LITFL Review 349
Welcome to the 349th 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
The Maryland CC Project shares a lecture from Samuel Tisherman, MD on the work-up and management of the acute abdomen in ICU patients. There is an overview of patient evaluation, classifications of peritonitis and causative microbes, as well as antimicrobial pearls with an emphasis on source control. The lecture ends with the management of abdominal compartment syndrome and the utility/risk of drains and negative pressure vacuum assisted closure. [TCN]
This is incredible! An entirely free handbook on rapid response: managing deteriorating patients has been written and uploaded by experts in the field! [SO]
Another winner from the Maryland CCProject. Listen to this excellent lecture on lung and diaphragmatic ultrasound– one of the best I’ve had the privilege of hearing. [SO]
The Best of #FOAMed Emergency Medicine
- How should we be dosing tPA for PE? Dr. Farkas reviews the literature and offers an answer here. [AJB]
- CanadiEM reviews the scary topic of “how do I manage VTE in pregnancy?” [MG]
- EMCases this week is all about management of the agitated patient, with tips starting from verbal de-escalation, all the way through what meds to dose. [MG]
- The HIGH STEACS trial assessing the utility of high sensitivity troponins, is reviewed by Fraser McGee for The Bottom Line this week. [SO]
The Best of #FOAMcc Critical Care and #FOAMres Resuscitation
- Scott Weingart has updated the Emcrit Airway Algorithm. Check out the vodcast and discussion. [SO]
- The most recent chapter in the Internet Book of Critical Care covers “community-onset pneumonia,”which groups together the current definitions of CAP and HCAP. This chapter details the complexities of pneumonia diagnosis, the value of an accurate history on the selection of empiric antimicrobial therapy, and the resuscitation of patients presenting with pneumonia. [TCN]
- Should we still be using lung recruitment in ARDS patients? Dr Swapnil Pawa discusses this in another excellent lecture from the CICM ASM. [SO]
The Best of #FOAMus Ultrasound
- Less is more on #POCUS sometimes – WES sign for gallbaldder ultrasound explained by @TamingtheSRU team [CMD]
- Watch and learn from this fantastic paediatric IV cannulation video from @RCHMelbourne team [CMD]
The Best of #FOAMpeds Pediatrics
- Ped EM Morsels recently reviewed Local Anesthetic Systemic Toxicity (LAST) and lipid rescue therapy in children. Considerations for selecting long vs. short-acting local anesthetics and the value of calculating doses are provided. Since children are at a greater risk of LAST, it is vital to identify the subtle symptoms and order 20% lipid emulsion as soon as LAST is suspected. [TCN]
- Don’t Forget the Bubbles parses the data from a recent paper that adds to the body of work surrounding the diagnostic dilemma of the otherwise well-appearing febrile infant. The data demonstrated significantly lower rates of serious bacterial infections in febrile infants with a documented viral infection but stressed that bacterial infection cannot be ruled out, especially in infants less than 28 days old. [SN]
- Over at R.E.B.E.L. EM, Rob Bryant walks us through the evidence for sub-code dose epinephrine boluses in pediatric patients with persistent hypotension or bradycardia and the practical implications of implementing this strategy safely at your institution. [SN]
The Best of #MedEd FOAM and #FOAMsim
- Cliff Reid and Brian Burns discuss high performance teams in this lecture recorded at the REPEL course. [SO]
News from the Fast Lane
LITFL Review is upgrading! Hopefully we can turn around the Google EAT protocol issues soon…
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.