Welcome to the new-look 86th 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 casts 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 to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
- This weeks top-spot has to go to the guru of all things ED critical care EMCrit. Scott walks us through a case in the Mind of the Resuscitationist: Stop Points were he presents us with a case were he fails to reverse the hypotension in this patient. He then talks us through all the approaches to managing the refractory-hypotensive patient, and finishes of with an uncanny cause for this patients hypotension! Who would have thought?
The LITFL Review Top Picks
Intensive Care Network
- Oli get’s together with two promising ICU registrars Andy Wilkinson and Eamonn Sheerin to discuss Good Housekeeping: STRESS ULCER and VTE prophylaxis, this is absolute gold as they nut through the evidence on which patients in ICU need stress ulcer and VTE prophylaxis – a must listen too!
- The dangers of FOAM – Simon highlights the adverse events that occur when playing with FOAM!
- This weeks journal club discusses Gut feeling about serious paeds infections. Time to get involved in this weekly discussion.
- This is a must read article….Make Ketamine Work For You…As Ryan says- “If your ED restricts the use of ketamine, you need to make that stop.”
- Dr Richard Levitan speaks on VL vs DL and all things airway! Worth a listen to one of the true airway masters of our time!
- How should the findings from NAP4 on SADs be considered in the pre-hospital environment?
- I think it’s septic …Recognising the septic patient isn’t always as easy as we think…Maybe a score will help us decide!
- Hyperglycaemia & mortality in sepsis – lactate dependent? – In a study of adult nondiabetic critically ill patients, hyperglycaemia had a significant association with increased mortality risk using simple univariate analysis. When they adjusted for concurrent hyperlactataemia however, hyperglycaemia was not significantly associated with increased mortality risk.
- Reassurance: difficult laryngoscopy in children remains rare – Take home message: As a very rough rule of thumb to illustrate the difference between the ease/difficulty of laryngoscopy between adults and kids, I think it’s fair to say grade III or IV views occur in about 10% of adults but only about 1% of children.
- Transtracheal airways in kids. Well, pigs’ kids anyway – This isn’t something your going to be doing often, worth reading this one by Cliff so your prepared!
- Externally rotate leg for femoral vein access– simple, easy, and effective!
- Trick of the Trade: Sterile cover for linear ultrasound probe – just glove it!
- The secret to patient presentations– great post worth reading for junior doctors and nurses!
- Andragogy: How adults learn best – Andragogy refers to learning strategies which help adults to learn more effectively.
- Want to know what QR codes are? And is there a role in education? Check out QR codes: a useful tool for medical education.
- Pelvic foreign body – Good point: when your not sure what something is, doesn’t hurt to ask the patient!
- Vindication – movin Meat challenges the dogma of routine LP in ruling out SAH and comes out vindicated.
- What malpractice looks like its a bit like pornography according to Movin Meat “I know it when I see it“.
- A low-tidal volume (or protective) strategy of mechanical ventilation (i.e., tidal volume of 6-8cc/kg of ideal body weight) has previously been demonstrated to be beneficial in patients with acute respiratory distress syndrome (ARDS).
- A meta-analysis was recently performed to determine whether this strategy of mechanical ventilation is also beneficial for patients without lung injury prior to initiation of mechanical ventilation.
- Dr. Neto, et al. performed a meta-analysis of 20 studies (total of 2,822 mechanically ventilated patients) comparing a conventional ventilation strategy (average tidal volume was 10.6 cc/kg) to a protective ventilation strategy (average tidal volume was 6.4 cc/kg) of mechanical ventilation.
- The authors concluded that patients ventilated with a protective lung-strategy had reductions in:
- Lung injury and ARDS
- Pulmonary infections
- Length of hospital stay
- Bottom-line: This meta-analysis supports the notion that a strategy of low-tidal volume ventilation may have benefits for patients without ARDS, however prospective studies are needed.
- Make Sure It’s Bell’s – great short, sharp review on recognising bell’s palsy in your droopy patients!
- Some thoughts on concussion– Brilliant post by Andy… Remember just because the CT looks normal doesn’t mean the brain is normal.
- Anatomy for Emergency Medicine #22 – shoulder: AC and SC Joints
- Better Out than In – Incision and Drainage how to make it less painful, and everything else that’s involved in abscess management features in this weeks podcast!
- an obscure acidosis… Remember not all lactic acidosis is sepsis…Think outside the box!
- Airway Tips and Tricks – A is for awesome, but A also means Airway! This months podcast provides an insightful look at approaching the airway for the junior airway practitioner!
- Spontaneous Pneumothorax in the paediatric patient, Sean gives you an approach that may change your practice!
- What are the current hot topics surrounding burns? Find out more in: Burns, “Answers”.
- Excellent review of octreotide as an antidote for sulfonylurea overdose -agree excellent well worth reading Leon’s summary!
- ECG Challenge– great case from Trevor, demonstrating how some acute coronary syndromes will present with benign, stable clinical features despite a high risk proximal coronary lesion.
- post, post-ictal? Help Casey out…What period of time do you wait before post ictal ins’t post ictal and needs further investigation???
The LITFL Review Shout Out of the Week
Shout this week goes to SOCMOB, meaning Standing on the Corner, Minding my own business in the ER. Is the newest and coolest blog to hit the FOAMed world. Headed up by Canadian EM resident Chris Bond (@socmobem), SOCMOB hopes to analyse the medical dogma, and separate the axioms from the pseudoaxioms. Check out his great introductory blog posts:
Twee Dee and Twitical Care
News from the Fastlane
- GMEP Goes Gangnam – That’s right GMEP is launched…So get over there and check it out!
- Register For SMACC Now! Would be awesome to meet you all over there!
The Final Words
- “There are only two sorts of doctors: those who practice with their brains, and those who practice with their tongues.”-Sir William Osler
- “Marriage – It’s like mechanical ventilation – easy to start, harder to guarantee a good outcome.”
– Mathew McPartlin
LITFL Review EM/CC Educational Social Media Round Up
123Sonography.com — Academic Life in Emergency Medicine — Adventure Medicine— A Life at Risk — All LA Conference — Al Sacchetti’s Youtube — Bedside Ultrasound — Better in Emergency Medicine — Broome Docs — CCM-L.org — — Critical Care Perspectives in EM — Dave on Airways —DrGDH — Dr Smith’s ECG Blog — ECG Academy — ECG Guru — ECG of the Week—ED Exam —ED-Nurse— EDTCC — EKG Videos — EM Basic — EM Core Content — EMCrit — Emergency Medical Abstracts —EMERJENCYWEBB –EmergencyLondon — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Tutorials—Emergency Medicine Updates —Emergucate —EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMProcedures — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — EM REMS — ER CAST — Free Emergency Medicine Talks — GMEP — Gmergency! — Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network — iTeachEM — keepcaring — Keeping Up With Emergency Medicine — KeeWeeDoc — KI Docs — LipheLongLurnERdok — MDaware — MD+ CALC — MedEDMasters — Medical Education Videos — Medicina d’urgenza — Medicine for the Outdoors — Micrognome — Movin’ Meat — Neurointensive Care — Pediatric EM Morsels — PEM ED — PEMLit — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — Resus.com.au — Resus.ME — — Richard Winters’ Physician Leadership —ruralflyingdoc — SCANCRIT — SCCM Blogs — SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SonoSpot — StEmylns — Takeokun — thebluntdissection—The Central Line — The Ember Project —The Emergency Medicine Resident Blog — The NNT — The Poison Review — The Sharp End — The Short Coat —The Skeptics Guide to Emergency Medicine — The Sono Cave – The Trauma Professional’s Blog — underneathEM.com — ToxTalk — TJdogma — Twin Cities Toxicology — Ultrarounds — UMEM Educational Pearls — Ultrasound Village