Welcome to the fashionable 87th 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 ripper is a Critical Care Update by EMCC legend Peter DeBlieux, who provides us with an update on the recent literature to help you manage your next critically ill patient in the ED, from EGDT in sepsis and antibiotic prescribing, to providing excellent therapeutic hypothermia. A must listen to.
The LITFL Review Top Picks
- Social Media Nurse of the Year: VOTE NOW!! - Don’t forget to vote for your favourite nurse on social media!
- Ian reviews and provides a wonderful insight into new blog It’s OK to die. A blog that’s dedicated to providing and supporting emergency staff through end of life care that our patients so desperately need.
- Dr Robbo chats with Kenji Inaba to discuss some pearls around Chest Trauma, from pericardial effusions, to the challenge of managing the haemothorax and chest drains.
- Pye on ECMO during CPR - Should we be doing it? Probably yes….But only if the heart that’s too good to die!
- Delaney on Sepsis Resuscitation - and no he’s not talking about the ARISE trial either, he just focuses on what works and what doesn’t when managing sepsis in the ICU.
- A simple laceration, using simple Evidence Based Laceration Repair - too easy! Nice review of the evidence!
- PID masquerade. The humble probe saves the day, but not the appendix!
- This weeks journal club topic- Trends in CT/MRI for Atraumatic Headache in the US.
- NICE on headaches - A bit alternative some of the treatments recommended.
- Gareth provides a brilliant insight into Getting Chilly Quickly 2…. Early hypothermia for ROSC? Bottom line: the evidence isn’t great for intra-arrest cooling, but we most probably should be giving it a go.
- Q&A with listener feedback - Minh sits down and answer some of his listener’s questions surrounding pre-hospital care, ketamine and cervical collars.
- Rob reviews a cool new app called Pocket an app for your iPhone/iPad that allows you to save stuff from online that you want to read or refer too later.- Looks cool, can’t wait to try it!
- Also preparation is underway for the 2013 International Emergency Medicine Teaching Course. So book your leave now!
- Trick of the Trade: Ultrasound-guided supraclavicular central line - not as tricky as we once thought they were.
- Teaching internationally: More than just a language barrier - Some tips on presenting internationally.
- Is the 6-12-12 adenosine approach always correct? Pearl to know: Caffeine is an adenosine blocker and can interfere with the successful reversion of PSVT. In fact, ingestion of caffeine less than 4 hours before a 6-mg adenosine bolus significantly reduced its effectiveness in the treatment of PSVT
- Trauma Mythbusters: NSAIDs And Fracture Healing. Take home point: NSAIDs can and should be prescribed in patients with short-term needs and simple fractures.
- LP for Subarachnoid Hemorrhage: The 700 Club - It turns out that following classic dogma means performing roughly 700 lumbar punctures for every one aneurysmal subarachnoid hemorrhage detected.
- More Airway and Cardiac Ultrasound - awesome episode this month, the boys look at some cracking cases of ultrasound guided cricothyriodotomy, have a crack at some of Australia’s most talent FOAMed gurus, and dabble in a bit more cardiac ultrasound.
- a pulmonary pummelling… A great case on flail chest, with some pearls from Chris on how to manage it.
- The post intubation X-ray is vitally important to ensure correct position of lines and tubes. You up for the challenge in this post intubation eval case?
- Antipsychotics, ECGs, QTcs and Catastrophes- Casey provide’s a great review on the topic and the approach needed. Has anyone ever seen a case of droperidal induced torsade’s???
- A dose of Dex?- A must in the patient with a sore throat, and even Cochrane agrees now.
- Suicide: Three Cases and a reference point - Which of these three cases do you think needs admission?
- ECG of the Week – 10th December 2012 - This one is looking a bit slow!
- Important new concept: opioid-induced hyperalgesia. Yep thats right - chronic opioid use can actually increase pain perception.
- Bizarre treatment recommendations survive editorial process at major emergency medicine journals - Leon questions the literature…It baffles me how some of these articles got through peer review….See for yourself!
- Many drugs remain potent long after their expiration dates - The authors conclude that their study “provides additional evidence that many prescription pharmaceuticals retain their full potency for decades beyond their manufacturer-ascribed expiration dates”. They point out that extending the expiration dates of appropriate medications may provide substantial cost-savings.
- Ketamine use in TBI – the ICP goes down not up. - This study provides a little bit more ammo that ketamine is safe for ICP. It’s not gold standard, bullet proof evidence but the case is building.
- Lung Protective Ventilation Still Good. Remember its not just for patients at risk of ARDS anymore.
- Colloids Vs Crystalloids. What to do?Throw your synthetic colloids out of the ICU, and possibly out of the hospital.Or maybe that’s too soon? Even if you think so, you should at least keep HES away from your severely septic patients, and most possibly from other critically ill patients as well. And think twice before giving them to anyone else. So, every time you feel the itch to give a quick fix of colloids – think again.
- Ken hammers through the evidence and breaks down the KT time in You Can Ring My Bell - a look at Bell’s Palsy!
It is not often that a CT will be able to give you a hint to a toxicologic diagnosis. The following are CT findings that are either suggestive and even sometimes almost diagnostic for a given to toxin:
1) Intraparenchymal or Subarachnoid Hemorrhage: sympathomimetics or mycotic anuerysm rupture secondary to IV drug abuse
2) Basal Ganglia bilateral focal necrosis: characteristic of carbon monoxide, cyanide, hydrogen sulfide and even methanol
3) Severe advanced atrophy out of proportion for age: alcoholism, toluene
- Atypical or typical, is this the question? What is the likelihood ratio when it comes to chest pain!
- FOAMing Up the Wards: Glucagon in CCB Toxicity? Lauren highlights how FOAM is up to date, but the textbooks are still a long way behind when it comes to treating CCB toxicity.
- Analgesia for abdominal pain - take home point from this study paracetamol is just as effective as buscopan in treating abdominal pain in the ED.
The LITFL Review Shout Out of the Week
- Trevor teams up with Ian Rogers to bring us the The ICE Series. Each has a clinical scenario, a series of questions, a clinical image and finally some professorial ponderings to highlight key learning points. In every one we trust that you will find a few clinical pearls or reminders that you could apply to your patients that you care for in your emergency department or other health setting. Check out the first one here: ICE 001.
Twee Dee and Twitical Care
News from the Fastlane
- The World At War! and SMACC 2013 is going to be the battle ground!
- Tessa reviews another cool clinical app, this ones all about wounds in this weeks TechTool Thursday 009.
The Final Words
- “If you care about being thought credible and intelligent, do not use complex language where simpler language will do.”
- Daniel Kahneman
- “A reliable way to make people believe falsehoods is frequent repetition because familiarity is not easily distinguished from truth.”
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 —PEMTweets Blog — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — Resus.com.au — Resus.ME — RESUS Room — Richard Winters’ Physician Leadership —ruralflyingdoc — SCANCRIT — SCCM Blogs — SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SOCMOB — 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 Podcast — Ultrasound Village