, or complicate, critical illness.
- Regarding the cardiovascular system, ESLD patients can develop:
- Hyperdynamic vasodilated cardiovasculature: low baseline blood pressure and high cardiac output
- “Cirrhotic cardiomyopathy”: impaired systolic response to stress or altered diastolic relaxation
- Autonomic dysfunction: reduced responsiveness to vasoconstrictors
- ESLD patients also tend to have a normal or near-normal lactate at baseline, despite lactate being cleared more slowly.
- When managing the critically ill patient with ESLD, look for signs of heart failure, expect an abnormal response to vasopressors, think about steroids for persistent shock, and don’t ascribe an elevated lactate simply to impaired hepatic clearance.
- Read this study first Delayed Diagnosis of Blunt Intestinal Injury in Children then Michael makes his imaging recommendations in the follow post when dealing with children with abdominal trauma Sonography In Place of CT For Paediatric Abdominal Trauma
- Trauma 20 Years Ago: Seatbelt Injuries. Basically seat belts cause’s its own set of injuries however these area relatively easy to manage when compared to the injuries it prevents aka “traumatic brain injuries”.
- Big in Japan not so big here, but a case that will rock you to your core!!!
- “That’s not a knife….” Brilliant case highlighting the importance of getting an accurate history and mechanism of injury in trauma patients, and having a high index of suspicion helps as well!!!
- Excited delirium – a new syndrome? It’s not new, been around for a while but poorly researched and highlighted…Have you seen a case? Do you know which patients are at risk of succumbing to it? Well worth learning about it on Broome Docs rather than being educated on it in the coroners court!!!
- Can’t Intubate, Can’t Ventilate! The low down on code brown Casey provides us with a sensational algorithmic look at managing the “Can’t Intubated, Can’t Ventilated scenario”.
- For the nurse are you ready to join Impacted’s hardcore nursing revolution?
- And yes bulimic patients can become artistic nexus vomitus.
- Dr G provides us with a look at Haemolyitc uraemic syndrome – its not just for kids anymore! a very topical subject at present with the recent case’s causing a storm in Europe from the contaminated vegetables in Germany.
- Like academia but don’t like working in an office, why not look at The Academic Practice of Wilderness Medicine?
- Tim provides us with a fascinating post on the management of Crocodile bites.
- The shocked skin – livedo reticularis or cutis marmorata? David mottles out an interesting post on the skin changes that occur during shock, well worth reading.
Twee-D and Twitical Care
Thanks to @precordialthump for highlighting the following tweets this week:
News from the Fastlane
- The LITFL team apologises in advance as the site will be updating its host this week, and some of you may find viewing content on the site difficult over the next few days.
- Mike been busy again behind the scenes getting the FACEM SAQ And SCE Remix questions up-to-date.
The Final Words
- “You only see what you look for, you only look for what you know.”
- “Amateurs discuss strategy; experts discuss logistics.”
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