Life in the Fast Lane Medical Blog The LITFL Review 055
Welcome to the splendid 55th 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 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 uber geek’s of emergency medicine are back with a lengthy look at Stress Testing: A Moment of Clarity - the SMARTEM team dives down through 40,000 leagues of medical literature on the utility of using the exercise stress testing in the emergency department. Congratulations David and Ashley on taking out top spot!
Academic Life in Emergency Medicine
- Trick of the Trade: Minimizing propofol injection pain - great tips inspired by Andy Neill’s recent contribution to R&R In The FASTLANE.
- Paucis Verbis: Pediatric fever without a source (Birth-28 days) - A nice approach guaranteed to come in handy!
- Joe’s pick of the week is by Karl Nibbelink on the difficult topic of I Suspect My Colleague Is Using Drugs: What should I do?
- “Legal Highs”: new psychoactive drugs - not the greatest article on new psychoactive drugs – but provides some useful facts.
- Honey Don’t: grayanotoxins, sex, and affairs of the heart - this honey is most probably not something to spread on your toast. This is an amazing pair of cases.
- Bath salts and necrotizing fasciitis: a case report - you have been warned!
- Left ventricular Aneurysm Morphology Distorted by Right Bundle Branch Block – Mimicking Acute STEMI with RBBB.
- Chest pain and hypotension in a patient who is 3 weeks post STEMI - is the patient having ongoing ischaemia or a complication post-STEMI?
- 11 Benchmarks That Should Matter to EPs. Take home point: Benchmarks serve no purpose if they do not reflect the needs and perceptions of all the stakeholders.
- Sickle Cell: 10 Things Every EP Should Know about SCD.
- You are twice as likely to die when flying on this aircraft – You wouldn’t fly on this plane with that risk- but patients that attend the emergency department are exposed to the same risk.
- 53 secrets the ED staff won’t tell you – What there is only 53??
- Ian gives a tribute in praise of our wardsmen (and women).
- Colin and team delve into controversy in this week’s podcast when discussing ISAAC blows wheezy whistle on APAP.
- Some excellent little pearls and pitfalls on a common ED resus medication - Know Before You Push — Adenosine - remember help your electrophysiologist out get a good ECG before giving.
- Craig Hore shares with us an interesting case in Emergency Pacing - and shares with us some excellent pitfalls in for transcutaneous pacing.
Emergency Medicine Literature of Note
- Further Harms of IV Contrast - Just in case you needed another reason to not order a contrast CT.
- The Harmful Rush To Hypothermia - Hard to know what to actually do with data. Is early hypothermia truly harmful?
- Consult Skills 2: When Agendas Collide or “Physician Know Thyself” – Casey shares his approach to the difficult patient or the difficult conversation.
Michael Winters pearl of the week - SAH and Pulmonary Edema – Think Twice About Diuresis!
- Delayed cerebral ischemia (DCI) is the most common cause of secondary neurologic injury in patients with aneurysmal subarachnoid hemorrhage (SAH).
- Intravascular volume depletion is one of several factors thought to cause, or worsen, DCI.
- Pulmonary edema frequently occurs in patients with SAH.
- A recent study in patients with SAH and pulmonary edema demonstrated that many were not volume overloaded. In fact, many were intravascularlyvolume depleted.
- Think twice about aggressive diuresis in patients with SAH and pulmonary edema, as this may exacerbate volume depletion and may worsen DCI.
- David smashes out another brilliant podcast episode when he teams up with anaesthetic consultant Simon Pattullo to provides us with an approach to the ‘Can’t Intubate – Can’t Ventilate” scenario – check out Airway-Preparing to Fail.
- Revitalising Professionalism - “The fact that medicine rarely cures many of the diseases that we attend to makes it even more morally significant.”
- Anatomy for Emergency Medicine – #5 CSF Circulation
Anatomy for Emergency Medicine – #5 CSF Circulation from Andy Neill on Vimeo.
- Learning to learn - The secret to life long learning is simple. Everyday, and every patient ask yourself ‘Could I have done that better?’
- Amit shares with us some of his revision notes on Radiation Illness and High Altitude Illness.
- Management of The Mangled Extremity - a new algorithm approach from some recently published literature.
- As Australian’s continue to have a love affair with Bali – ED doc’s and nurses need a good understanding on Saturday Night Dengue Fever & Staying Alive - Worth reading!
- Bleeding Hell! Dabigatran is Here. Forget the Vit K or prothrombinex its straight of to dialysis for these patients!
Pediatric Emergency Medicine Morsels
- This weeks morsel is on how to rotate back the Malrotation.
- Vasopressors in Neurogenic Shock - Remember: shock in a trauma patient should be presumed to be secondary to hemorrhage until proven otherwise. If you’re certain it’s neurogenic shock, then optimize BP with crystalloid fluids, followed by a pressor as above to increase your MAPs and increase spinal perfusion.
- Hypothermia in Trauma - Until further word, preventing and correcting hypothermia is recommended.
The Trauma Professional’s Blog
- The Societal Cost of ED Thoracotomy - Bottom line: use the guidelines and save your own health, safety and hospital resources. Is it really worth it if you know the patient will not survive?
- Can Lead Poisoning Occur After A Gunshot? - Not something you come across every day, but some important pearls and pitfalls here on treatment options.
- A Cool Way To Remove Embedded Foreign Bodies - This is a very slick technique that promises to dramatically increase the success rate and decrease complications from removing foreign bodies.
A Life at Risk: the Emergency Physician
- Septic Arthritis and Arthrocentesis - Although arthrocentesis is not a risk-free procedure, synovial fluid analysis is essential for the diagnosis.
More Musings (of a Distractible Kind)
- Good Things in Medicine #2: Puzzles – Problem solving is central to being a good diagnostician. The quirky and insightful Rob Lambert tells us why diagnosis is cool, and how to get good at it.
A holistic orthopaedic surgeon is one who cares for the whole bone and not just the fracture.
@otorhinolarydoc
Trainee ENT Surgeon
- Yosef Liebman’s Emergency Medicine Update January 2012 - is out…so check it out!
- There is still time to go into the draw to win in the Test The Textbook Trilogy.
- ‘Accept ignorance, accept that you just don’t know, once you get that into your head you’ll start to learn.’
- Jim Ducharme
- “One of the major biases in risky decision making is optimism. Optimism is a source of high-risk thinking.”
- Daniel Kahneman
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
Life in the Fast Lane Medical Blog - Emergency Medicine education blog
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