The LITFL Review 035

Welcome to the influential 35th 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!

Academic Life in Emergency Medicine

Top spot this week is occupied by Michelle Lin. Why? For helping us deal with the bug-bear that is distracting injury when trying to clear the C-spine. So what is a Distracting injury in c-spine injuries? Basically, it can be summed up by the following two points:

  • If your trauma patient does NOT have chest trauma, it may help you avoid unnecessary cervical spine imaging, as suggested by the NEXUS criteria.
  • If your trauma patient DOES have significant chest trauma, have a lower threshold to obtain cervical spine imaging despite the neck being non-tender.
  • There’s also this Trick of the Trade: Epley maneuver — time to start taking the spin out of BPV.

The Usual Suspects


  • EMcCrit is back with part 2 of Dr. Rivers on Severe Sepsis. This episode addresses CVP and fluid responsiveness, whether end-stage renal failure patients should get lots of fluids and whether vasopressin should be a first line pressor.

Emergency Physicians Monthly

  • Beyond R.I.C.E.— what else can you offer your patients with soft tissue and ligamentous injuries?
  • We Band of Brothers — In the Internet age, attending national meetings may seem unnecessary, but it offers the epinephrine of comradeship — a nice viewpoint from Greg Henry.
  • The Perils of Premature Closure — an interesting case with some pearls and pitfalls of the pelvic ultrasound.


Cliff  delivers a barrel-load of stellar reviews of recently published trauma papers:

Emergency Medicine News

  • ACLS Guidelines: Special Interventions in Cardiac Arrest — Not all cardiac arrests should follow the same ACLS algorithm. We need to adapt and change things around according to whether we’ve got an asthmatic or anaphylactic patient in cardiac arrest, a pregnant patient or crashing pulmonary embolus patient. This is a nice review of what to do in these special circumstances.
  • Now That’s A Shock!  — A man with toxic shock syndrome!!
  • The Emergency Airway — Remember the Rule of Threes for Optimal BVM.

Free Emergency Medicine Talks

  • Joe’s pick of the week has look at the use of HBO in Burns.

Emergency Medicine Updates


 Dr Smith’s ECG Blog

A busy week over at Dr Smith’s place. Check out his posts below and his two talks on Wide Complex Tachycardias and Narrow Complex Tachycardias:

The Poison Review


  • The blogging world welcomes back Impactednurse back in print from his short siesta. Ian gives us a some insight into why he took a break from blogging, and these’s a lesson to be learned in it for all us in the blogging world. Anyway enough of the reflective stuff, its great to have Impactednurse back in the LITFL R/V…It has missed you!
  • VED: volunteers in the Emergency Department. Ian highlights the programme his hospital has just created having volunteers in the ED, to assist and provide patients and staff with minor things, that count and that make a huge different to the patients, and provides the ED staff with that little extra support….And don’t we need it.

The Rest Of The Best


Andy Neil the dude behind Emergency Medicine Ireland  has taken a deep dive into some of the literature and tuned out these two NNT reviews:

THE NNT Antibiotics JPEG

Riods in migraine JPEG

Emergency Medicine Ireland

The lads at  have once again put together some great cases on the use of ultrasound in the emergency room.

  • 29 yo M painful upper lip

  • 37 yo F ectopic pregnancy

Broome Docs


  • Double Down for Persistent Refractory Ventricular Fibrillation — an interesting approach to refractory VF: use two defibs and give consecutive, near simultaneous shocks. It might improve ROSC but will it give us the return of neurological function we strive for in these patients?

Emergency Medicine Literature of Note

  •  Sternal IO is the Best IO — but not the most practical, stick to the humeral head when placing your IO’s!!!
  • Adrenaline Neither Wins Nor Fails — So, there’s two ways to look at it: (1) adrenaline works, and we just need to figure out how to salvage more of those with ROSC; or (2) adrenaline is flogging far too great a number of lost husks back to life that will go on to consume ICU resources and expire regardless.
  • Impedance Threshold Devices Are Useless — yep we’d have to agree with this one!

UMEM Educational Pearls

Haney Mallemat brings us this weeks pearl on using ultrasound to confirm tracheal intubation:

  • Multiple methods of confirming endotracheal tube placement exist, however quantitative waveform capnography is the most reliable method. Unfortunately this may not be immediately available at all medical centers.
  • Recent studies demonstrate that bedside ultrasound may assist in the detection of proper endotracheal tube placement.
  • The T.R.U.E. (Tracheal Rapid Ultrasound Exam) was demonstrated to be 99% sensitive, 94% specific, 99% PPV, and 94% NPV during intubation.
  • The basic exam involves placing a high-frequency linear-array probe on the anterior neck above the sternal notch and identifying the trachea and esophagus during intubation.
  • The following video is an example of what you DO NOT want to see during an intubation:

  • Assessing Self-Harm Risk or suicide in adolescents is a daunting concept for the occasional player — not anymore with excellent podcast giving you a structured approach to this challenging encounter.

The Trauma Professional’s Blog


  • It’s to forget everything you know about medicine and just drill bone… Check out Napoleon Dynamite, MD, but take some pain killers before hand becasues your belly is gonna ache with the laughter!

Twee-D and Twitcal Care

A classic Tweet from @flobach:


And Rueben follows up with this:

Alcohol tweet JPEG

News from the Fastlane

  • If you read the post Own The Oxylog 3000! earlier in the week, Chris has updated it with some handy advice on measuring plateau pressure using the Oxylog 3000.

The Final Words

  • “Good judgement comes from experience, and a lot of that comes from bad judgement.”

— Will Rogers

  • “One thing I have learned from blogging is to never engage criticism.”

— KevinMD

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



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