Welcome back to the sensational 48th LITFL Review!
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 is taken out by Dr Jeffery Guy with another stellar podcast tackling Necrotizing Soft Tissue Infection (NTSI). This episode discusses the pathophysiology, presentation, and treatment of NSTI. Remember to treat these patient like you treat your severe burns patients!!!
The pic of the week is thanks to @bungeechump
The Usual Suspects
- Free Emergency Medicine Talks is have a little trouble with hosting issues right now (we know the feeling!) — however the LITFL team have inside info that the team is working around the clock to have us back listening again to their educational goodness very soon.
- Graham Walker delivers another excellent emergentology piece: Off the Beaten Path — he takes us on a journey of how we make diagnostic decisions.
- The Challenge for Emergency Medicine: The Next Five Years and Beyond — are you prepared to start managing patients whose disease entities are only now being recognised or whose therapies have only recently developed?
- Keeping Frequent Fred out of the ED — What strategies do you use to keep your frequent flyer’s out of the ED?
- Restaurant keeps 2 Michelin stars after fugu poisoning — not the best restaurant to go to on your first date!
- Cocaine, levamisole, and the white blood count — be on the look-out for cocaine users presenting with soft-tissue infections or oropharyngeal complaints.
- Massive quetiapine overdose causes delayed cardiotoxicity — As Leon states the biggest take home point from this articles is that in massive overdose of quetiapine, fatal consequences can be delayed up to 50 hours after ingestion, if not beyond.
- This is the go-to article when you want to know about the Toxicology of Synthetic Cathinones.
- Cliff highlights a nice systematic review looking at Sedation for traumatic brain injury. Take home point: there is no evidence that one sedative agent is better than another for improvement of neurologic outcome or mortality in critically ill adults with severe TBI.
- Make space for pre-hospital intubation — remember: “Control your environment – don’t let it control you”
- Trick of the Trade: Bandaging the scalp laceration — Geez soon hairdressing with be another subspecialty available to EM docs.
- Paucis Verbis: a nifty little feedback card — will help give you talking points when give feedback during and at the end of each shift.
- Why the Flank Pain? — A nice review demonstrating some pearls and pitfalls of ultra-sounding the kidneys.
- Subtle Inferoposterolateral STEMI — learning points from this case: “Scrutinize the ECG for T-wave size and morphology, especially in reciprocal leads III and aVL.”
- Another inspiring post from Ian: Enjoy Every Sandwich about death ,a doctor and sandwiches — what do you do to find balance in your medical life?
The Rest Of The Best
The bounce-back of a case of severe cellulitis:
- 2-Point Compression Ultrasound for DVT in the ED — can diagnose proximal DVTs with 100% sensitivity and 99% specificity in trained hands – wow!!
- Amit gives us the low down on IO vs IV access during out of hospital cardiac arrest, an RCT. Time to forget the IV in OHCA.
- Increased chest compression fraction on ROSC in non VF cardiac arrest — might HELP with ROSC — but isn’t RONF what were really after at the end of the day?
- Sedation in traumatic brain brain injury — Amit debunks the myth of not using Ketamine to intubate patients with TBI.
- Differentiating ‘benign’ from ‘dangerous’ vertigo/dizziness — Do you know what the word dizzy means? Also highlights the awesomeness of R&R In The FASTLANE!!!
- The Micrognome has been out of action recently related to some Kinetic effects — great post on the infective complication’s of trauma. Glad to here you doing ok now Tim!!
- It’s Another Chest Pain Prediction Rule! — not another one, and it doesn’t tell us much more than we already know!
- No More Excuses For Not Giving TPA — As Ryan state’s “it seem’s this is another example of bad literature undermining trust in a probably efficacious treatment”.
- Dog Bites and Antibiotics — for when the relevance isn’t relevant!
Haney Mallemat shares this weeks pearl on an alternative to CPAP. Or as i like to call it “CPAP Lite”.
- Up until recently, a tight-fitting mask was one of the only ways to deliver non-invasive positive-pressure ventilation.
- High-flow nasal cannulas (HFNC) have been adapted from use in neonates to adults to deliver continuous positive airway pressure (CPAP).
- HFNC provides continuous, high-flow (up to 60 liters), and humidified-oxygen via nasal cannula providing positive pressure to the pharynx and hypopharynx. Patients tolerate it well and it is less claustrophobic than tight-fitting masks.
- HFNC does not generate the same amount of pressure as CPAP so it may be best utilised as an intermediate step between low-flow oxygen (i.e., traditional nasal cannula) and non-invasive positive pressure ventilation with tight-fitting masks.
- Check with your respiratory department if these devices are locally available.
- Neonatal HSV — Take home point: This is a rare condition, but one that is potentially devastating… It is imperative that we keep it on our radar!
- Yes, Smoking is Bad! — No sh!t Sherlock….And it’s bad for fracture healing as well!!!
- Bucket Handle Injury from what it is… To how to manage it in Bucket Handle Injury – Part 2, remember this injury can be severe enough to prevent your patient from even writing a bucket list!!
- Where do kidney stones come from — a quick pathophysiology refresher.
- Medications Used to Treat Ischemic Priapism — but don’t forget aspirating can work just as well as medications.
- Microscopic haematuria — important take home point: “Haematuria in a patient over 40 years of age represents a malignancy until proved otherwise!”
- Todd catches up with Dr Myles Conroy discusses the latest in acute pain management for the intensive care unit. Check out Part 1 and Part 2, on managing acute pain in the ICU.
- The ZDogg and Dr Harry try to answer one of the toughest questions in medicine. Who is HARDER? Paediatrics Vs. Hospitalist — you be the judge!
Twee-D and Twitcal Care
News from the Fastlane
- The biggest news of the week… We introduce our newest blogger Michelle Johnston — welcome to the team MJ, check out her first post Funtabulously Frivolous Friday Five 070.
- Chris shares with us on Twitter a must read article on How Doctors Die.
- Yosef Leibman December Emergency Medicine Update is out, with a special bonus featuring EMU essays.
- Ed produces another brilliant Tox conundrum in A Fumbling, Mumbling Mess!
The Final Words
- “Being defeated is often a temporary condition. Giving up is what makes it permanent”.
— Marilyn vos Savant
- “One thousand Americans stop smoking every day — by dying.”
— Author Unknown
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