The LITFL Review 146

LITFL review

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.

Welcome to the 146th edition, brought to you by:

The Most Fair Dinkum Ripper Beaut of the Week

resizerBrilliant new series from Academic Life in Emergency Medicine highlights how successful people in EM work smarter. Posts from Michelle Lin, Victoria Brazil and Esther Choo. [AS] Want a simple, awesome and comprehensive guideline?…Check out these Guidelines for Paediatric Concussion [KG]

The Best of #FOAMed Emergency Medicine

  • Computers can’t be trusted to do simple calculations . . . at least not when it comes to the QTc duration. Stephen Smith discusses in a case of syncope and bradycardia. [AS]
  • With changeover of junior doctor’s looming in the UK, the EmergencyPedia team set out 10 fundamentals of how to impress in the Emergency Department. [SL]
  • Wonder how accurate your respiratory diagnoses are in the ED? The St.Emlyns team discuss potential to improve our practice following a recent publication on point of care ultrasound for the breathless patient. [SL]
  • A pharmaceutical company (Boehringer Ingelheim) suppressed data? Inconceivable! If you’ve fallen behind on the dabigitran controversy, Ryan Radecki gives a short commentary on the situation. [AS]
  • New LBBB = STEMI? Not always. New LBBB with > 5 mm discordant ST elevation = STEMI? Nope. Great case from Stephen Smith highlighting the fact that ST segment elevation increases with tachycardia and the importance of STE-S wave ratio. [AS]

The Best of #FOAMcc Critical Care

  • How should we care for the sick and trying to die pregnant patient? Haney Mallemat discusses the Critical Pregnant Patient on the All NYC EM Podcast. [AS]
  • More greatness from SMACC Gold: Scott Weingart weighs talks on Sepsis in New York:  Our first 15,000 patients, while Mark Wilson talks on Monroe Kellie 2.0. [SO]
  • Interested in ICU physiology, particularly heart-lung interactions? Jon-Emile Kenny from Vancouver has an excellent set of animated lectures at www.heart-lung.org. Check them out! [SO]
  • Trans-oesophageal echo. It’s complicated, bulky, and outside the remit of point-of-care use for resuscitationists. Or is it? Matt and Mike from the Ultrasound Podcast present a lecture on POC TEE/TOE by Rob Arntfeld: Part 1 & Part 2 [SO]

#FOAMPed Paediatrics

  • Sean Fox at PED EM Morsels reviews delayed diagnosis of foreign bodies. It might be just a cough, but consider asking about that peanut they choked on six months ago…. [TRD]
  • Don’t Forget the Bubbles reviews a recent paper on ketamine dosing in obese adolescents – are we giving them too much? [TRD]
  • Is loss of consciousness useful in determining which kids with minor head trauma need a head CT? Rory Spiegel delves into the PECARN data and discusses its limitations. [AS]
  • Kids are just little adults. At least when it comes to the first hour of sepsis management, Simon Carley argues to think of kids as little adults to prevent the paralysis induced fear that EM physicians who rarely treat kids can feel. [AS]

The Best of #FOAMTox Toxicology

  • Poisoned patients…….the next group of ED patients to benefit from the bedside US?  Dr Leon Gussow discusses the use of POCUS for the poisoned.  [CC]

News from the Fast Lane

  • Michelle is back with her masterful writing skills with a look at Nothing New Under the Sun….Will have you thinking and questioning your own small world! [KG]

Reference Sources and Reading List

 

The post The LITFL Review 146 appeared first on LITFL.

Research and Reviews in the Fastlane 041

Research and Reviews in the Fastlane

Welcome to the 41stedition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

Ultrasound, Pulmonary, CardiologyR&R Hall of Famer Blue

Laursen CB, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomized controlled trial. The Lancet Respiratory Medicine – July 2014 PMID: 24998674

  • One of the first RCTs examining the utility of POCUS for ED patients presenting with dyspnea. Using a POCUS protocol performed by a single experienced provider, examining the heart, lungs, and deep veins of the LE, authors found significant improvement in their primary endpoint – the rate of correct diagnoses made at 4 hours. Though promising, these benefits did not translate into improvements in hospital or 30 day mortality, length of stay or hospital free days. Furthermore there was a significant increase in downstream testing in patients randomized to the POCUS group indicating there may be a degree of over-diagnosis that occurs with the introduction of such a protocol. (Rory Spiegel)
  • This is further evidence that POCUS of the chest may be of benefit in the ED. However, although this is an RCT there are some significant biases within it. Whilst I personally agree with the results and in all honesty I wish them to be true, there is not evidence here to firmly change practice. For me I would like to see more studies using a broader population base, multiple USS operators and larger numbers. (Simon Carley)
  • Recommended by: Rory Spiegel, Simon Carley
  • Read More: POCUS for the Breathless Patient (St. Emlyn’s) and ED Hocus POCUS . . . or Just a Hoax (EM Literature of Note)

The Best of the Rest

Emergency Medicine,RespiratoryR&R Game Changer? Might change your clinical practice

Righini M et al.Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study.JAMA. 2014 Mar 19;311(11):1117-24. PubMed PMID: 24643601. [JAMA Full Text]

  • This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values?
  • Recommended by: Jerremy Fried
  • Read More: Age Adjusted D-Dimer Testing (REBEL EM)

Trauma, Resuscitation

R&R Game Changer? Might change your clinical practice

Harvey V, Perrone J, Kim P.Does the Use of Tranexamic Acid Improve Trauma Mortality? Ann Emerg Med 2014; 63(4):460-462. PMID 24095056 [Annals Full Text]

  • This is a review of the literature regarding tranexamic acid use in traumatic hemorrhage showing that tranexamic acid significantly decrease mortality in bleeding trauma patients, without significantly increasing serious prothrombotic complications if administered within 3 hours of injury. There is, however, no evidence of benefit in patients with traumatic brain injury. The authors recommend early treatment with tranexamic acid in trauma patients without isolated brain injuries who have or are at risk for significant hemorrhage and in patients who receive resuscitation with blood products, particularly if they require massive transfusion or have a high risk of death at baseline.
  • Recommended by: Anand Swaminathan

Critical Care, Pediatrics

R&R Game Changer? Might change your clinical practice

Kelleher DC et al.Factors affecting team size and task performance in pediatric trauma resuscitation. Pediatr Emerg Care. 2014 Apr;30(4):248-53. PMID 24651216

  • This study investigates factors associated with varying team size and task completion during trauma resuscitation. Video of 201 pediatric trauma resuscitations were reviewed and task completion was then analyzed in relation to team size using best-fit curves. Having 7 people at the bedside during a pediatric trauma resuscitation was optimal in patient management. Beyond this number, the investigators saw diminishing returns.
  • Recommended by: Cliff Reid
  • Read More: Resus Team Size and Productivity (Resus.Me)

Resuscitation, Renal

R&R Game Changer? Might change your clinical practice

Allon M et al.Effect of bicarbonate administration on plasma potassium in dialysis patients: interactions with insulin and albuterol. Am J Kidney Dis. 1996 Oct;28(4):508-14. PMID: 8840939 [AJKD Full Text]

  • This is the paper that should have pushed people away from using bicarb in hyperkalemia, or at least started them towards researching it. Whereas insulin and albuterol are effective temporizing measures to shift potassium rapidly from the extracellular to the intracellular fluid compartments and thereby lowering plasma potassium acutely, bicarbonate by itself is not. But bicarbonate is believed to have a potentiating effect on albuterol and insulin. Using a prospective cross-over design, 6 treatment protocols combining bicarbonate, albuterol, insulin and saline respectively were investigated for acute effects on plasma potassium as well as blood bicarbonate and pH in nondiabetic hemodialysis patients. The resulst observations suggest that bicarbonate administration does not potentiate the potassium-lowering effects of insulin or albuterol in this patient population.
  • Recommended by: Justin Hensley

Pediatrics, Haematology

R&R Eureka

Singleton T et al.Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010 Aug;39(2):158-65. PMID: 18757163 [JEM Full Text]

  • Heriditary bleeding disorders are reletively rare and most often are treated in out-patients-clinics. Emergency physicians rarely encounter them with the potiential for delays in diagnosis and administration of replacement therapy. In this great review of ED evaluation and management of hemophilia and Von Willebrand disease to outline some of the issues facing emergency physicians and the options available for the treatment of these patients.
  • Recommended by: Sean Fox

Wilderness Medicine, Pediatrics

R&R Landmark

Hwang V et al.Prevalence of traumatic injuries in drowning and near drowning in children and adolescents. Arch Pediatr Adolesc Med. 2003 Jan;157(1):50-3. PMID: 12517194 [JAMA Full text]

  • In this ten-year retrospective review of pediatric drowning and near drowning the prevalence of traumatic injury was low. In fact the authors only identified cervical spine injuries, and all but 1 patient had a clear history of diving. Use of specialized trauma evaluations may not be warranted for patients in drowning and near-drowning accidents without a clear history of traumatic mechanism. So not all submersion victims are trauma victims! If they are not a trauma victim, then do you and the patient a favor and remove the C-Collar.
  • Recommended by: Sean Fox

Trauma, Neurology, Neurosurgery

R&R Hot Stuff

Nishijima DK et al. Utility of platelet transfusion in adult patients with traumatic intracranial hemorrhage and preinjury antiplatelet use: A systematic review. J Trauma Acute Care Surg: 2012;72:1658Y1663. PMID 22695437

  • Preinjury use of antiplatelet agents (i.e. aspirin, clopidogrel) is common. Patients with ICH on these agents have higher morbidity and mortality. this systematic review reveals the lack of evidence to support or refute the utility of platelet transfusion in these patients. Physicians must weight the risks and benefits of a platelet transfusion in patients on antiplatelet agents who present with traumatic ICH.
  • Recommended by: Anand Swaminathan

Toxicology, Resuscitation

R&R Game Changer? Might change your clinical practice

Dries DJ and Endorf FW.Inhalation injury: epidemiology, pathology, treatment strategies. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:31 .PMID 23597126

  • Relatively few diagnosis-specific therapeutic options have been identified for patients with inhalation injury or chemical products of combustion. In this paper, pathophysiology current treatment strategies and medical strategies under investigation for specific treatment of smoke inhalation (beta-agonists, pulmonary blood flow modifiers, anticoagulants and anti-inflammatory strategies) are reviewed
  • Recommended by: Soren Steemann Rudolph

Emergency Medicine, Resuscitation

R&R Eureka

Shokoohi H et al.Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients. Ann Emerg Med. 2013 Feb;61(2):198-203. PMID 23141920 [Annals Full Text]

  • A well-instituted US-guided peripheral IV program will indeed decrease rates of central line insertion. Among of 401,532 patients, 1,583 (0.39%) received a central venous catheter. During a 5-year study period the rate of central line placement decreased by 80% The decrease in the rate was significantly greater among non-critically ill patients than critically ill patients. Not groundbreaking but nice to have some solid evidence.
  • Recommended by: Seth Trueger

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’sR&R in the FASTLANEor if you want to tell us whatyouthink is worth reading.

The post Research and Reviews in the Fastlane 041 appeared first on LITFL.

Pressure volume loop of the left ventricle

Basic Science in Clinical Context (BSCC) videos will be 2minutes long and in 2 parts.

  • Exam candidate answering a question (under exam conditions)
  • Professor providing a more detailed explanation (with transcript)

Below is an example of the process. Feedback greatly appreciated as we are still very early in the production phase of the project.

Question:

Please draw and describe the pressure volume loop of the left ventricle

Examinee response

Examiner explanation:

Pressure volume loop diagram

  • This pressure volume loop diagram represents the 5 phases of the cardiac cycle.
  • It makes more sense to start at the end of stage 4 of the cardiac cycle: isovolumetric relaxation and beginning of stage 5- ventricular diastole.
  • At this point, the end systolic volume of the LV is +- 50ml.
  • LV diastole begins, stage five of the cardiac cycle. This phase allows the ventricle to fill. Remember that atrial systole or phase 1 of the cardiac cycle occurs late in diastole and propels some additional blood into the ventricles-allowing the volume in the LV to reach around 130ml (this is the LV end diastolic volume)
  • At point “a” is when ventricular diastole ends, the mitral valve closes and phase 2 of the cardiac cycle or isovolumetric contraction begins.
  • At point “b”, the pressure in the left ventricle rises above the pressure in the aorta causing the aortic valve to open. Now begins phase 3 of the CC- ventricular systole. 70-90ml (80ml) of blood is ejected into the aorta. This is stroke volume.
  • At point “c” the pressure in the LV drops below that of the aorta and the aortic valve closes. The remaining volume/the end systolic volume in the LV is around 50 ml.
  • This allows you to work out the ejection fraction of the LV: 80/130=62%.
  • Now phase 4 of the cardiac cycle begins:  isovolumetric relaxation.
  • The pressure in the LV drops to below that of atrial pressure. Phase 4 ends and Phase 5 begins again.
  • Some pressure volume loop diagrams describe an additional line. This line represents the end systolic pressure volume relationship. (ESPVR). It is the maximal pressure that can develop by the left ventricle at any given LV volume.
  • This line becomes steeper/shifts left as inotropy/contraction increases and will flatten as inotropy/contraction decreases.

The post Pressure volume loop of the left ventricle appeared first on LITFL.

Basic Science in Clinical Context (BSCC)

We leave medical school liberated.

Free to insouciantly frolic through remedy meadows and deprecate nostrum – impassioned with the heady erudition of establishment edification.

Free from the trammels of institutional learning we throw off the shackles of theoretical knowledge and plunge into the limpid pools of practical skill acquisition.

In general we are blissfully unaware of the insidious but exponential decay of our theoretical knowledge as we enthusiastically acquire practical life skills. We are even less aware that on at least two occasions in the ensuing 10 years our cerebrum will be galvanised back into action to thwart the examination Leviathan.

LITFL is producing a series of asynchronous learning videos combining basic science knowledge with clinical context application (BSCC) to reduce the rate of theoretical knowledge decay, improve the sanity of trainees and reduce the examination induced divorce rate.

We are not looking to reinvent the wheel but be synergistic with the programmes already produced such as Anatomy for Emergency Medicine (AFEM) by Andy Neill.

As LITFL authors have the attention span of intoxicated decorticate gnats, we will limit our presentations to 120 seconds each. We record an exam candidate answering a question (under exam conditions) and then record the professor providing a more detailed explanation (with transcript)

Below is an example of the process. Feedback greatly appreciated as we are still very early in the production phase of the project.

Question:

Please draw and describe the pressure volume loop of the left ventricle

Examinee response

Examiner explanation:

Pressure volume loop diagram

  • This pressure volume loop diagram represents the 5 phases of the cardiac cycle (CC).
  • It makes more sense to start at the end of stage 4 of the CC-isovolumetric relaxation and beginning of stage 5- ventricular diastole.
  • At this point, the end systolic volume of the LV is +- 50ml.
  • LV diastole begins, stage five of the CC. This phase allows the ventricle to fill. Remember that atrial systole or phase 1 of the CC occurs late in diastole and propels some additional blood into the ventricles-allowing the volume in the LV to reach around 130ml (this is the LV end diastolic volume)
  • At point “a” is when ventricular diastole ends, the mitral valve closes and phase 2 (of the CC or isovolumetric contraction begins.
  • At point “b”, the pressure in the left ventricle rises above the pressure in the aorta causing the aortic valve to open. Now begins phase 3 of the CC- ventricular systole. 70-90ml (80ml) of blood is ejected into the aorta. This is stroke volume.
  • At point “c” the pressure in the LV drops below that of the aorta and the aortic valve closes. The remaining volume/the end systolic volume in the LV is around 50 ml.
  • This allows you to work out the ejection fraction of the LV: 80/130=62%.
  • Now phase 4 of the CC begins-isovolumetric relaxation.
  • The pressure in the LV drops to below that of atrial pressure. Phase 4 ends and Phase 5 begins again.
  • Some pressure volume loop diagrams describe an additional line. This line represents the end systolic pressure volume relationship. (ESPVR). It is the maximal pressure that can develop by the left ventricle at any given LV volume.
  • This line becomes steeper/shifts left as inotropy/contraction increases and will flatten as inotropy/contraction decreases.

The post Basic Science in Clinical Context (BSCC) appeared first on LITFL.

Nothing New Under the Sun

The World still hurts.

Considering current global events our planet seems a panoply of despair, a train wreck of evil choices. We feel wounded, flabby and impotent, and we struggle to understand. We look for answers as to how we can make things better, both on a global scale, and in our own back yards. One of the solutions, of course, is right, myopically, in front of us, and is an echoing sentiment that can be heard from the moment man first began to document history.

If you look carefully, if you take the time, you can see a gossamer thin strand, lacing and linking through the past. Woven throughout the ages of human history, in amongst the warp of the words of great and influential figures and the weft of fiction, is this thread; a sentiment that keeps glinting its colour and its disposition, time and time again.

We occasionally read, listen, perhaps nod in agreement, but how often do we take the time to reflect upon it? A luminous little thought, a meditation clarified over centuries, staying no less relevant now than when it was first recorded on paper. The thought goes something like this –

the mark of a truly civilised human is the way that they treat those inferior to them’

It only finds its way onto the virtual pages of Life in the Fast Lane, because here we are the repository for many of the happenings in the critical care world, a sort of thermomix for ideas, and we like to occasionally step tentatively into the hall of mirrors, and take a piercing look at the people we are, and the attitudes we bear along with us. How do we, as individuals, treat those who are not as strong as us, who are weaker, or somehow positioned downwind on the social pecking order? Our Emergency Departments are seething with people, many of whom are less fortunate, in lesser jobs, sometimes even desperate individuals, jobless, luckless, the drug-addicted and the lost. And an even subtler phenomenon, how do we interact with some of the patients with chronic illnesses, such as obesity? Do they fall under the umbrella of what the modern philosopher Jean Harvey characterises as ‘civilised oppression’?

Moreover, how do we conduct ourselves with those whose roles are perhaps perceived to be subordinate to ours? There would be little argument that the world of critical care is evolving in an admirably egalitarian way, however there are still countless episodes, everyday, where somebody less knowledgeable is belittled, one of the cogs of the working machinery of healthcare is ignored, we diminish the opinions of others through the ether, or we simply lash out at those most easily wounded, as a response to a dwindling level of respect laid out for us by our own managerial types. View the unfortunate occasional interactions between specialty teams and junior doctors, phone answering ED consultants to junior staff trying to send patients in from elsewhere, or even the way we listen to a handover.

And also, as an aside, this concept IS the solution to world peace, but let us not digress into trivialities here.

However this little piece is not a conveyance for my opinions, it is a chance to reconnoiter this singular notion, voiced by a good many figures who knew a thing or two about the inner workings of humanity, lain down repetitively like a palimpsest. So we should hear from just a few of them:

Seneca (the Younger) – Rome’s leading intellectual in the first century of the Common Era. A Stoic, a humourist, a statesman and a dramatist.

There is a proverb: ‘You have as many enemies as you have slaves.’ But in truth we make them our enemies. We abuse them as if they were beasts of burden. When we recline for dinner, one wipes our spittle, another picks up the scraps and crumbs thrown down by drunkards. The point of my argument is this. ‘Treat your inferior as you would like to be treated’”.

The Earl of Chesterfield, (Philip Stanhope), statesman and essayist, in published letters to his son (1748)

‘The characteristic of a well-bred man is, to converse with his inferiors without insolence, and with his superiors with respect, and with ease.’

Samuel Johnson – lexicographer, poet and essayist says it thus

The true measure of a man is how he treats someone who can do him absolutely no good.’

In 1910, the Rev. Charles Bayard Miliken, of the Methodist Episcopal Church, Chicago

It is the way one treats his inferiors more than the way he treats his equals which reveals one’s real character.’

Sirius Black, a brave, clever and energetic pure blood wizard (according to Albus Dumbledore), misunderstood for many years, and who received the education of life in Azkaban

If you want to know what a man’s like, take a good look at how he treats his inferiors, not his equals.’

Repeatedly and anew, we are reminded of what can make us rise up over effrontery, over our mediocrity, our incivility, and sit lightly upon the heavy dark mass of society. Every interaction we have with another human, on this vast concatenated web of a life we lead, is an opportunity to improve our measure as a civilised being, and thus improve it, in some inestimable way. It’s not always easy, but the opportunities are there, every single day of our interacted lives.

Simplistic? Yes. Moralistic? Yes. But an incontrovertible truth? Yes.

And although this was written to give you a moment’s fleeting reflection, we shall now allow the filmy nature of the words to pop and dissipate, and let’s have a little fun, inviting our quoted people of today to a dinner party, sit them down, and ask them to expound one of their lesser known quotations, for the amusement of us all back here in reality. (I didn’t invite the Reverend, not really knowing him, and not sure he’d approve of the company)

Seneca, what is your opinion on bathhouses?

“I would die if silence were as necessary to study as they say. I live just above the bath house.”

“Consider all the hateful voices I hear! When the brawny men exercise with their lead weights, I hear their groans and gasps. Or when someone else comes in to get a vulgar massage: I hear the slap of a hand on his shoulders. Add those who leap into the pool with a huge splash. Beside these, who at least have normal voices, consider the hair plucker, always screeching for customers, and never quiet except when he’s making someone else cry.”  

Earl Chesterfield, how do you perceive of marriage?

‘Marriage is the cure of love, and friendship the cure of marriage.’

Oh, I see.

Samuel Johnson, another drink?

‘One of the disadvantages of wine is that it makes a man mistake words for thoughts.’ 

Sirius, the others at the table here have been rather flippant.  Do you have any closing remarks?

“We’ve all got both light and dark inside of us. What matters is the part we choose to act on. That’s who we really are.” 

Well at least somebody can take this post seriously.

The sentiment remains, however, that the only way to better the microcosm of your small world, as well as this planet Earth, as it stands, is to treat every individual, no matter their station, with respect.

 

Carry on the #FOAMlove.

The post Nothing New Under the Sun appeared first on LITFL.

The LITFL Review 145

LITFL review

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.

Welcome to the 145th edition, brought to you by:

The Most Fair Dinkum Ripper Beaut of the Week

resizerThe Ripper award this week heads over to INTENSIVE’s Steve McGloughlin who gave a fascinating infectious diseases talk at smaccGOLD on the The Dying Traveller – a must listen. [KG, CN]

The Best of #FOAMed Emergency Medicine

  • Ryan Radecki explains the difference between can and should in discussing the use of absorbable sutures for extremity and trunk lacerations [AS]
  • What’s better than an ECG? Serial ECGs, of course. Amal Mattu discusses the importance of serial ECGs in patients with ongoing or changing symptoms. [AS]
  • Chicken or the Egg?  Did the altered mental status result from the trauma or did the trauma result from the altered mental status. Amal Mattu reviews a great trauma ECG teasing out a medical cause of trauma. [AS]
  • Lauren Westafer offers a different set of ABCs in her blog post covering the basics of End of Life Care in the ED. The post also has a great lecture with audio and screen capture of slides to check out. [AS]

The Best of #FOAMcc Critical Care

  • By now you have no excuse to not have a free subscription to Rob MacSweeney’s Critical Care Reviews Newsletter rounding the week’s medical literature – FOAMcc at its best. [CN]
  • EDECMO Episode 11 – The Paris ECMO Course: Scott talks to Joe Belezzo and shares some insights from the Paris ECMO course. Fascinating stuff, though lot’s of differences from how we intensivist-led peripheral ECMO cannulation at The Alfred. Food for thought! [CN]

The Best of #FOAMTox Toxicology

  • Leon Gussow reviews a recent paper detailing two cases of patients presenting post-ingestion of laboratory-proven 25B-NBOMe and 25C-NBOMe toxicity. Marketed as ‘synthetic LSD’, this drug is definitely not LSD [JAR]
  • When is too much caffeine too much? Leon discusses an interesting case series discussing deaths where caffeine has been implicated. Not quite what the title reports but interesting read [JAR]
  • The latest episode of Toxtalk is out with this episodes discussing mustard toxicity- not the type that goes with a hot dog or a nice porterhouse steak! [JAR]
  • Ever heard of guanfacine? This extended-release, clonidine-like drug used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) has the potential to cause significant sedation even with low doses. Leon discusses at The Poison Review [JAR]
  • Want to brush up on cannabinoid hyperemesis syndrome? Leon discusses a recent review that’s worth looking at [JAR]

#MedEd Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

 

The post The LITFL Review 145 appeared first on LITFL.