LITFL Update 074
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.
Awake in VF: A previously healthy man in his 50s presents to the emergency department with 45 minutes of severe central chest pain. He is alert and orientated. HR 58 bpm, BP 96/60 mmHg, SpO₂ 98% on room air.
ECG Criteria for LVH: Review the principal ECG criteria for left ventricular hypertrophy, their historical development, diagnostic performance, limitations, and modern use.
Bennett Fracture: An unstable two-part intra-articular fracture-dislocation of the base of the first metacarpal involving the thumb carpometacarpal joint. Review imaging, management, distinction from Rolando fracture, and more.
Latest updates from the #FOAMed world
The definition of myocardial infarction has changed. St Emlyn’s breaks down the new Fifth Universal Definition for emergency clinicians: primary, secondary, and procedure-related MI, sex-specific troponin thresholds, the increasing importance of cardiac imaging, and why an elevated troponin alone still means myocardial injury – not necessarily myocardial infarction.
Peptides are increasingly appearing in the performance and image-enhancing drug space – but what do clinicians actually need to know? Nick Dafters, Ingrid Berling, and Geoff Isbister explore the growing range of unregulated peptides, the limited human evidence behind them, and the emerging adverse effects clinicians may encounter in practice.
When should we scan – and when is waiting the better decision? This excellent EM Cases episode explores the everyday uncertainty behind ED imaging: cumulative CT radiation, delaying CT for ultrasound in appendicitis, emerging brain injury biomarkers, and using PVR and CT when MRI isn’t available for suspected cauda equina syndrome.
Chest pain + abnormal ECG + positive troponin = ACS… right? Not always. This excellent EM Mastery case explores decision-making when the diagnosis remains uncertain: interpreting a striking ECG, understanding what an elevated troponin actually means, avoiding anchoring, choosing early therapies, and managing risk before definitive cardiac investigations provide the answer.
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Emergency nurse with ultra-keen interest in the realms of toxicology, sepsis, eLearning and the management of critical care in the Emergency Department | LinkedIn |
BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby, medical history, medical education, and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | On Call: Principles and Protocols 4e| Eponyms | Books | Horology