Welcome to the in-depth 91st 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 taken out by the master of ECG’s Amal Mattu. Each week he puts out a new beaut case or concept in ECG interpretation. This weeks he gets down and tricky with a 12 lead ECG case in a paediatric patient. Check it out, and his ECG library at EKG Videos.
The LITFL Review Top Picks
- Mind of the Resuscitationist Series: Cliff Reid’s Own the Resus Room. This awe-inspiring video by Cliff Reid will have you leading, and dominating the resuscitation room in no time! Sensational work, thinking, and approach by Cliff – a must watch!
- Bradycardia - great review on the causes of bradycardia….Remember always think about hyperkalaemia!
- When there’s no psych reg insight…Do you know how to do a Suicide Assessment ? Which patients are high risk, which are low….Not sure? Listen to the ultimate guide from two guru’s Casey and Rob Orman leading us on insightful journey through the steps they use when assessing suicidality!
- Broome Docs Vodcast 009: Airway 101 with Drs Tim Leeuwenberg and Jamie Doube. Checkout part 1 is a simple, robust and “bush-doc- friendly” approach to the airway in an emergency scenario.
- Is pulmonary embolism really all that bad?… Again… - Pulmonary embolism is bad!! But what should we doing with the pulmonary fluff that really doesn’t cause too much harm?
- IV dextrose for kids with gastro - it seems to make a slight diference, better clearance of ketones, earlier rehydration and discharge- might be worth a shot!
- Listen to LITFL’s Chris Nickson giving us 5 pearls on managing cardiotoxic drug overdoses. Nickson on Cardiotoxic Overdoses - A must listen to and remember never surrender!
- Need an update on managing paracetamol and aspirin overdoses? Have a listent to Kelly on Paracetamol Toxicity.
- Talking about asking the big question….Crowdsourced Instantaneous Review: The Peer Review of FOAM? Is what we put online peer reviewed enough? I think most posts get more discussion and debate in there comment section and on Twitter than any journal article! Check out FOAM: A Market of Ideas for more on this!
- Diverticulitis – The Sinusitis of the Colon? - These authors propose that diverticulitis is most frequently a self-limited process, rather than one that requires antibiotics.
- Who Are the PE Positive PERC Negatives? - Pleuritic chest pain was more common in PERC-negative patients with PE, along with pregnancy or post-partum status.
- How to assess for swallowing difficulty in stroke patients. Its simple as just ASSISTing them!
Great pearl this on blunt cardiac injury by Semhar Tewelde:
- BCI results in a spectrum of outcomes from asymptomatic to sudden cardiac death
- Normal screening ECG is associated with a 98% negative predictive value
- Sinus tachycardia is the most common ECG abnormality among trauma victims
- Myocardial contusion (MC) is the most common & ambiguous diagnosis following BCI
- MC has no consensus definition or uniform diagnostic criteria and can be loosely defined as BCI w/mild increase in cardiac biomarkers or frank cardiac dysfunction (e.g. wall motion abnormalities, arrhythmias, conduction disturbances, or SCD)
- BCI w/ a normal ECG & stable haemodynamics have a benign clinical course and rarely require further diagnostic testing or long periods of close observation
- Individuals w/ECG abnormalities, haemodynamic instability, or rapid deceleration injury concerning for blunt aortic injury (BAI) warrant imaging of heart and great vessels by echocardiogram and CT scan
- I Pulled Off a Tick By Mike Epter – great podcast on the management of tick bites, and tick born disease!
- Drinking the PPI Hate-O-Rade - Bottom Line: PPIs do not reduce 30 day mortality, rebleed rates or surgery requirements at 30 days. However, because of reduced need for endoscopic intervention and the prolonged period required for knowledge translation, their empiric use will continue for the foreseeable future.
- Why your suicidal patient might benefit from ketamine – the latest evidence - It would be awesome if there was the standard of care in treating and reducing suicide, just need more studies and investigations to give us a more clearer answer.
- Rapid Sequence Intubation safety briefing - Great concept by Minh, so who’s using this before each tube!
- DrGDH’s Adventures in Wonderland: Stroke Thrombolysis. Check out Dr G whistle stop tour of the evidence surrounding stroke thrombolysis! Warning doesn’t come with Ondansetron!
- First case-report: designer Quaalude intoxication - The authors conclude: “MMQ appears to have a similar acute toxicity profile to methaqualone, with marked psychomotor stimulation. Symptoms of acute toxicity can be expected to resolve within hours with supportive care.” Of course, all expectations may go out the window in cases of massive overdose.
- SVC Syndrome - How to pick it on the CT chest scan!
- Make sure your CRAP patient doesn’t have the signs of Crohn’s Disease Red Flags!
- Read this and make sure you don’t miss the devastating condition of Compartment Syndrome - remember the 5 P’s to stay safe, remember the 6th P means plaintiff!!
- Mentorship: Who benefits? - What makes up a good mentor-mentoree relationship?
- Trick of the Trade: Reducing the metacarpal fracture - using the Jahss reduction technique. Check out the video for more:
- Contusion to elbow and patients wants to know Is it broken? It seems if good ROM, limited indication for imaging!
- a swollen face… Interesting case and images on managing the orbital floor fracture!
- #KeeweePatient - The ultimate case in FOAMed education! When the blogger becomes a patient!
The LITFL Review Shout Out of the Week
- Shout-out this week is taken out by the new and exciting blog Resus Room Management, headed up by Aussie EM specialist Andy Buck and Amit Maini. RRM has been created to help Emergency Department medical and nursing staff develop a skill set that will allow them to better manage resuscitation cases, to enhance group dynamics and functionality, improve communication, to deal with external “help” in an optimal fashion, expedite disposition and maximise patient safety. Check out theses stella first posts from the guys:
The GMEP Plug of the week
50 yo male with cough and dyspnea. What’s the diagnosis? (via @criticalcarenow)
Twee Dee and Twitical Care
News from the Fastlane
- Chris has been extremely busy putting the finishing touches on the Critical Care Compendium. Check out over 1150 core topics and controversies in critical care!
- SMACCtastic PK Talks! - Wow these are amazing, imagine what the conference is going to be like!
The Final Words
“The evidence is clear: when an Emergency Surgical Airway is required, it is not the procedure that kills the patients, but delaying or not doing it is what causes harm.”
-Dr Cook & Dr MacDougall-Davis
“Airway day? Every day is airway day!”
- Minh Le Cong
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 — Resus Room Management — 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