The LITFL Review 071 - Life in the Fast Lane medical education blog

Welcome to the?striking 71st 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

Emergency Medicine Abstracts

• This week?s top spot goes to?Emergency Medicine Abstracts ? a well known?monthly?podcast created by two legends of emergency medicine, Rick?Bukata?and Jerry Hoffman. Previously EMA has only been accessed by paying a subscription fee, ruling it out of LITFL Review contention, however its seems they have embraced the FOAMprinciple and now provide a free screencast of the show each month. These two experts nut through the?articles?to provide us with stellar pearls and pitfalls that will change the way you practice medicine.Check out the August edition below:

The LITFL Review Top Picks

Intensive Care Network

• LITFL?s own Paul Young talks with Oil Flower on?Fever in sepsis: good, bad or ugly??They discuss the upcoming HEAT trial and?discusses the history of our interpretation of fever in sepsis and why it may not be a bad thing.

PulmCCM.org

Emergency Physicians Monthly

• ?Gone are the days of rampant cricothyrotomies, yet the competent emergency physician needs to know the ins and outs of the surgical airway.?Rick Levitan helps us dominate ?the ins and outs of this in A Primer On the Surgical Airway.

• Haney Mallemat recently put out an excellent video on Ultrarounds.com?highlighting a case of how effective?Subclavian Ultrasound ?is at gaining central access- check out the video if you don?t believe me. Seth then follows up with a few questions of his own for Haney on this technique. Have a read at?Questions for Haney on SCUS.

1. Massive ingestions are not typical cases, and may present with altered pharmacokinetics and delayed toxicity.
2. Paracetamol ingested in combination with another medication that can slow gastric emptying ? e.g., anticholinergics or opiates ? may result in delayed peak levels and late toxicity.

• To call, or not to call?? ? Great pearl from this post by Trevor:???Many ?protocols? are in fact guidelines that require significant, high level interpretation and decision making to optimise outcomes from their use.?

• Is it time to abandon plain radiography in the trauma room? ? Ultrasound has dominated the abdomen in the trauma bay, but now its moving up up to dominate the chest as well!!
• COPD and heart disease interactions ? Take home point:?Patients admitted with COPD exacerbation?s are more susceptible to myocardial infarction during the admission.
• Don?t ignore the diastolic ? A recent study showed that a low diastolic BP was one of several factors predictive of cardiac arrest on hospital wards: the most accurate predictors were maximum respiratory rate, heart rate, pulse pressure index, and minimum diastolic BP.

EMERJENCYWEBB

• This week?s pearl is from Mike Winters on?Low-Tidal Volume Ventilation Still Underutilized:

• It?s been over 10 years since the publication of the ARDSnet trial, which demonstrated an 8.8% absolute reduction in short-term mortality for patients with ARDS ventilated with ?lung protective? settings (tidal volume 6 ml/kg, plateau pressure < 30 cm H20).
• A recent study in the BMJ evaluated the association of these settings with 2-yr survival in patients with acute lung injury.
• The study, carried out in 13 ICUs from 4 academic hospitals in Baltimore, found some surprising results:
  • In patients whose ventilator settings were 100% compliant with lung protective settings, there was an 8% absolute reduction in mortality.
  • For each increase of 1 ml/kg above recommended tidal volume there was an?18% relative increase in mortality.
  • 37% of patients?never?received lung protective ventilation.
• Take home point: lung protective settings appear to confer not only short-term but also long-term mortality benefit for patients with acute lung injury, yet remain underutilized even in major academic centers.

Dave on Airways

• REVIVE airway study?? Dave highlights a new study that hope to answer was is the best way to manage the airway during cardiac arrest.

Emergency Medicine Ireland

Impactednurse

• PQRST: but why??? nice sharp review of what each letter means on the ECG.

StEmylns

Broome Docs

EM Literature of Note

• When Do Patients Need Blood Cultures? ? Essentially, based on a few pieces of decent evidence and a few pieces of poor evidence, the authors determine a few general categories of infectious?etiology?with varying pretest probability for bacteremia.? These are:
  ? Cellulitis, community-acquired pneumonia, community-acquired fever: low (<14%) probability
  ? Pyelonephritis: mid (19-25%)
  ? Severe sepsis, septic shock, bacterial meningitis: high (38-69%)

?SCANCRIT

• ACLS GOES ECMO ? Great case of highlighting how promising the future ECMO is going to be in the?management?of critically ill patients, that previously might have be thought to have non-survivable outcomes.

Emergucate

• Superb review packed full of pearls on?managing?Ludwig?s Angina.?Remember?its a?potentially fatal disease ? can progress to death within hours, usually by sudden asphyxiation

The LITFL Review Shout Out of the Week

iTeachEM

• What is iTeachEM-you ask? iTeachEM is a blog dedicated to the art, science and fun of medical education.
• Who is?iTeachEM?for? iTeachEM is for real world practicing clinicians who love blowing bubbles and want to get better at it!
• And guess who it?s by? EM educator extraordinaire Rob Rogers (@EM_Educator) and his LITFL wingmen Mike and Chris!

?No bubble is so iridescent or floats longer than that blown by the successful teacher.?
? Sir William Osler

Check out these great educational posts from iTeachEM:

Twee Dee and Twitical Care

News from the Fastlane

The Final Words

• You can do anything, but not everything.

?David Allen

• ?Always forgive your enemies; nothing annoys them so much.

  ?Oscar Wilde

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 kane AT lifeinthefastlane.com

LITFL Review EM/CC Educational Social Media Round Up

123Sonography.com???Academic Life in Emergency Medicine???A Life at Risk???All LA Conference???Al Sacchetti?s Youtube???Broome Docs???CCM-L.org???CLIC-EM???Critical Care Perspectives in EM???Dave on Airways??DrGDH???Dr Smith?s ECG Blog???ECG Academy???ED Exam???EDTCC???EKG Videos???EM Basic???EM Core Content???EMCrit???Emergency Medical Abstracts??EMERJENCYWEBB???Emergency Medicine Cases???Emergency Medicine Education???Emergency Medicine News???Emergency Medicine Ireland???Emergency Medicine Updates??Emergucate??EM Literature of Note???empem.org? ??EMpills? ??Emergency Physicians Monthly???EM Lyceum???EMProcedures???EMRAP????EMRAP: Educators? Edition???EMRAP.TV????ER CAST???Free Emergency Medicine Talks???GMEP???Gmergency!????Greater Sydney Area HEMS???HQmeded.com? ??ICU Rounds???Impactednurse???Intensive Care Network??iTeachEM?-?Keeping Up With Emergency Medicine???KeeWeeDoc???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???PHARM???Priceless Electrical Activity???Procedurettes???PulmCCM.org???Resus.com.au???Resus.ME???RESUS Room???Richard Winters? Physician Leadership???SCANCRIT???SCCM Blogs????SCCM Podcast???SEMEP???SinaiEM???SinaiEM Ultrasound????SMART EM?????SonoSpot???StEmylns???Takeokun????The Central Line???The Ember Project???The NNT? ??The Poison Review???The Sharp End???The Short Coat????The Trauma Professional?s Blog???The Underneaths of EM???ToxTalk???TJdogma???Twin Cities Toxicology???Ultrasound Podcast???UMEM Educational Pearls? ??Ultrasound Village

Source: http://lifeinthefastlane.com/2012/08/the-litfl-review-071/

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