Welcome to the festive 89th 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
- Top spot this week is taken out by The Skeptics Guide to Emergency Medicine, as they take on the (lack of) evidence for the use of PPI’s in GI bleeders! This seems to be a routine and widely adopted treatment we all reach for when someone presents with a GI bleed. But is the evidence there to supports us…? Find out in SGEM #16: Ho, Ho, Hold the PPI!
The LITFL Review Top Picks
- Lessons from the STOP Sepsis Collaborative! Remember its not about all the invasive measures that makes a difference in septic patients, the non-invasive approach delivers results and Scott tells us how. The ED approach: get and check lactate, early antibiotics and fluids, source control, early critical care/senior review is what its all about when dealing with the septic patient.
- A Rant on Video Laryngoscopy - a reader shares a rant with Scott on VL, are you really using it for what its designed for?
- Pediatric UTI Controversies and there is plenty of them, Colin and the team nut through them all and provide us with sound advice for cracking and curing your next paediatric UTI case!
- Michelle shares with us her Top 7 people I follow on Twitter (outside of EM) and why. Some fascinating people on this list, all with great experience and lessons to share with us in 140 characters.
- Trick of the Trade: Combine Adenosine with the Flush- The success of adenosine depends as much on the administration technique as it does the mechanism of action.
- Physical exams: A relic of the past? Some humbling thoughts on were we are at when it comes to the physical exam in today’s practice of medicine!
- Pain Control on the Wrong Track - Best to avoid codeine in paediatric patients, at the end of the day there are better analgesic options out there!
- Predicting Immediate Improvement After tPA - part of a slow, gradual trend of attempts to delineate which patients have the best potential to benefit from tPA.
- Why I Don’t Like Finger Thoracostomy - Bottom line: As you can tell, I’m not a big fan of finger thoracostomy, mainly due to speed (or lack thereof). Just stock some big fat needle catheters in your trauma bay and be done with it. But if you really, really want to use the finger technique, make sure that the person doing it is very experienced. This is not a learner’s procedure. It should take no more than 15 seconds, or the wrong person is doing it.
- The Passing Of The Rectal Exam In Trauma. The Bottom Line: For most major trauma patients, the rectal exam is not worth the patient aggravation it causes. RIP DRE!
- Despite the expanding array of video and other imaging laryngoscopes there are some fundamental principles that apply to all new airway devices that emergency physicians should know. Richard Levitan shares his Four Secrets to Video Laryngoscopy - pure FOAM gold!
- ECG of the Week – 24th December 2012 - Can you crack the case of this patient this ECG, that presents with LIF pain and D&V’s!
- About time the nurses caught up to the Dr’s. Check out Our first hangout on Nurse+ great start with a discussion on technology in health-care! Look forward to seeing more of these develop.
- Congratulations Philip Darbyshire: Social Media Nurse of the Year 2012!- Well done Phil, and great concept/idea Ian!
- Tips on delivering IV fluids STAT.- Remember 999mls/hr is not STAT!!!!
- The Thunderbox Papers: Migraine -A nice one pager on the ins and outs of migraine treatment!
- Another brilliant anatomy review from Andy on Shoulder: Dislocations!
- FOAMtastic top 5 for 2012 - Andy top 5 tips and tricks from 2012 that have helped him dominate the bedside.
- A 19 year old woman presents to your ED with two hours of rapid palpitations and lightheadedness…. and her heart rate is 300bpm WTF!!! Time to take on the ECG Challenge 2!
- #FOAMed Online Airway training Program – Airway Decision making - Min puts together some of the stars of FOAMed and airway management, to provides us with a sensational review of airway decision making! A must watch!
- PHARM Podcast 55 : Xmas message 2012 - Minh shares his good will and hat tips to all those have supported him and taught him in 2012! Look forward to more great PHARM stuff in 2012!
- Who here has intubated Santa Claus :and would he be a difficult airway? Not sure? Minh gives you some pointers on how to intubate the big red man!
- The role of ketamine in acute agitation management : a review by Minh on the evidence and his personal experience as a retrieval doctor with the use ketamine. Nice vodcast Minh!
- Choosing your Battles: My Christmas Pearl of 2012. Some sound advice on taking part in the FOAMed revolution: To summarize, being young and enthusiastic about medical education, EBM and FOAM is awesome. But regardless of your medical profession (EMT, nurse, resident, etc.), if you are keen on FOAM, you will be saying some crazy sounding things. If you are in a position to effect change, fantastic, but this is another situation where less may be more, and choosing your battles wisely is a lesson for us all.
- A Constipation Cocktail - what do you use or should I say do to disimpact your patients. Don’t forget the PO naloxone if the patient is taking opiates!
- Concussion assessment and return to play controversies from the motorsport perspective. Great first vodcast Mathew!
- Broome Docs Podcast 005: HCGs, Ectopics Etc with Dr Geordan Shannon - Casey delves into the complex world of women’s health and covers it in a 15min podcast – Great effort mate!
- Fluid balancing act - How to manage fluid resuscitation in a dialysis dependent ESRF patient? Not an easy task.
- Epidurals with Dr Dave Forster - Dave shares with us his practice pointers, tips and tricks to make epidurals in the Obstetric realm as fun as they can be.
- New STEMI guidelines – Cliff provides a short summary on whats new and what we should be doing in reperfusing our STEMI patients!
- The Resus Room Life Guard aka the resus room safety officer. Who’s looking out for the patient and resus team when things go wrong in the resus room? Cliff takes a page out of Atul Gawande book and creates a checklist.
- Little Itty Bitty 3 – Supraclavicular: ultrasound guided access to the subclavian using the supraclavicular approach.
- Patella Fracture - how to pick em on the X-ray, and a brief guide to managing them.
- Brussel-sprout-induced inhibition of warfarin anticoagulation - Another reason not to eat your brussel-sprouts!
- Must-read: Cold War experiments into BZ, sarin and other chemical weapons- A look back at history and the sub lethal does of drugs the US military tried on its soldiers. Fascinating reading!
- Surprise quiz: metformin overdose – absolute FOAMed gold here from Leon, as he quizzes us on the ins and outs of Metformin toxicity!
- Clopidogrel + head injury = CT? - What’s the bottom line? Even accepting the limitations, this evidence strongly suggests that patients taking clopidogrel are at substantial risk of ICH after head injury. Scan them. Even in the absence of other indications.
- The #FOAMtastic 2012 top ten from St.Emlyn’s Simon shares his top 10 lessons learned from the FOAMed community in 2012!
- Christmas 2012 style: Away in a Resus Trolley, No Crib for a Bed A satirical view on if Jesus was born today By Rick- Brilliant!
- Middle Aged Male with Chest Pain and Previous MI - Great pearl from Dr Smith - Opiates are associated with 1.5x mortality in ACS. Why? Probably because they lead the physician to a false sense of security. In this case, the absence of any further chest pain was reassuring to the physicians.
- Compression -Only CPR at least not worse than trad CPR. Take-home message: The study tells us OHCA-victims stand a 1-2% improved chance of long time survival if the bystander performs compressions-only CPR instead of traditional CPR with rescue breaths.
This week’s pearl is by Michael Winters on Ultrasound-Guided Pericardiocentesis:
- Though emergent pericardiocentesis is a relatively rare procedure in the ED, it is a critical intervention in patients with effusion and life-threatening instability/PEA arrest.
- Ultrasound-guided pericardiocentesis is preferred over the traditional “blind” approach, as it allows the provider to choose an optimal position and is associated with fewer complications.
A few pearls when using ultrasound for emergent pericardiocentesis:
Consider placing an NGT for abdominal decompression
Don’t mistake the epicardial fat pad for an effusion; fat pads don’t change size and usually move in concert with the ventricle
The apical 4-chamber view tends to be the most common probe position, as the largest collection of fluid is usually around the apex.
If you are unsure about your needle location, inject 5-ml of agitated saline to confirm you are in the pericardial space.
- Pyridoxine Dependent Seizures - Not something your going to see every day..But worth thinking about when dealing with the seizing neonate.
The LITFL Review Shout Out of the Week
This weeks shout-out is taken out by new EM blog EMDutch, that will be discussing all things EM from below the sea-level. They’re off to a great start with these first round posts:
Twee Dee and Twitical Care
News from the Fastlane
- Dr Ben McKenzie and Dr Mark Putland share an awesome guest post on LITFL. Check out…. Trauma Under Pressure!
- Yousef Leibman’s Emergency Medicine Update December 2012 is out!
- Extubation In The ED - not something we do often, but this handy flow chart from George Douros, will guide you through it easily.
- And finally A Time For Reflection. On a personal note i would like to thank Chris, Mike and all the LITFL Review readers for your continuing support and encouragement for the review over 2012. Wishing you all the best 2013, and look forwarded to reviewing more FOAMed for you all in 2013.
The Final Words
- “I made no resolutions for the New Year. The habit of making plans, of criticizing, sanctioning and molding my life, is too much of a daily event for me.”
– Anaïs Nin
- “Be always at war with your vices, at peace with your neighbours, and let each new year find you a better man.”
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 —boringem—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 —EMDutch — 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 — EXPENSIVECARE — Free Emergency Medicine Talks — GMEP — Gmergency!—Got Resuscitation— 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