Welcome to the awe-inspiring 66th 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
- Atypical antipsychotic overdoses are a frequent presentation in emergency departments as the prescribing of these drugs skyrocket. Leon has a great review on a recently published review article about atypical antipsychotic overdose, and sums the article up nicely in true “TPR fashion”. Although Leon does not agree with everything in this article (like whole bowel irrigation!), he still recommends it as a must read article for all toxicology enthusiasts.
The LITFL Review Top 20 of the Week
- This in an absolute stellar post by Cliff on a case of Laryngospasm after Ketamine. Cliff slams home some major pearls and pitfalls in the use of ketamine in the emergency department making this a must read post for every ED doctor and nurse. He also links to a LITFL case-based Q&A on this topic: Nasal foreign body, laryngospasm and ketamine.
- Ian shares with us the ultimate guide for dominating the role of Airway Nurse - hey docs worth a read too you might pick ups some tips and tricks from the nursing perspective.
- Chest pain/protocols and algorithms. Not everyone needs an EST! – Time for us to start thinking logically about chest pain patients in the ED, and using the evidence to guide our practice, instead of the fear of litigation.
- Ever been out in the middle of nowhere and come across a medical emergency that needed a scalpel? Well you don’t always need MacGyver around to create a Homemade Scalpel this articles shows you how, and highlights a cool new book that’s just been published on Improvised Medicine: Providing Care in Extreme Environments.
- Can hemodialysis be avoided in selected patients with significant serum levels of ethylene glycol? The wrap up of this study: in selected patients with acute ethylene glycol toxicity (e.g., those with normal renal function and without severe metabolic acidosis), the use of fomepizole without adjunctive hemodialysis appears to be safe.
- Tips For Surgeons: Seat Belt Sign - Michael shares some of his observations and approaches he takes to towards the patient with a seat belt sign. He does make this interesting point – “Seat belt sign on physical exam requires abdominal CT for evaluation, regardless of age. The high incidence of significant injury mandates this test.”
- Is CRP correlated to CT result in the evaluation of abdominal pain? The bottom line: CRP is often used to evaluate abdominal pain.
The utility of this test alone is limited. Normal CRP does not exclude a positive CT study. On the other hand a high level CRP does not mean a positive result, CRP became increasingly more specific as levels increased.
- Meet the New ARDS: Highlights the recent release of an expert consensus panel on a new definition and severity classification system for patients succumbing to ARDS.
- How Many Emergency Physicians Are On Twitter? - The simple answer – not enough!!!!
- Radiation Risks of CT Scans: What Now?- Some logical rational advice on doing repeat CT scans in patients with renal colic, and a brief look at and some advice on scanning the pregnant patient to rule-out PE.
- Scott teams up this week to talk to Ben Abella, both of these two are really have a passion for therapeutic hypothermia in post cardiac arrest victims. Have a listen for yourself to Who the Heck to Cool after Cardiac Arrest with Ben Abella
- ST changes due to limb lead LVH? - Another great challenging ECG case by Dr Smith.
- Lateral Canthotomy For Orbital Compartment Syndrome - Dont want to read the post? Check out the video below:
- Finally the End of the Road For Activated Protein C? That’s right there’s no magic bullet in sepsis management – good outcomes come from early recognition, timely antibiotic and fluid administration, and excellent meticulous supportive care.
- Cephalosporins Can Be Used in Penicillin Allergy - In summary – 3rd-generation and greater cephalosporins with disimilar R1 side chains can probably be used in appropriate clinical situations despite a PCN allergy without incidence of allergy greater than in those patients who do not have a documented PCN allergy.
- Minh interviews Dr Rob Bryant on his hospitals policy and protocol for delayed sequence intubation or as they like to call it Damn Sexy Intubation, he walks you through the approach he takes and the experience and expertise he has gained from using this approach to emergency airway management.
- Paucis Verbis: Approach to increased osmolal gap - this often difficult task is made simple and easy in this week’s Paucis Verbis.
- Lauren shares some of her thoughts, and those of others, in Clinical Training Wheels from ‘what is clinical gestalt?’ through to ‘what are clinical decision rules and how do we use them effectively to guide our practice?’
- Feeding the NGT through the nasopharynx on the intubated patient can often present as the impossible challenge. Well now we have The ScanCrit Manoeuver - to help us dominate this procedure - my only recommendation is make sure there paralyzed well first!!
The LITFL Review Shout Out of the Week
- Well there is another EM blog on the scene, by someone I used to work with and hold in high regard. That’s right TJdogma is a blog by emergency physician and fanatical cyclist Trevor Jackson. In his own words he describes the blog as: A corner of the interweb devoted to emergency medicine education, with occasional digressions into my other passions. Dogmata are omnipresent in medicine and life, but I’m not actually dogmatic in my approach to either. Having known him and his approach to medicine I can guarantee his writing will be methodical, structured and straight to the point, packed full of educational pearls and pitfalls that he has gained over the years.
Don’t believe me…Read for yourself.
Twee-D and Twitical Care
News from the Fastlane
- Chris wants to know How Do You Do ICU Rounds On The IPad?
- Michelle is trying to break down the time honoured traditional teachings in Socrates And Sophistry - amazing concept and work Michelle.
- Seth and Minh are back with part 2 of Awake Intubation In Audio II.
The Final Words
- “We do not remember days, we remember moments.”
- Cesare Pavese
- “And what greater might do we possess as human beings than our capacity to question and to learn?”- Ann Druyan
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
LITFL Review EM/CC Educational Social Media Roll Call
Academic Life in Emergency Medicine — A Life at Risk — All LA Conference — Broome Docs — CLIC-EM — Critical Care Perspectives in EM — CritIQ Podcast — DrGDH — Dr Smith’s ECG Blog — ED Exam — EDTCC — EM Basic — EM Core Content — EMCrit - EM Literature of Note — Emergency in the Shed — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News - Emergency Medicine Ireland — Emergency Medicine Updates — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMRAP: Educators’ Edition — EMRAP.TV — ER CAST — Free Emergency Medicine Talks — Gmergency! — Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network — Keeping Up With Emergency Medicine — LipheLongLurnERdok — MD Aware — MD+ CALC — MedEDMasters — Medical Education Videos — Medicina d’urgenza — Medicine for the Outdoors — Micrognome — Movin’ Meat — Pediatric EM Morsels — PEM ED — PHARM — Priceless Electrical Activity — PulmCCM.org — Rahul’s EM Blog — Resus.com.au — Resus.ME — RESUS Room — Richard Winters’ Physician Leadership — SCANCRIT — SCCM Blogs — SCCM Podcast — SinaiEM — SinaiEM Ultrasound — SMART EM — Takeokun — The Central Line — The NNT — The Poison Review —The Short Coat- The Trauma Professional’s Blog — The underneaths of EM — ToxTalk — TJdogma — Twin Cities Toxicology — Ultrasound Podcast — UMEM Educational Pearls — Ultrasound Village