LITFL Review 217

LITFL review

Welcome to the 217th LITFL Review! 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.

The Most Fair Dinkum Ripper Beauts of the Week

resizer

How do we reach deep within to find empathy when we feel at our worst? By remembering the other side of the story, writes Phil Berry in his blog.“The trick at such times is to access the human in ourselves” [SO]

 

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

The Best of #FOAMtox Toxicology

The Best of #FOAMus Ultrasound

The Best of #FOAMped Paediatrics

The Best of #FOAMim Internal Medicine

The Best of #FOANed Nursing

The Best of Medical Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

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Funtabulously Frivolous Friday Five 133

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 133

Question 1

Why do onions make you cry?onion

  • Propanethiol S-oxide
  • When you cut an onion, separate enzymes start mixing and produce propanethiol S-oxide, which is a volatile sulphur compound. The gas that is emitted reacts with the water of your eyes and forms sulphuric acid. The sulphuric acid causes burning sensation in your eyes and in turn leads to the tears glands secreting tears. [Reference]

Question 2

Does a full moon correlate to extreme behavioural disturbances?
moon

  • Yes, according to a study done here in Australia:
  • Of 91 patients with violent and acute behavioural disturbance, 21 (23%) presented during the full moon — double the number for other lunar phases (P = 0.002). Sixty (66%) had either alcohol intoxication or psychostimulant toxicity, and five attacked staff (biting [2], spitting [1], kicking [1] and scratching [1]). In contrast, 512 hospital security calls for patients with less severe behaviour were evenly distributed throughout the lunar cycle. [Reference]

Question 3

What does ‘hampton’s hump‘ represent on a CXR?

  • Refers to a dome-shaped, pleural-based opacification in the lung most commonly due to a pulmonary embolism and lung infarction (See image below – right middle zone on the lateral aspect) [Reference]
  • Other signs include Fleischner sign and Knuckle sign hamptons hump

 

Question 4

Protamine sulphate is used to reverse heparin but where was it originally isolated?

 

Question 5

What is St Anthony’s fire?

  • Erysipelas. 
  • It is an infection of the upper dermis and superficial lymphatics, usually caused by beta-haemolytic group A streptococcus. 
  • Erysipelas is more superficial than cellulitis, and is typically more raised and demarcated. 
  • Or occasionally herpes zoster if you are from Italy or Malta.  [Reference]erysipelas

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TechTool Thursday 066 MAP+EM

TechTool review – MAP+EM by Eola Holdings on iOS and Android

MAP+EM (Manage and Prescribe Emergency Medicine) aims to deliver your local hospital guidelines and prescribing policies in one easy-to-find place on your phone. It has been developed by three junior doctors in the UK.

Website: – iTunes – Google Play – Website

Design

Their website is lovely for a start, and gives a really clear overview of their aims and what the app offers. I don’t normally comment on app names, but I’m not sure why they chose the name MAP+EM. Their guidelines are for the whole hospital, not just the Emergency Department, so the name seems to unnecessarily limit their market. And the plus in the middle of the name is confusing. They will find it very difficult to be searched on Google.

The app design is nice and clean. It has a good colour scheme and is easy to navigate. The guidelines can be downloaded on your mobile, so no internet connection will be needed to use it.

User Interface

iphone1

iphone2

mapem android 1

mapem android 2

Clinical Content

The content will be determined by your hospital but can include:

  • Treatment guidelines
  • Prescribing guidelines and doses
  • Pagers/hospital contact numbers
  • Calculators
  • Details about teaching/conferences.

How much does it cost?

  • FREE
  • The app is free for doctors to use.
  • Currently hospitals can use it for free, but clearly that’s not a sustainable business model, so I guess they may have to charge hospitals at some point

Room for improvement

  • The treatment guidelines have yellow highlighted sections for the drug dosing – it cheapens the look and is distracting. There is other bizarre highlighting going on throughout that should be removed
  • The giant red exclamation mark in the bottom right of every screen (disclaimer) is unnecessary – we should be able to accept the disclaimer and then get rid of it
  • A name change would help make their aims clearer and also improve online searchability

What’s the overall verdict?

  • This app solves two of the problems that most annoy me as a hospital worker – access to treatment guidelines and contact numbers.
  • The number of hours wasted trying to locate pager numbers and find guidelines must be costing the public health system a fortune.
  • There are other apps that do this, but MAP+EM is one of the best-looking and best-designed ones I’ve seen. I hope the developers can persuade hospitals to use this as it would benefit us all

The post TechTool Thursday 066 MAP+EM appeared first on LITFL: Life in the Fast Lane Medical Blog.

Research and Reviews in the Fastlane 119

Research and Reviews in the Fastlane

Welcome to the 119th edition 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 5 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

Retrieval, prehospital and disasterR&R Hall of Famer - You simply MUST READ this!

 

Böttiger et al. Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis. Crit Care 2016. PMID 26747085

  • The never ending battle between EMS physians and paramedics rages on. In this meta analysis based on 14 studies and a huge number of patients (126829) the authors suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes. Although meta analysis are only as good as the data allows, and in this meta analysis no RCTs where included (as they do not exist), this represents the best evidence available.
  • Recommended by: Soren Rudolph

Best of the Rest

Resuscitation

Grant S et al. Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emerg Med Australas 2016. PMID 26764895

  • It’s widely accepted that aggressive pre-oxygenation prior to RSI decreases the risk of intra- and post- procedure hypoxia but what is the optimal method? These authors discuss their approach to ventilator assisted non-invasive pre-oxygenation.The strength of this article is in the detailed explanation of the logistics of applying this intervention. A great primer to adding non-invasive ventilation to your pre-oxygenation approach.
  • Recommended by: Anand Swaminathan

Critical care

Nehme Z et al. Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction. Heart 2016. PMID 26740484

  • More on the potential harm from supplemental oxygen in MI patients. This study examines the dose-relationship of oxygen therapy and infarct size assess by biomarkers. Excluding hypoxic patients and those with cardiogenic shocks 441 patients with STEMI were randomized to oxygen or room air. Every 100 L increase in oxygen exposure in the first 12 h was associated with significantly increased cTnI and CK of 1,4% and 1,2% respectively.
    As the median supplemental oxygen exposure was 1746 L this would result in a 21% increase in infarct size.
  • Recommended by: Soren Rudolph

Quirky, weird and wonderful

R&R WTF Weird, transcendent or funtabulous!” width=Wood CD et al. Evaluation of sixteen anti-motion sickness drugs under controlled laboratory conditions. Aerosp Med. 1968;39(12):1341-4. PMID 4881887

  • When NASA spun astronauts around to induce motion sickness, amphetamines and scopolamine were the best at preventing nausea. Promethazine was pretty good, but meclizine was surprisingly bad.
  • Recommended by: Ryan Radecki

Toxicology
Zuckerman M et al. A review of the toxicologic implications of obesity. J Med Toxicol 2015:11: 342-354. PMID 26108709

  • The management of drug overdose in the setting of obesity is complicated by alterations in physiology, pharmacokinetics and comorbidities, potentially placing this patient population at increased risk of drug-related death. This article provides an excellent in-depth dive into these factors and discusses alterations in utilization and dosing of antidotes. Importantly, the authors highlight an overdue need for inclusion of obese subjects in clinical research to better understand drug toxicity in this growing patient population.
  • Recommended by: Meghan Spyres

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’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

 

 

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LITFL Review 216

LITFL review

Welcome to the 216th LITFL Review! 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.

The Most Fair Dinkum Ripper Beauts of the Week

resizerAll the talks from the recent UK Intensive Care Society Conference State of the Art Conference have been made freely and open accessible via the web site or by subscription via iTunes. A true smorgasboard of intensive care content, and enough to keep us all busy for a while, A fantastic resource! [SL/SO]

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

The Best of #FOAMtox Toxicology

The Best of #FOAMus Ultrasound

The Best of #FOAMped Paediatrics

  • Damian Roland this week reminds us that distraction is a powerful tool, especially in paediatric pain, and calls on us all to remember as calm as we are, is as calm as they’ll be.  [CC]

The Best of #FOAMim Internal Medicine


News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

The post LITFL Review 216 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Funtabulously Frivolous Friday Five 132

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old-fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 132

Question 1

What is the Asboe-Hansen sign, seen in toxic epidermal necrolysis (TEN)?

  • The Asboe-Hansen sign (also known as “indirect Nikolsky sign”or “Nikolsky II sign”) refers to the extension of a blister to adjacent unblistered skin when pressure is put on the top of the bulla. [Reference]
  • Nikolsky commonly occurs with Steven’s Johnson Syndrome, Staphylococcal Scolded Skin Syndrome, TEN and Pemphigus vulgarise.

Question 2

Why do germs seem to spread in winter?man-flu

  • Drier air. 
  • Lab experiments have looked at the way flu spreads among groups of guinea pigs. In moister air, the epidemic struggles to build momentum, whereas in drier conditions it spreads like wildfire. [Reference]

Question 3

What eponymous fractures cause a Dish-face sign?

    • Le Fort II and III [Reference]
    • See pictures below for Le Fort I, II and III

LeFort1 LeFort2 LeFort3

Question 4

Pterygium is the Greek for what?pterygium

  • A Little Wing 
  • Sometimes referred to as a bat’s wing but any small winged creature will do. [Reference]

Question 5

And finally the answer to the great modern medicine dilemma…. Is it less painful to remove a plaster slowly or fast?

  • Fast
  • What is truly great about this study is the use of a pain scale out of 11 (its always an 11 in real life) and the use of medical students. If you don’t believe the answer then utilise your own students. [Reference]

The post Funtabulously Frivolous Friday Five 132 appeared first on LITFL: Life in the Fast Lane Medical Blog.