Welcome to the 102nd 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
- Cliff Reid over at Resus.ME smashes his way to top spot this week, as he brings us 3 great hot-of-the-press articles, that really tackle the core of what we do. He starts off with Another argument for ED thoracotomy – yes that’s right – we know we don’t often get a meaningful outcome for these patients, but we can give their families and other patients an meaningful outcome through organ donation. Cliff then sheds some light on where EMCC is, and where it should be heading on Upstairs vs Downstairs: an EPIC Conundrum – the comments on this post are a must read. He finishes the week with a look at swallowing a camera in GI bleed – it can only diagnose and not treat, making its benefit questionable in the unstable patient – but an interesting concept none the less!
The LITFL Review Top Picks
- Andy vodcasts us through some Basic Anatomy of Abdomen and Pelvic Trauma and Basic Anatomy of Chest Trauma – Excellent FOAM for the novice, and a nice refresher for the rest of us.
- Rick provides a nice and timely review Why hyper-troponin-aemia does not always equal acute myocardial infarction – aka “Myocardial Infarction Type 2”
- New STEMI Guidelines – the recommendations are to get these patients to cath lab as soon as we can even if post arrest or in cardiogenic shock.
- JC: Point of care USS for Hypotension in the ED. – its good and it helps… But does it really make a difference?
- David leaves the hustle and bustle of the ICU and takes us on a journey into What is Palliative Care? A lesson for us all in here!
- Flat IVC on CT Means High Mortality – If you see it on CT you might have to be a bit more aggressive with your resuscitation effort.
- Scott goes hardcore and delves deep into the science of Acid Base in the Critically Ill – Part V – Enough with the Bicarb Already.
The Sono Cave
- FAST Examination – the RUQ view. James goes to town on all the tricks and traps of the RUQ view.
- Head Injuries for Junior Docs. Prof Wayne Triner — A primer on the assessment and management for the junior staff member – more great FOAM!
- SAM – What’s SAM you ask? SAM stands for Systolic Anterior Motion of the mitral valve and may be seen as a complication of hypertrophic cardiomyopathies (HCM), myocardial infarction and mitral valve repair or dysfunction.
- Indulging in Intubation – Lessons for the Novice – Read and follow these pearls from Lauren and will have you on the right track to become a skilled intubator in no time.
- Casey puts us through our paces with Paeds Spot Diagnosis Quiz: part 2 and Paeds Spot Diagnosis Quiz – part 3 – these were great Casey hope you do more of these.
- Lessons Hard Learned – Episode 6 with Dr Melanie Thompson – Wow a difficult experience is a very difficult environment.
- Evidence Based Management of Acute Heart Failure: Forget LMNOP, think POND! The new pneumonic in managing ACPE is: POND – Positive pressure/position, Oxygen, Nitrates, Diuretics – glad the evidence is starting to catch up.
- The First Law Of Trauma — Remember: Any anomaly in your trauma patient is due to trauma, no matter how unlikely it may seem (… until proven otherwise).
Academic Life in Emergency Medicine
- NG Lavage: Indicated or Outdated? – NG lavage DOES NOT help patients in the emergency department with acute upper GI bleed and is an outdated practice. They’re obviously a bit behind the times in the States if there still doing this!
- Trick of the Trade: Fluorescein for lost contact lens – Great trick to find these often tricky, slippery little lenses!
- Trick of the Trade: Rapid Oral Phenytoin Loading in the ED – Handy tip, however most post seizure patients get an IV – so why not just load them IV and send them on there way with a script?
- Management of Syncope a.k.a “Done Fell Out” – Take Home Point: It is our job as emergency physicians to NOT identify a precise cause of syncope. Instead, we should aim to risk-stratify our patients: Who needs to be hospitalized (high risk) versus who can be safely discharge home (low risk) with outpatient follow up?
- Be a great speaker: 10 practical pearls (part 5 of 5) – A great last ten tips to wrap up this awesome series of pearls.
- A Pictorial Approach to Ultrasound in Shock – core concept turned graphically great!
- Eyelid Laceration -Nice Review of a deceptively difficult diagonsis and management problem.
- The Mediterranean Diet – A Life-Saving Discharge Instruction -Time to look beyond statins and bring on the olive oil when discharging the post MI patient!
- Does early GI decontamination improve outcomes in acute-on-chronic lithium toxicity. Is the answer going to come down to faith vs science? Leon seems to think so!
- Catching a plane, minding my own business – What would you do if in Minh’s place? Inspiring!
- If you had 45 minutes could you intubate ANYONE? – Its seems the NODESAT principle is making its way into the anaesthesia world.
- Minh shares with us the latest in the great debate on cricoid pressure in Cricoid Pressure – You Decide.
- Do you know what to do? Or what your role is at the scene of a disaster? Have a read of ED personnel at the scene of a disaster.
- This episode focuses on the renal colic shuffle, and can you flush that stone out? Want to know more have a listen to – Stone Me.
- Headaches in kids – In this “noggin-cast” they explore the causes of headache, including primary headachse like migraine and tension headache, and secondary headaches from viral illness and a few other strangeosities…
- in with a chance… – A superb, simple informative overview by Chris on managing and recognising a trauma patient with a chance fracture.
- Pulmonary Edema, Hypertension, and ST Elevation 2 Days After Stenting for Inferior STEMI – Time to call the cardiologist again!
- Calcium Channel Blockers, Beta Blockers and Undifferentiated Hypotension….OH MY! Nice review on one of the most sphincter tightening overdoses to deal with in adult and paediatric emergency medicine. This covers it all from insulin to intralipid.
- Episode 12 – New Trauma Guidelines: ATLS and Spine. Scott brings us up-to-date with the new ATLS guidelines for 2013! Take home point: less clear stuff and more red stuff is the key to resuscitating the haemorrhaging trauma patient.
- Resus Time Out Checklist – V2.0 – Andy puts his checklist to the test and reflects on its strengths and weaknesses.
- A 30yo presents with pericarditis. Do you hear the horses?
- Antibiotics and Communication … Before we change our patient behaviour regarding antibiotic prescribing, maybe we should change ours first!
This weeks pearl on Keppra is by Ellen Lemkin:
- Although Keppra has been used more frequently in clinical practice, there is little evidence for its use in status epilepticus.
- It has a wide spectrum of action and few drug interactions.
- Initially, case series appeared to be highly successful in terminating seizures as an add-on agent.
- A review of 2 prospective studies found efficacies of 44% as an add- on agent, and 75% as a primary agent. The studies had markedly different populations.
- In a retrospective study, the treatment failure rates were 3X higher than that of intravenous valproic acid as an add-on agent in terminating status epilepticus.
- Therefore, although it is used frequently, the evidence for use is limited and inconclusive in terminating status epilepticus.
The LITFL Review Shout Out of the Week
Shout this week goes to new Aussie Blog EM Journey By Chris Edwards (@EMtravellor). Chris’ philosophy for this blog is:”Given the wealth of blog and podcasts sites available, I am attempting to find a niche by providing a forum for a concept I thought of, called Crowd Learning and Problem Solving (CLaPS).”
- Check out his first post – #CLaPSem01
The GMEP Cases of the week
GMEP Video of the week
Video of the week is By James Rippey on.
GMEP Image of the week
This patient came in septic with hypotension, tachycardia, obtunded mental status.
Twee Dee and Twitical Care
News from the Fastlane
- Another bumper issue is out EMA April 2013.
- Want to find those spinal metastasis on X-ray? Its easy just look for the The Winking Owl Sign!
- Chris gets involved in the epic debate with his thoughts on the future of EMCC in Crippen’s Law
The Final Words
“Every Turkey has a Terminal Event”
– Billy Mallon
“Critical Care should be a Philosophy- Not a Place”
– Haney Mallemat
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 — 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 —EM on the Edge —Emergucate —EM Journey — 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 — — 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 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