Well back from a relaxing honeymoon, thanks to Chris for filling in last week. Well it’s that time of the week again for another epic 47th edition of the LITFL R/V!
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 heads over to our local emergency paediatric gurus Colin, Kate and Chris at empem.org. This fortnight’s podcast on Meningococcal Disease: Pearls and Pitfalls is absolute gold and will have you dominating this problematic disease in no time.
Pic of the week:
The Usual Suspects
- Rob teams up with legendary infectious disease blogger and podcaster Mark Crislip to have a chat on Vaccines and Why You Should Get a Flu Shot — have you got yours yet!
- Scott takes the pro side of the Debate: Paralytics for ICU Intubations? against ICU guru Paul Mayo. Both make some excellent points — what are you doing at your institution?
- Scott also shares with us a nifty video on using the Tonopen properly!
- Joe’s pick of the week is Swaminatha Mahadeven’s 2011 trauma literature update.
- Is methylene blue beneficial in treating calcium-channel-blocker overdose — “it’s worth knowing about, but probably not the be all and end all in managing CCB toxicity.”
- Review: IV N-acetylcysteine in acetaminophen overdose — Leon sums this article up well with “The overarching lesson from this article is that the fine points of using IV NAC to treat APAP overdose are not at all simple, and the clinician would do well to consult with a local poison control center in all but the most straightforward of cases.”
- Complications after penetrating cardiac injury — take home point: if they survive, they generally have good outcomes without the need for operative interventions.
- Trick of the Trade: Securing a peripheral IV on sweaty skin — awesome trick — will come in handy, just need to watch out for the tourniquet effect.
- Paucis Verbis — A handy little sheet for what’s helpful and what’s not when diagnosing Acute vestibular syndrome and HINTS exam.
- The Non-Healing Tattoo — dress it, give antibugs and send them off to the dermatologist.
- ED Physics: Class is in Session — Greg Henry gives us a lesson in physics to help us gravitate around the emergency department.
- David Newman shares with us his thoughts on Communicating Risk & Sharing the Burden when talking to patients in the emergency department.
- Atrial Flutter Mimicking ST Depression — don’t be fooled into thinking this is sinus tachy!!
- Several Cases of ST Elevation from Early Repolarization — excellent points on early repolarisation,this might even prevent you from triggering a false positive cath lab activation!
- 1 shift, 3 stories — powerful, hard-hitting and a lesson in empathy.
The Rest Of The Best
- This months podcast gives a run through Different Cardiac Output Monitors & Physiology — excellent info for the budding intensivist as well as the ED doc interested in ‘upstairs care, downstairs’.
- Computer Reminders For Pain Scoring Improve Treatment — we still have a lot of room for improvement in treating patients pain in the ED.
- ED Blood Pressure Management In Acute Stroke Is Terrible — tell us what you really think Ryan!!
- C1-Esterase Inhibitor Might Improve Some Sepsis Outcomes — the future is hopeful for this drug, but we need some big studies to support it.
This weeks pearl highlights managing the adult patient with first time seizure.
- Seizures occur commonly and it is estimated that 1 of 26 people will develop epilepsy at some point in their life.
- A first seizure provoked by an acute brain insult is less likely to recur (3-10%) than a first-time unprovoked seizure (30-50% over the next 2 years).
- As an emergency provider managing an adult who presents with their first-ever seizure, there are four primary questions that require answering:
- Was it in fact a true seizure? (often associated with tongue biting, urinary/bowel incontinence, preceding aura, post-ictal phase; examples of seizure mimics include syncope (i.e. cardiogenic, neurogenic, vasovagal), vertigo, myoclonic jerking, psychogenic convulsions, movement disorders.)
- Does the patient have epilepsy? (defined a having at least 2 unprovoked epileptic seizures by any immediately identifiable cause.)
- What type of epilepsy? (cryptogenic (i.e. of unknown etiology) or symptomatic (i.e. caused by prior central nervous system insult such as brain injury.)
- What is the cause? (metabolic panels to assess for uremia, electrolyte and glucose abnormalities, and drug intoxications should be performed, as well brain imaging to determine the presence of focal intracranial lesions.)
- Many patients do not require anticonvulsant medication following a single, first time seizure; A general consensus is that such therapy should be strongly considered for initiation after a second episode of seizure activity.
- MDI vs Nebulizer for Asthma Exacerbation — the preference is for spacer with MDI, however the sick dying asthmatics will need the nebs.
- To frolic with renal colic — Casey provides an excellent short ‘to-the-point’ review on renal colic from how to find the stone, to what works and what doesn’t!!
- The lads are dedicating the month of December to teaching us all about scanning the scrotum, check out part 1 of Testicular Ultrasound.
- DVT: Does spinal cord level make a difference? — Yes, this study does confirm the suspicion that paraplegics are at higher risk for DVT than quadriplegics. Why? We don’t know.
- Acute appendicitis and signs — bottom line: no clinical signs alone are able to rule in, or out, an acute appendicitis.
- An oral pressor for a patient with a MAP of 46 mmHg? — Agree… this report did leave me a little unsatisfied with its conclusion.
- IV Contrast — Bottom line always check the kidneys before giving the contrast juice. Remember…. always think about the global needs of your patient and plan accordingly (and safely).
- ZDogg goes where no blogger or podcaster has gone before and introduces us to Mrs ZDogg – you’re a brave man Zubin!!!
Twee-D and Twitcal Care
News from the Fastlane
- Want to know how to dominate the FFFF? Now you can even contribute. Chris show’s you how in How To Kick FFFF Ar$E!.
- Mike is battling with a(nother) mid-life crisis and wearing sandals to work in the Sanuk Barefoot Challenge.
- Congratulation to emergency education extraordinaire Dr Trevor Jackson for receiving the UCEM diploma of HTFU — well deserved!
The Final Words
- “There is nothing in this world quite so dangerous as sincere ignorance or conscientious stupidity”.
— Scott Weingart
- “If you call an organic process psychiatric, we have another name for you — the defendant”.
— Greg Henry
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