Welcome to the long overdue 67th edition! (Bear with us while we play a bit of catch up…)
The LITFL Review is your regular and reliable source (well most of the time anyway!) 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 will cast 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.
The Most Fair Dinkum Ripper Beaut of the Week
- Daily Aspirin Harms More Than It Helps — Ryan reviews a paper with a bugger of a conclusion. As always we need to think of the whole patient before dishing out the pills.
The LITFL Review Top Picks of the Week
- Tolchock to the gulliver and Tolchock to the gulliver… part 2 – the evidence — a great 2-part case-based series reviewing the evidence for the management of traumatic brain injury from a remote practitioner’s perspective.
- The gap between print/HTML and the bedside — do blogs and journals neglect the day-to-day reality of semi-(non)-urgent care in the emergency department? Andy says there is a disconnect here. I think he’s right.
- Seth shares with us two great links from grand rounds in FB EM GR: TEE in CA. First up is EM Intesivist Robert Artnfield (Editor of EM Critical Care) on the use of TEE in cardiac arrest victims, the second talk is by Scott Weingart (heard of him?) on ‘what would you do if you run out of etomidate?” – go work in Australia I guess! We seem to do just fine without etomidate.
- Trick of the Trade: Hair tourniquet release — fantastic tip: use a cutting needle!
- Prehospital cardiac arrest management with Paramedic Chris Watford — Watford + Le Cong = listen!
- Differentiating between upper and lower GIB can be challenging.
- A recent review evaluated the accuracy of historical features, symptoms, signs, and lab values in distinguishing between UGIB and LGIB.
- Features with the highest likelihood for identifying UGIB included:
- Melaenic stool on exam (LR 25)
- A prior history of UGIB (LR 6.2)
- Serum urea:creatinine ratio > 30 (LR 7.5)
- Features that increased the likelihood of severe UGIB (defined as requiring blood transfusion, need for urgent endoscopy, surgery, or interventional radiology) included:
- Heart rate > 100 bpm (LR 4.9)
- Hemoglobin < 8 g/dL (LR 6.2)
- History of cirrhosis or cancer (LR 3.7)
- For patients with an UGIB, the Blatchford Score can be used to determine the need for urgent intervention. Those with a Blatchford Score of 0 have a low likelihood for severe UGIB and may not need emergent intervention.
- As a cardiologist, Confucius was nearly right… — a somewhat slow ECG puzzle from my Fellowship exam mentor Trvor Jackson: “It does not matter how slowly you go so long as you do not stop”
- Quinolones: Another Cautionary Tale — a journal article of the future may well read ” Amazing discovery – a drug that doesn’t cause prolonged QT”. That drug won’t be a quinolone…
- Episode 30 – Ultrasound Guided Nerve Blocks Part 2 — nerve blocks can revolutionise procedures in the ED; learn ’em and use ’em (appropriately, of course).
- Rational Medical Clearance for Psychiatric Care — A great talk by Les Zun from his Behavioural Emergencies conference, on a spiky topic. The word clearance should probably be banned from the ED.
- Acknowledging Death in the ER — “Perhaps if we could discuss this part [death] of our practice lives as easily as we discuss a diagnostic dilemma or the proper management of a complex case, we might create a culture that supports and nourishes us as we try to come to terms with experiences that are part of our daily lives.”
- CT Contrast Administration Via Intraosseous Cathether — Yes, it can be done (maybe just hand inject though).
- Acute cerebellar syndrome? Think methoxetamine — A new ketamine analogue os on the streets that apparently doesn’t rot your bladder with chronic use. However it does render its users exquisitely ‘unco’ to use a Kiwi-ism.
- Understanding Pacemakers — pacemakers are perpetually puzzling… so you’ve got to love this from Scottie W.
- ST depression after cardiac arrest is frequently not due to ACS — some good learning points and a bit of controversy: “don’t always think “STEMI”, or even “cath lab,” when you take care of a patient with resuscitated cardiac arrest, and even if they have ST depression; the cath lab need only be emergently activated for definite STEMI-equivalent, persistent ischemia, electrical instability, or hemodynamic instability. “
- The death of President Lincoln. A doctors report — At 7.20 AM he breathed his last and “the spirit fled to God who gave it”…
- Paucis Verbis: Toxic alcohols – Ethylene Glycol — key facts on a handy little card.
- Anticoagulation Reversal — Rob O goes to town on how to undo the damage done by drugs that make you bleed. Nice to see links to LITFL’s posts on warfarin overdose and the Australian guidelines on warfarin reversal.
News from the Fastlane
- LITFL’s Differential Diagnosis Database — a new feature on LITFL that you’ll find on the dropdown menu under resources — a constantly growing list of causes and reason for anything in emergency medicine and critical care, whether on the floor or in the exam.
- The usual torrent of LITFL products has been stemmed somewhat by Mike getting “lost” first in Ireland and then in New Zealand, Chris driving halfway across Australia to the Top End, and Kane still praying to the Internet Gods that he gets a reliable connection soon…!
The Final Words
- ‘The most beautiful thing we can experience is the mysterious. Tis the source of all true art & science’
That’s it for now…
Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps you to deal with anyone, anything, anywhere at anytime for at least another week! If you’d like to suggest something for inclusion in the next edition of The LITFL Review, email our roving reporter: kane AT lifeinthefastlane.com
LITFL Review EM/CC Educational Social Media Roll Call
Academic Life in Emergency Medicine — A Life at Risk — All LA Conference — Broome Docs — — Critical Care Perspectives in EM — CritIQ Podcast — DrGDH — Dr Smith’s ECG Blog — ED Exam — EDTCC — EM Basic — EM Core Content — EMCrit – EM Literature of Note — Emergency in the Shed — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News – Emergency Medicine Ireland — Emergency Medicine Updates — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum — EMRAP: Educators’ Edition — EMRAP.TV — ER CAST — Free Emergency Medicine Talks — Gmergency! — Greater Sydney Area HEMS — HQmeded.com — ICU Rounds — Impactednurse — Intensive Care Network — Keeping Up With Emergency Medicine — KeeWeeDoc – LipheLongLurnERdok — MDaware — MD+ CALC — MedEDMasters — Medicina d’urgenza — Medicine for the Outdoors — Micrognome — Movin’ Meat — Pediatric EM Morsels — PEM ED — PHARM — Priceless Electrical Activity — PulmCCM.org — Rahul’s EM Blog — Resus.com.au — Resus.ME — — Richard Winters’ Physician Leadership — Rob Rogers’ Medical Education Videos — SCANCRIT — SCCM Blogs — SCCM Podcast — SinaiEM — SinaiEM Ultrasound — SMART EM — Takeokun — The Central Line — The NNT — The Poison Review —The Short Coat– The Trauma Professional’s Blog — The underneaths of EM — ToxTalk — TJdogma — Twin Cities Toxicology — Ultrasound Podcast — UMEM Educational Pearls — Ultrasound Village