Welcome to the sensational 24th 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!
Top spot this week heads over to Gareth Hardy with his controversial post on NIV in asthma, and his excellent review on nerve blocks in patients with fractured neck of femurs.
- Ok so its time to get all controversial with NIV in asthma? No point right? Although many questions are still unanswered I think Scott Weingart’s comment at the bottom of the post sums up what we should be doing with our sick and dying asthmatics; “all I ask folks to do is when they get an asthmatic who they are going to intubate, while they are getting everything set, put them on NPPV with continuous nebs. If they still look like crap, they don’t have a perfect sat, or their mental status is not where you like, then go ahead an intubate. If they look a little better, hold off a few minutes and give NIV a chance.”
- The fractured NOF is bread and butter for the Doc’s were i work, but is it were you work. This post on Fascia Iliaca Block for fractured neck of femur. Do you? You should! gives you an awesome review on providing effective analgesia to your patients with fractured NOF’s.
The Usual Suspects
- This week talks comes from one of the premier educators in emergency medicine Stuart Swadron on Bleeding from the Trach.
- Intubating a Patient with Epiglottitis Awesome article explaining an approach to a situation we all never want to face, but all need to know how to approach and do.
- It’s Electric! How to do manage the patient thats come into contact with a strong current.
- Just How Good is Nebulized Fentanyl in Kids? Seems effective and another alternative to placing an IV in a child.
- Remember you “never want to be the first to adopt a new treatment – or the last.” Ultrasound First in Suspected Appendicitis highlights this and why we are still subjecting our paeds patients to high does of radiation to rule in/out appendicitis. Bottom line Australia, take the European approach rather than the American approach.
- Should HBO Be the Standard of Care for CO Poisoning? A nice review of the evidence surrounding this topic, unfortunately the jury is still out if HBO provides a benefit over standard treatment measures.
- Interesting Normal heart and respiratory rates in children, maybe it’s time to update out resuscitation charts, and change our approach to abnormal vital signs in our little patients.
- How about pre-hospital tranexamic acid? Take home point: Tranexamic acid should be given as early as possible to bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful.
- Dexamethasone for community acquired pneumonia, study outcome showed that Dexamethasone can reduce length of hospital stay when added to antibiotic treatment in non-immunocompromised patients with community-acquired pneumonia.
- Central lines in coagulopathic patients maybe we don’t have to be so cautious after all.
- The development of an inferior-posterior STEMI, from prehospital to hospital
- Chest pain, SOB, and tachycardia. What is the rhythm? Is it MI?
- Prehospital ST Elevation and pain resolve with NTG. ECG and Echo normal in ED. Dr Smith give you these three take home points in a case like this:
- 1. Transient ST elevation is hazardous
2. Pay attention to ECG changes
3. After the ECG has normalized, the echo may normalize as well.
- 1. Transient ST elevation is hazardous
- Trick of the trade: I need more lidocaine but I have sterile gloves on! Not sure if infection control will support this approach?
- We all have to give presentations from time to time, check out theses Simple rules to make your Powerpoint talk rock
- Paucis Verbis: looks at Clostridium Difficile and a brilliant review on Upper GI bleeding, stick with the RBC’s over the PPI’s!!!
- Ted Video of the Week: Apps in Medicine
- Make the Diagnosis, Sherlock! Leon gets you putting on your detective hat to solve this toxicological conundrum, remember always ask about dietary and health food supplements!!!
- “Mad Honey” and History. I wouldn’t go putting this on your toast in the mornings.
- Intranasal administration safe and effective for selected drugs, although i prefer the IO route the intransal route of delivering medication is effective, reliable, in certain medications and situations when vascular access is difficult.
- We have been hammered with literature from cardiologist and emergency physicians on this drug, now its time for a toxicologist perspective and Leon doesn’t disappoint Dabigatran etexilate: a new challenge for emergency physicians and toxicologists.
The Rest Of The Best
- Colin and Kate give us the lowdown on approaching and managing Neonatal Jaundice.
- Andy takes a shallow dive into the world behind the Evidence for thrombolytics in stroke – Part 1 and read what he follows up with in Part 2.
- Steroids for Migraine. Do they prevent recurrences… You be the judge.
- Andy has a look at How does the centralisation of specialties affect the ED? And makes highlight to an excellent video by Aussie EM physician Peter Kas, who gives us the nuts and bolts approach to what emergency medicine really is about:
Rob Rogers brings us this week pearl on the Complications of Acute Aortic Dissection
There are several complications of acute aortic dissection that emergency physicians must be familiar with.
- Cardiac tamponade (most common cause of death)
- Acute aortic regurgitation
- Free intrathoracic rupture
- Malperfusion syndrome (kidney, spinal cord, bowel, extremity, etc.)
*Key Pearl: If a patient with suspected or confirmed acute aortic dissection suddenly arrests consider cardiac tamponade.
- Early Coagulopathy After Severe Traumatic Brain Injury Equals Poor Outcome. Bottom Line:
- Prehospital: Coagulopathy should be suspected if the patient is bleeding profusely from multiple sites, including your IV needle sticks. This indicates severe brain injury and demands triage to a trauma center with immediate neurosurgical support.
- In-hospital: Coagulopathy that is noted in the ED portends severe injury and poor prognosis. Rapid access to CT scan and your neurosurgical consultant is critical.
- A review on the study by the man behind emcrit Scott Weingart looking at Extubation in the Emergency Department for trauma patients.
- Casey has a look at sepsis this week with an interesting case in Septic Surprise. He then takes on the clinical utility of using lactate levels in septic patients with some interesting comparions made in the following two post comparing lactate to a paps smear and Maybe Lactate is more like a Surg review for RIF pain…
- Ming Le Cong another outback Doc from the bush shares a lecture on Broome Docs on Are you an Occasional Intubator? Excellent pearls and pitfalls in his talk for securing the airway., and debunking the controversies.
- Blind drunk – unilateral nice review on using ultrasound to detect retinal detachments.
- Bias in nursing practice. Ian provides a nice review to help us identify and prevent our cognitive errors that are caused by these bias’s.
- Food for thought……Stick with the Herd? Or lets change it. Let’s take the time to venture outward, leading the herd. Let’s generate knowledge and take time to test it, apply it, and teach it.
- David takes a look at some Interesting facts about the ETT, you will be surprised by what he and his staff came up with in this months podcast.
- The mysterious athletic heart can sometimes challenge us, is that bradycardia normal? Was that syncope just from dehydration or is it something sinister? Dr John answers these questions and many more.
- Ever wonder how the dude from ABBA died? Why all these rock stars keep dying of asphyxiation? Can you die of food poisoning? The crazy dudes at Doctors unplugged have a look at Famous Deaths.
- ZDogg throws a few punches at celebrity MDs and puts the rap on them with Sucker MDs
Twee-D and Twitcal Care
Some of the interesting encounters you get being an emergency physicians by @peteralley
News from the Fastlane
- The LITFL team apologiser’s for anyone that had difficulty accessing the site over the last week, as we updated to a new host.
- We also make welcome to our newest author on the Fast Lane, Dr Bishan Rajapakse check out his post here and follow him on Twitter @trainthetrainer
The Final Words
- The true sign of intelligence is not knowledge but imagination
- Knowing is not enough. We must apply.-Johann Wolfgang von Goethe
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