Welcome to the amazing 26th 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!
It seems Rob has recovered from his team up with ZDoggMD and bounced back this month and taken out top spot with a brilliant podcast on the truth about distal radial fractures. Rob answer’s the tough questions on how important is it to get a perfect reduction? Is it even worthwhile to try? And covers much more.
The Usual Suspects
- Cliff highlights a novel case of paramedics diagnosing a inferior STEMI 12 ECG in a prone patient using the posterior approach.
- Paeds BVM for adult resuscitation may help to deliver more guideline-consistent ventilation in patients with tracheal intubation.
- Scott carries on from last weeks amazing and lengthy debate on the the PERC and Wells criteria for diagnosing PE, with a podcast by Jeff Kline the PE guru on Fibrinolysis in Pulmonary Embolism. Dr. Kline basically says that if you have an SBP < 90 at any point, the patient MUST be given fibrinolysis or you better have a good reason why on your chart. What are your thoughts on this?
- Scott also provides us with a short nice summary blog from the recently published American Heart Association PE Guidelines.
- This weeks “talk of the week” is on the patient we love to hate… Remember its either nothing or its everything when dealing with the The Chief Complaint of Weak and Dizzy!!
- Dr Smith present us with an interesting case on waiting until after the ECG to give Nitroglycerine and follows it up with these take home points:
- NTG may cause reperfusion
- Record an ECG before NTG
- Always look at prehospital ECGs
- Even after STEMI (if reperfused, with small amount of myocardium infarcted), and even when the ECG is diagnostic of ACS (as it was the next day), the simultaneous echocardiogram may be normal.
Academic Life in Emergency Medicine
- Paucis Verbis: Cardiac tamponade or just an effusion? How do you determine the difference between the two?
- Academic Life in Emergency Medicine has joined Facebook check them out and like the page today!!
- Trick of the Trade: Want to control that bleeding epistaxis and make your patients look silly…Check out Epistaxis control with tongue blades.
- Narcotic bowel syndrome: an important diagnosis. Have you heard of it, I hadn’t and Leon hadn’t either so what is it? NBS is defined as chronic or recurrent abdominal pain associated with increasing doses of narcotics. The cause is paradoxical increased pain perception as a result of chronic narcotic use, along with a functional bowel obstruction from decreased GI motility.
- Leon reviews an excellent site for all things toxicology. The Toxic Web: a guide to online toxicology resources.
The Rest Of The Best
- If You Don’t Reperfuse STEMI, That’s Bad, getting STEMI patients out of the ED and into the cath lab is a no brainer…But remember “reckless abandon towards shoving a semi-stable patient out the door won’t always lead to better outcomes”
- Andy takes a break from all things stroke with a look at Aortic Dissection and the IRAD study, and provides his thought’s on management of aortic dissections.
This weeks pearl comes from Haney Mallemat on Amiodarone and Thyroid Disease. Follow Haney on Twitter @CriticalCareNow, and get even more pearls.
Amiodarone is a class III anti-arrhythmic for tachyarrhythmias
Although most patients remain euthyroid on amiodarone, 4-18% develop thyroid disease months to years after exposure.
Amiodarone-induced thyroid disease occurs because amiodarone is structurally similar to triiodothyronine and thyroxine and each 200mg tablet contains 75 mg of iodine.
Two types of amiodarone-induced thyroid disease:
- Amiodarone-induced hypothyroidism (AIH)
- Amiodarone-induced thyrotoxicosis (AIT)
Amiodarone-induced hypothyroidism (AIH):
- Presents with subtle to overt hypothyroidism
- Treat by discontinuing amiodarone; thyroid recovers within 3 months
- If amiodarone cannot be discontinued, start levothyroxine
- Sudden symptom onset months to years following exposure; mean 2-47 months post-exposure
- Can be a life-threatening presentation (similar to thyroid storm) with severe cardiac manifestations and hemodynamic instability
- Treatment (treat like thyroid storm, if severe)
- Discontinue drug, if possible
- Thionamides (inhibit enzyme producing thyroid hormones)
- Methimazole or propylthiouracil
- Airway and hemodynamic support
- Casey highlights the joys and challenges of tropical medicine in Dr Sally’s Unusual Ulcers.
- LITFL newest guest author also pimps out his blogging capabilities over at Broome Docs with an excellent post, packed full of pearls and pitfalls on transferring psychiatric patients by air in A Bridge over Troubled waters?
A huge week over at The NNT check out these hard hitting reviews:
- Aspirin to Prevent Cardiovascular Disease in Patients with Known Heart Disease or Strokes
- Hormone Replacement Therapy For Cardiovascular Prevention (After Prior Heart Attack or Stroke)
- Hormone Replacement Therapy for Cardiovascular Prevention of a First Heart Attack or Stroke
- Aspirin to Prevent a First Heart Attack or Stroke
- Clopidogrel to Prevent Cardiovascular Disease for People Who Have Had Heart Attacks or Strokes
- This months podcast looks at the management of Smoke Inhalation Injury, and why this condition is so deadly.
- Alternative and complimentary medical treatments in the hospital. This post is summed up nicely in the last sentence “there is no such thing as complimentary or alternative medicine….there is just medicine.”
- Having trouble with your nursing team? Maybe its time to employ nurse Abby!!
- Part 1 on Making a Difference in Acute Hyperkalemia, takes a peak at the accurate dosing of sodium bicarbonate.
- Its that time over the year were in some parts of the world the new interns hit our departments/wards. So apart from taking 2 months holiday it might be time to offer them some Advice to New Interns.
Twee-D and Twitcal Care
Want your daily dose of Emergency Medicine Education? Check out @EM_PEARLS
News from the Fastlane
- The team welcomes guest author Dr Minh Le Cong, and were wowed with is debut post Planes, Pregnancy And Bleeding. Look forward to reading more contributions from Minh.
- Although recent literature would have us believe that Australia has a paucity of resources for learning about ocular emergencies, luckily for us we have blogs and Chris Nickson to prove current literature wrong. What to find out more, have a read of Resources For Ocular Emergencies.
The Final Words
- “Courage and cheerfulness will not only carry you over the rough places in life, but will enable you to bring comfort and help to the weak-hearted and will console you in the sad hours”
-Sir 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