Welcome to the centurion 100th 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 Casey Parker over at Broome Docs, with his thought provoking, awe-inspiring podcast Lessons Hard Learned – Episode 2. This powerful, hard hitting story highlights to us all that our words can mean everything to our patients!
- Mental Health Assessment in the ED by Dr Andrew Webster – A quick short sharp look at assessing the mental health patient in the ED, so that psychiatry can see and treat them.
- 5 Quick Tox Cases – Dr Bryan Hayes gives the answers. Casey teams up with toxicologist and ED pharmacist Bryan Hayes (@ERPharmToxGuy) to answer the questions from the recent tox quiz. Some great pearls and questions are answered in this podcast.
The LITFL Review Top Picks
- DO2GMA — New recruit Kate (@mullybean) takes on the dogma on one of the most used drug’s in emergency medicine – Oxygen! Are we giving our patients a benefit or are we causing them harm by giving them oxygen? Thinks James comment sums it up well – The lesson is we should always continue to question, and search not just for an answer, but for the right one.
- Lateral chest thrusts for choking – Interestingly – and I didn’t know this (although perhaps should have!) – the Australian Resuscitation Council (ARC) recommended lateral chest thrusts instead of abdominal thrusts for over 20 years.
- High flow nasal cannula oxygen – Can be of extreme benefit if you select your patient wisely, we just need to study the method of oxygen delivery a bit more to get the data to support this.
- A classic ultrasound clip of a common cause of abdominal pain – Another awesome ultrasound case. Remember: ultrasound is incredibly useful when searching for bowel pathology.
- What’s the MATTER(s) with Tranexamic Acid? – Stop being skeptical about this drug and start using it in your massive transfusion protocols.
- White Whale – Think twice before discharging your patient with “costochondritis”.
- EMCrit Wee – The Vortex Approach – Scott reviews and provides his opinion on the new difficult airway tool – The Vortex. Also Nickson has set the challenge to Weingart no more airway podcast for 3 months! IWe get the chance to set a challenge for Nickson as well!
- Paracentesis – Not Difficult, but like most things.. better with Ultrasound.
- GMC Guidance on social media use by doctors. While all this get debated… I would take these wide worse from Simon on board and you should be ok: “my advice is to think carefully before posting.”
- An Easter Message: Let’s Talk About Dying & Palliative Care. Death is inevitable in some of our patients, we owe these patients everything. Natalie shares some sound advice and resources on how we can manage the dying patient better.
- The Probe – this gives us a nice in-depth review on inotropes and vasopressors in the ED, and touches briefly on on rhinosinusitis.
- Don’t Get Sick on the Weekend – It’s probably never going to be the case that weekend shifts are less desirable – so we’re probably stuck with this slight mortality bump on weekends.
- IST-3 Annals JC Answers Available – The experts challenge the IST-3 in Annals of EM Journal Club.
- Tamara shares with a list of great FOAMed resources that taught her all about Ventilation: a Crash Course.
- Acute Severe Pulmonary Edema: What is the Diagnosis? – Brilliant, exciting ECG case this one, guaranteed to challenge you.
- BBC Horizon & Kevin Fong Explore Human Factors in Healthcare. At look at why we make mistakes, and what we should be doing to prevent and prepares us so we don’t make these mistakes.
- nurses fuck cancer. Let educate our patients and change the outcomes from some of our biggest killers.
- Aged care activity box for emergency departments. Great idea Ian, we do it for kids and it works…Why not adults to?
- Excellent review with tips and tricks on The Agitated Patient in the ED: Assessment & Mild Agitation.
- A “big Christmas cardigan”: recreational use of ketamine and methoxetamine – Methoxetamine, the new street ketamine!
- Does phenobarbital add benefit in treating alcohol withdrawal syndrome? – The authors note that phenobarbital might add benefit because it has a longer duration of action than does lorazepam. It is possible that using a longer-acting benzodiazepine such as diazepam might give the same advantage without complicating the treatment regimen.
- Stroke Me, Stroke Me – We all know the conclusion is going to be here… So has anyone stopped giving it yet?
This weeks pearl from Michael Winters on Extubation in the ED:
- With the increasing LOS for many of our intubated critically ill ED patients, it is possible that select patients may be ready for extubation while still in the ED.
- Patients who remain intubated unnecessarily are at increased risk for pneumonia, increased hospital LOS, and increased mortality.
- To be considered for extubation, patients should meet the following criteria:
- The condition that resulted in intubation is improved or resolved
- Hemodynamically stable (off pressors)
- PaO2/FiO2 > 200 with PEEP < 5 cm H2O
- If these criteria are met, perform a spontaenous breathing trial (SBT).
- Discontinue sedation
- Adjust the ventilator to minimal settings: pressure support or CPAP (5 cm H2O) or use a T-piece.
- Perform the trial for at least 30 minutes.
- If the patient develops a RR > 35 bpm, SpO2 < 90%, HR > 140 bpm, SBP > 180 mm Hg or < 90 mm Hg, or increased anxiety, the SBT ends and the patient should remain intubated.
- Before removing the endotracheal tube, be sure to assess mentation, the quantity of secretions, and strength of cough.
- When Morphine Hurts – A must listen for anyone who sees patients on chronic opioids, treats pain in patients with chronic pain, or knows someone who does.
- Acute agitation, sedation, aspiration, Cannot intubate/ventilate – lessons from Coroners cases – Great point Minh, the coroners court has been providing us with FOAM for years, we just need to take the time to read it!
- Excited delirium syndrome in 2013 – Minh provides a nice review of the most recent literature published on excited delirium.
- When an anaesthetist asks for help from an intensivist – Human Factors My Story – Interesting case highlighting how “influential noise” affects us and ability to perform in certain situations. Worth a read!
- Ultrasound Guided Stellate Ganglion Block for Refractory Ventricular Fibrillation. Wow – anyone actually tried this?
- BAAM device for Nasotracheal Intubations – handy device for assisting with naso-tracheal intubations – what are they ?
- The importance of a good history in tox patients. History is paramount in the tox patient, when simple isn’t so simple – great case!
- FOAM AND SIMULATION: KINDRED SPIRITS IN EDUCATION – Jesse puts it to us that FOAM should be used as a tool, teaching technique and a resource, and embedded into our teaching curriculum’s, that doesn’t require a curriculum by itself.
- SOCMOB How To: Make an atomizer device. Nifty video showing you how to MacGyver your own atomizer for intranasal and orotracheal drug administration.
- Chest Pain (Part 1 of 3): What is the Value of a Good History? A must read post – nice review of the literature to help the next time your assessing or triaging your chest pain patient.
- Is ATLS wrong about palpable blood pressure estimates? – Yes, but ATLS are listening and viewing the evidence, and no longer recommend or refer to these values. The hard part is changing this ingrained dogma.
- Sim Case: Cocaine toxicity and placental abruption – Great new initiative on ALIEM, how to write and set up sim cases – and the sharing free for us all to use in the spirit of FOAM.
- Myth Buster: Maximum Dose of Enoxaparin -Myth busted: There is NO maximum enoxaparin dose for treatment of VTE.
- Rare cause of intracranial hemorrhage… Do you know what disseminated coccidioidomycosis is?
The LITFL Review Shout Out of the Week
This weeks shout out is a thank you to you all the readers and the supporter of the LITFL Review, as we just crack our 100th edition. I would also like to thank Chris and Mike both for the opportunity, support, ideas and critiquing each week of the LITFL review to keep making it better and more informative for you the reader.
The GMEP Cases of the week
GMEP Video of the week
GMEP Image of the week
Pic of the week highlights how powerful anatomy simulators can be! Thanks for sharing K. Scott Richey.
Twee Dee and Twitical Care
News from the Fastlane
- Goal-Directed Echocardiography Great review by Timothy Horeczko, can guarantee there more excellent FOAM out there that’s hiding on peoples USB sticks, hard drives etc. Its time to start share this awesome content like Timothy has.
- Chris lets us in on a bit of critical care gold, when he stumbled across Critical Care Reviews.
- Doug is back again this week with a few more of his famous Jelly Beans: JellyBean 003 with Pre Hospital Pro Ben Meadley, JellyBean 004 with LITFL Tech-maven Tessa Davis, JellyBean 005 with Paeds EM enthusiast Natalie May.
The Final Words
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 — CLIC-EM — 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 — EM CapeTown — 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 — emimdoc — 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 —Injectable Orange — Intensive Care Network — iTeachEM — IVLine — 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 Review — 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