LITFL Review 156

Welcome to the 156th 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 chunk of Global FOAM.

The Most Fair Dinkum Ripper Beauts of the Week

Is clot retrieval in ischemic stroke the next development? Caution in allowing one marginally positive study to change practice. Rory Spiegel implores us to study our past mistakes (NINDS-2) so as to avoid repeating them. [AS]

Master your management of status epilepticus with help from this podcast from Oli Flower When the Seizure Doesn’t stop from SMACC. [SL]

The Best of #FOAMed Emergency Medicine

• Looking for a deep dive into the EKG findings associated with subendocardial ischaemia? Check out this case from the EMS 12 Lead blog. For more effective learning, read the original case first. [MG]
• St. Emlyn’s discusses gestalt in Emergency Care and the confusion of the term with Clinical Judgement. [AS]
• Wide complex tachycardia isn’t always ventricular tachycardia. Amal Mattu asks that we consider toxic/metabolic causes when the WCT rate < 120-130 beats per minute and/or the QRS complex is really wide. [AS]
• Cardiac arrest is easy enough to identify when they are brought in by ambulance, but what does an arrest look like if it happens right in front of you? The EMS 12 Lead Blog has collected a number of video clips and cases to show us all the different ways this can present. [MG]
• What is Ludwig’s Angina? Your word association may yell “difficult airway!”, but this post from the Mayo Clinic EM Blog will help you understand what’s really going on. [MG]

The Best of #FOAMcc Critical Care

• Jonathan Downham of criticalcarepractitioner.com has a great review of Paul Marik’s paper on iatrogenic salt water drowning- complete with well-researched references. Have a gander. [SO]
• Do we need to correct the anion gap for albumin concentration?  No, according to this excellent post by Josh Farkas. Dogma successfully lysed. [SO]
• Phillipe Rola discusses two trials of ECMO-CPR in this thoughtful post– the Australian CHEER trial, and a Canadian study by Bernardczyk et al. Both showed remarkably similar outcomes (about 50% survival with CPC 1-2 status). Is this really the future? [SO]
• Don’t give up on patients with epidural hematomas and bilateral fixed and dilated pupils. Cliff discusses a recent article showing that a significant portion of these patients have good outcomes. [AS]
• Master anaphylaxis with an excellent session from SMACC Gold by Rose. [SO]
• Simon Carley, Minh Le Cong, Anthony Delaney, Oli Flower, Jonathan Downham, James Day and LITFL’s own Segun Olusanya sat down to discuss the recent ARISE trial of early goal-directed therapy in sepsis. See the study dissected from EM, PHEM, and ICM points of view. Have a listen!  [SO]

The Best of #FOAMus Ultrasound

• A TED talk on Point of Care Ultrasound? You betcha! Resa Lewiss delivers a talk on the rising relevance of POCUS– TED style. [SO]
• Wonderful tip from the “Lung queen” Vicki Noble on assessing pupillary reflexes in patients who can’t open their eyes- involving ultrasound, obviously. [SO]
• Great case from Ultrasound of the Week involving a young woman, antiphospholipid syndrome, warfarin, and abdominal pain. [SO]
• Ken, Matt and Mike (from the Ultrasound Podcast) investigate the utility of Ultrasound for the diagnosis of AAA. [AS]
• You have a sick patient that concerns you for tamponade, but you can only obtain limited echo views. What do you do? Check out this case at the Ultrasound of the Week. [MG]

The Best of #MedEd FOAM and #FOAMsim

• The KeyLIME podcast discusses the importance of trust in medical education and specifically in Emergency Department trainee education. Great topic for all medical educators. [AS]

LITFL Weekly Review Team

Reference Sources and Reading List

• #FOAMed – #FOAMcc – #FOAMres
• #FOAMped – #FOAMtox – #FOAMus
• #FOAMim – #FOANed