Welcome to the goal-directed 62nd 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
- Ok it seems the blogging/podcast world has gone airway mad – and the LITFL Review is no exception! This week top spot is taken out by Scott Weingart for providing us with a top shelf vodcast on Airway Management by the guru of emergency airway management Richard Levitan.
The LITFL Review Top 20 of the Week
Amal Mattu shares some pearls on cardiogenic shock he’s gained from Dr. Semhar Tewelde:
1. CS is most commonly secondary to a large MI where > 40% of the myocardium is involved; however mechanical, valvular, dysrhythmogenic, and infectious etiologies should also be considered: papillary or chordal dysfunction, free wall or septal defects disease, insuffiency of any valve, myopericarditis, endocarditis, Tako-tsubo, end stage cardiomyopathy, and tamponade.
2. Incidence of 5-10% STEMI and 2.5-5% NSTEMI
3. Mortality ~50%
4. Immediate coronary reperfusion is the best treatment (NNT 8). Medical therapy is a distant second choice in management, with reperfusion and pressors as needed. Early intra-aortic balloon pump use is key.
5. Recent case reports have shown improved outcomes when induced hypothermia was used in patients refractory to traditional therapy with pressors/inotropes/IABP.
- This weeks pick of the week is taken out by one of the best speakers in emergency medicine critical care Michael Winters with a look at What Does CORTICUS Tell Us in Steroids and Sepsis - a must listen to talk.
- Rib fractures and mortality This months podcast provides us with a discussion with Fred Luchette regarding factors associated with mortality following rib fractures. They discuss who requires evaluation at a trauma center, who requires ICU admission, pain control, and the role of rib plate fixation and tracheostomy in these patients.
- Levamisole-adulterated cocaine: an excellent review - It’s not often Leon uses the word excellent – so it’s probably worth checking out this article!
- Cliff provides with an excellent summary on International recommendations for lung ultrasound - highlighting the big 4 uses from pneumothorax and pleural effusion detection, all the way through to using it for detecting lung consolidation and interstitial syndrome!
- Pradaxa-related pill esophagitis–A new adverse effect? - Dr John makes us aware of a particularly distressing condition associated with this new blood thinner.
- Do You Really Need To Repeat That Xray? - Bottom line: Don’t let the xray tech disrupt the team again by reflexively repeating images that are not technically perfect. See if you can use what you already have.
- Under Pressure - an excellent guide to performing lateral canthotomy to relieve the pressure and preserve vision in a patient with ocular compartment syndrome, and is supported with amazing clinical images.
- Lightheaded and Diaphoretic, with Bradycardia - Take home point: When in the node, AV block has a much better prognosis than when below the node.
- Andy simple guide and approach to 1st trimester bleeding.
- Diffuse Axonal Injury (DAI) - Bottom line: The diagnosis of DAI can generally be made clinically with the assistance of head CT. MRI is not very useful, unless it is needed to confirm the diagnosis. It does not predict speed or degree of recovery so is otherwise not very useful. Supportive care, avoidance of complications and early therapy and rehab are the best treatments we have to offer.
- Toxicity of high-caffeine “energy” drinks -This comprehensive review article is somewhat limited in that the clinical relevance of much of the discussion is not clear, based as it is on associations, case reports, and animal studies. However, the authors do provide a good summary of caffeine toxicity.Effects of caffeine include:
- Cardiovascular: atrial fibrillation, atrial flutter, tachcardia, hypertension
- Neurologic: new-onset seizures
- Psychiatric: anxiety, psychosis, sleep disturbance
- Glucose-Insulin-Potassium For MI? - although this study showed some positive results plenty before its have showed negative outcomes- a cautious approach would be recommended before implementing this approach in ACS patients.
- This I really had to ventilate the patient?- A look at the use of non-invasive ventilation in the provision of end of life care in the emergency department.
- It’s never easy to share a case that potentially highlights a near miss – but was this a near miss? Or does this case further highlight that the classic presentation is not “classic” in real life!Code Brown: Tension Pneumothorax.
- Some excellent tips and tricks for managing the Jehovah’s Witnesses And Blood Transfusion Demystified in the emergency department. A must read post!
- Syncopal Salesman - Wow tough case Casey! Would never had come up with that diagnosis- check out the case to find out the cause of this collapse.
- Scott share’s with us Even More on Surgical Cricothyrotomies, with a video from Ram Reddy to explore all of the permutations of surgical cricothyrotomy.
The LITFL Review Shout Out of the Week
- Modern EM is the newest blog to hit the scene. Created by Dr. Timothy Peck with some support and assistance from Michelle Lin of Academic Life in Emergency Medicine. Modern EM will feature examples of how Web 2.0 influenced the management of specific patient encounters. Also guests will be allowed to contribute mini-case presentations where they will report how a Web 2.0 activity changed how they managed a patient. Check out Timothy first case Case #1 and #2: Strep Pharyngitis!
Twee-D and Twitical Care
News from the Fastlane
- Last week Chris added even more Q&A posts to the Trauma! series – if you want to check them out and many more cases, have a look at the LITFL clinical cases collection!
- The FFFF turned all French on us this week- don’t believe me, have a look for yourself.
The Final Words
- “It’s not about plastic in the trachea, it’s about oxygen in the lungs”
- Richard Levitan
- “Pulling it out is more satisfying these days than putting it in.”
- Scott Weingart on ED Extubation
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