LITFL Review 324

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Welcome to the 324th 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

Nice discussion by Josh Farkas on when you should consider letting major secondary endpoints affect your management decisions in your patients and when you should think about them being hypothesis generating only. [SR]


The Best of #FOAMed Emergency Medicine

Theresa Kim-Chi discusses a can’t-miss diagnosis: euglycemic DKA from SGLT2 Inhibitor medications used in managing diabetes mellitus.  Treatment is essentially the same as DKA, with the exception of the type of fluid you use. The key is to keep this diagnosis in your differential. [SR]

Excellent, concise review of pre-eclampsia–identification, management and expert pearls. [AS]

Ryan Radecki analyzes a recent paper on how many patients with acute stroke presenting within 6 – 24 hours will actually meet DAWN and DEFUSE-3 criteria for endovascular stroke therapy. [SR]

Justin Morgenstern and Casey Parker are back at it again with their First10EM Journal Club: March 2018. Topics include: which chest pain patients need cardiac monitoring; CCTA vs standard care in chest pain; nebulized furosemide; use of bougie & first pass intubation; head CTs prior to LPs; PO vs IV antibiotics for cellulitis; plus much more greatness. [SR]

Do we need to get an EKG prior to giving odansetron? Bryan Hayes reviews the literature and concludes that while QTc prolongation is real, it’s unlikely to have clinical meaningfulness. [AS]

D-dimer is notoriously difficult to interpret in pregnancy, but a new trial may shed some light on the subject. Read REBEL EMs review of the DiPEP study. [MG]

Lewis Leads to the rescue! Another example of how this simple technique can alter your management. [MMS]

FOAMcast gives a great review of critical appraisals on the top articles from 2017 that got people talking. [MMS]


The Best of #FOAMcc Critical Care and #FOAMres Resuscitation

The Maryland CCproject discuss the care of the critically ill burns patient. Thanks, Dr Chung. [SO]

Here’s a review of post-intubation hypotension with a handy (and slightly rude) mnemonic to make the causes memorable. [SO]

Does low dose dexmedetomidine at night affect delirium? Imelda Gavin expertly reviews a paper on this for The Bottom Line. [SO]


The Best of #FOAMus Ultrasound

Basic Cardiac ECHO skills by @ultrasoundjelly [CMD, SR]

Evaluation of Pediatric Neck Masses with @eusmd [JSh]

The amazing team from Ultrasound Training Solutions are releasing their talks from SonoAus18 to the FOAMiverse. First up is Arun Nagdev on some useful but obscure nerve blocks, and Chris Fox discusses some mistakes when scanning for ectopic pregnancies. [LP]

The final edition (Part 3) from Ultrasound GEL.org’s special edition POCUS crit care mini series in Dublin, As provided in the last 2 week, here’s Part 1 & Part 2. [LP]


The Best of #FOAMpeds Pediatrics

Bronchiolitis season is mercifully ending in the northern hemisphere, but below the equator it’s only just beginning. Ben Lawton reviews the recent PARIS trial published in NEJM examining Optiflow (HFNC) in infants with bronchiolitis. Before putting all your bronchiolitics on HFNC, however, consider the value of surrogate endpoints. [RP, SR]

Treating acute pain in children? Know the child, know the family and know the physiology. Latest chapter from Management of Pain and Procedural Sedation in Acute Care, an open access, online textbook. [MMS]


The Best of #FOAMtox Toxicology

Loperamide isn’t a new drug, but it’s only recently become a drug of abuse. Learn all about Loperamide toxicity at emDoc’s TOXCard. [MG]


The Best of #FOAMim Internal Medicine

Dr. Brittany Chapman gives an incredibly informative talk about patients with epilepsy and special considerations in women at Louisville Lectures. [RP]


The Best of #MedEd FOAM and #FOAMsim

Mike Lauria and Scott Weingart discuss just-in-time performance-enhancing psychological skills (PEPS).  Beat The Stress Fool…Breathe, Talk, See, and Focus. [SR, AS]

Great panel post from the Don’t Forget the Bubbles team and Tessa Davis on rudeness.  Take a deep breath, choose your words wisely, reframe your responses to focus on the patient, talk to friends/colleagues, and finally, always look out for your colleagues (don’t just be a bystander). [SR, RP]

“We are the specialists who still live up to the essay we wrote for medical school.” Don’t miss this collective wisdom on the future of emergency medicine by Judd Hollander at emDOCs.net. [RP]

What motivates good teaching? “Simply put, faculty who teach because they enjoy and value it tend to teach in the most effective ways.” [MMS]

The importance of having “Untouchable Days” every week and how it can impact your productivity & wellness. [MMS]

In the ongoing quest to become a better educator, CORE EM goes over a 8 step process for building better presentations for our learners. [MMS]


LITFL Weekly Review Team

LITFL RV brought to you by:

Anand Swaminathan [AS] (EM:RAP, Core EM,REBEL EM and The Teaching Institute)
Andrew J. Bowman [AJB]
Bruno Tomazini [BT] (ICURevisited)
Chris Connolly [CC] (RCEMFOAMed, FOAMShED)
Chris Nickson [CN] (RAGE, INTENSIVE and SMACC)
Cian McDermott [CMD] (POCUS Geelong, SMACC)
Craig Wylie [CW] (BadEM)
Jeffrey Shih [JSh](ALiEM)
Luke Phillips [LP] (POCUS Geelong)
Manpreet ‘Manny’ Singh [MMS] (emDOCs.net)
Marjorie Lazoff [ML] (TandemHealth)
Mat Goebel [MG]
Matt Siuba [MS]
Philippe Rola [PR] (Thinkingcriticalcare)
Rick Pescatore [RP] (EM News UC:RAP)
Sarah Newman [SN]
Salim Rezaie [SR] (REBEL EM, The Teaching Institute)
Segun Olusanya [SO] (JICSCast, The Bottom Line)
Thomas C. Neal [TCN]


Reference Sources and Reading List


LITFL Review

#FOAMed Updates

Marjorie Lazoff, MD FACP. Board certified internist with clinical background in academic emergency medicine, currently the founder of The Healing Red Pen, an editorial consulting company. Dr Lazoff is a full-time editor and strong supporter of FOAMed.

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