The LITFL Review 089

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

The Skeptics Guide to Emergency Medicine

  • 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!

Academic Life in Emergency Medicine

EM Literature of Note

The Trauma Professional’s Blog

  • 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!

Emergency Physicians Monthly

  • 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


  • 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.

Emergency Medicine Ireland


  • 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!

EKG Videos



  • 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!

Intensive Care Network

Broome Docs


  • 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.

Ultrasound Podcast


  • Patella Fracture – how to pick em on the X-ray, and a brief guide to managing them.

The Poison Review


Dr Smith’s ECG Blog

  • 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.


UMEM Educational Pearls

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:

  1. Consider placing an NGT for abdominal decompression

  2. Don’t mistake the epicardial fat pad for an effusion; fat pads don’t change size and usually move in concert with the ventricle

  3. The apical 4-chamber view tends to be the most common probe position, as the largest collection of fluid is usually around the apex.

  4. If you are unsure about your needle location, inject 5-ml of agitated saline to confirm you are in the pericardial space.

Pediatric EM Morsels

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

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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.”

-Benjamin Franklin

LITFL Review EM/CC Educational Social Media Round Up

Emergency Medicine and Critical Care Blogroll

Emergency Medicine and Critical Care Podcasts — Academic Life in Emergency Medicine — Adventure Medicine—  A Life at Risk — All LA Conference — Al Sacchetti’s Youtube — Bedside Ultrasound  Better in Emergency Medicine boringemBroome Docs — — CLIC-EM — Critical Care Perspectives in EM — Dave on Airways —DrGDH — Dr Smith’s ECG Blog — ECG Academy — ECG Guru — ECG of the WeekED 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 TutorialsEmergency Medicine Updates —Emergucate EM Literature of Note —  — 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 —  — 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 — — Radiology Signs — Radiopaedia — — Resus.ME — RESUS Room — Richard Winters’ Physician Leadership —ruralflyingdoc — SCANCRIT — SCCM Blogs —  SCCM Podcast — SEMEP — SinaiEM — SinaiEM Ultrasound —  SMART EM   SOCMOB — SonoSpot — StEmylns — Takeokun — thebluntdissectionThe 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 —  — ToxTalk — TJdogma  Twin Cities Toxicology — Ultrarounds —  UMEM Educational Pearls  —Ultrasound Podcast — Ultrasound Village

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