The LITFL Review 062

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

UMEM Educational Pearls

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.

 Free Emergency Medicine Talks

  • 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.
  • 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!
  • 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.
  • 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.
  • 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.
  • 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.
  • Nursing the superbugs? Ian provides an link to an interesting discussion on  super bugs in the hospital setting, and provides us with  thunderbox paper No:2 on oxygen delivery devices.

The LITFL Review Shout Out of the Week

Modern EM

  • 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

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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

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