Welcome to the 353rd 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

Fantastic analysis by Josh Farkas on the results of the FLORALI and HIGH Trials.  Although, FLORALI is considered a “positive study” and HIGH a “negative study,” the devil is in the details.  The two studies actually say something similar about high-flow nasal cannula (HFNC). [SR] 

The Best of #FOAMed Emergency Medicine

• Nice review from CanadiEM on the emergence of new oncologic emergencies in the era of immunotherapy. [AS]
• Do you call falls in the elderly “mechanical” or “non-mechanical.” This episode of GEMcast will change that practice, and how you think about these patients. [MG]
• Pacemakers can be confusing, but Dr. Smith demystifies them through a case study of extreme bradycardia. [MG]

The Best of #FOAMcc Critical Care and #FOAMres Resuscitation

• Great video from George Kovacs on the incrementalization of airway management.  EVLI = Epiglottoscopy, Valleculoscopy, Laryngoscopy, & Intubation. [SR]
• An all-in-one table on how to reverse anti-platelet medications and anticoagulants in patients with both spontaneous and traumatic ICH. TY Alex Chen & Clay Smith for publishing this. Be sure to download the PDF and put it where you can find it, when you need it. [SR]
• Two takes on the SUP-ICU study on stress ulcer prophylaxis: by The Bottom Line’s Adrian Wongand Emcrit’s Josh Farkas. Digest both write-ups, as it were. [SO]
• Jonny Wilkinson has another excellent roundup  of critical care articles and ultrasound clips from October. Nice work mate [SO]
• The Papworth Critical Care team have a lovely weekly round up of articles on important cardiac and POCUS. [SO]
• A flurry of awesome ECMO posts have been released by the Alfred ICU team. Check out this latest one on making ECPR happen. [SO]
• Josh Farkas tackles a recent RCT on the use of antipsychotics in the treatment of delirium in critically ill patients.  On the surface this looks like a negative study, but there are several reasons why we should not consider it to be so. [SR]
• Fantastic post by Charles Murchison on the  bicarbonate therapy in cardiac arrest.  Only 2 clinical trials to date, neither of which showed benefit and the AHA no longer recommends use of this medication in ACLS. [SR]
• Justin Morgenstern reviews all, and I do mean all, of the evidence for or against epinephrine in OHCA.  Bottom line is that, at the current dosing regimen used, epinephrine increases rates of ROSC and survival to hospital admission. But epi at routine doses does not improve the patient-oriented outcome of survival with good neurologic function. If you’d rather listen to the discussion than read it, check out this week’s EMCases featuring Justin Morgenstern and Rory Spiegel. [SR, MG]

The Best of #FOAMtox Toxicology

• The latest offering from the ATRIUM Cardiology Collaborative blog tackles the data for propofol-induced myocardial depression. Often cited dogma regarding the incidence and mechanisms behind this reaction are challenged and criterion for the safe use of propofol in cardiovascular surgery patients are proposed. [TCN]

The Best of #MedEd FOAM and #FOAMsim

• Learn to keep up to date from one of our own as Salim Rezaie discusses tips to avoid information overload. [MMS]
• In case you weren’t able to attend the first ever Ikigai Med Ed conference, follow along on twitter via #IkigaiMedEd. [MMS]

News from the Fast Lane

• In case you missed the debate on ‘Has Medutainment Replaced Education’ between Chris Nickson and Bala Venkatesh, you’re in luck with their recorded battle just released. [MMS]

LITFL Weekly Review Team

Reference Sources and Reading List