LITFL Update 068

Sending you free open-access medical (FOAM) content from around the globe. We keep an eye on all the trends and best articles and share them with you so that you stay top of your field.

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Latest updates from the #FOAMed world

This excellent critical care case walks through a structured, bedside approach to diagnosing and managing severe hypoxaemia in the ventilated trauma patient. Topics include using ventilator waveforms as a diagnostic tool, interpreting peak versus plateau pressures, identifying massive air leaks, optimising patient positioning and V/Q matching, and navigating the delicate balance between PEEP, oxygenation, and haemodynamic stability. A practical, high-yield discussion packed with pearls for emergency, trauma, critical care, and retrieval clinicians.

• Ventilator Management in the Critical Trauma Patient

How do we avoid missing rare diagnoses while not overcalling them? In this engaging podcast episode, Nick and Cyrus revisit the concepts of horses, zebras, zorses, and hebras to explore diagnostic reasoning in allergy and immunology. Using real-world examples, they discuss cognitive biases, disease prevalence, and the challenges of balancing common diagnoses with uncommon but important conditions. A thought-provoking listen for emergency, acute care, and primary care clinicians looking to sharpen their diagnostic thinking and clinical decision-making.

• Zorses & Hebras Part II

Can uncomplicated appendicitis be safely managed without surgery? This thought-provoking SGEM review explores the growing evidence supporting an antibiotic-first approach for carefully selected patients with imaging-confirmed uncomplicated appendicitis. The discussion examines who may be suitable for non-operative management, the risks of recurrence and treatment failure, and the importance of shared decision-making between clinicians and patients.

• When you go your way, and I Go Mine – Surgery or Antibiotics for Acute Appendicitis.

High-performing trauma team leaders don’t just manage tasks – they manage time. In this practical leadership tip, Simon Carley highlights the importance of setting clear, team-specific time goals during trauma resuscitations to maintain momentum, improve communication, and reduce delays. By establishing targets such as time to primary survey, CT, blood products, or definitive intervention, teams develop a shared mental model and remain focused on critical priorities. An excellent read for trauma team leaders looking to improve efficiency, situational awareness, and patient flow in the resuscitation room.

• TTL Tips 13: Set your team specific time goals