The LITFL Review 102 - Life in the Fast Lane medical education blog

Welcome to the 102nd edition!

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.

The Most Fair Dinkum Ripper Beaut of the Week

Resus.ME

• Cliff Reid over at?Resus.ME?smashes his way to top spot this week, as he brings us 3 great hot-of-the-press articles, that really tackle the core of what we do. He starts off with?Another argument for ED thoracotomy?- yes that?s right ? we know we don?t often get a meaningful outcome for these patients, but we can give their families and other patients an meaningful outcome through organ donation. Cliff then sheds some light on where EMCC is, and where it should be heading on?Upstairs vs Downstairs: an EPIC Conundrum?- the?comments?on this post are a must read. He finishes the week with a look at ?swallowing a camera in GI bleed - ?it can?only?diagnose and not treat, making its?benefit?questionable?in the unstable patient ? but an interesting concept none the less!

The LITFL Review Top Picks

Emergency Medicine Ireland

StEmylns

EXPENSIVECARE

• David leaves the hustle and bustle of the ICU and takes us on a journey into?What is Palliative Care??A lesson for us all in here!
  

eMeducation

?EMCrit

The Sono Cave

Emergency Medicine Tutorials

SCANCRIT

• SAM?- What?s SAM you ask??SAM stands for Systolic Anterior Motion of the mitral valve and may be seen as a complication of hypertrophic cardiomyopathies (HCM), myocardial infarction and mitral valve repair or dysfunction.
  

The Short Coat

Broome Docs

SOCMOB

The Trauma Professional?s Blog

• The First Law Of Trauma ? Remember:?Any anomaly in your trauma patient is due to trauma, no matter how unlikely it may seem (? until proven otherwise).
  

Academic Life in Emergency Medicine

boringem

Pediatric EM Morsels

• Eyelid Laceration?-Nice Review of a deceptively difficult diagonsis and management problem.
  

Emergency Physicians Monthly

The Poison Review

PHARM

Resus Review

The Skeptics Guide to Emergency Medicine

• This?episode?focuses on the renal colic shuffle, and can you flush that stone out? Want to know more have a?listen?to -?Stone Me.

empem.org

• ?Headaches in kids?-?In this ?noggin-cast? they explore the causes of headache, including primary headachse like migraine and tension headache, and secondary headaches from viral illness and a few other strangeosities?

thebluntdissection

• in with a chance??- A?superb, simple informative overview by Chris on managing and recognising a trauma patient with a chance fracture.
  

Dr Smith?s ECG Blog

PEM ED

?Practical Evidence

• Episode 12 ? New Trauma Guidelines: ATLS and Spine. Scott brings us up-to-date with the new ATLS guidelines for 2013! Take home point: less clear stuff and more red stuff is the key to resuscitating the haemorrhaging trauma patient.
  

Resus Room Management

EKG Videos

?EMpills

UMEM Educational Pearls

This weeks pearl on Keppra is by Ellen Lemkin:

• Although Keppra has been used more frequently in clinical practice, there is little evidence for its use in status epilepticus.
• It has a wide spectrum of action and few drug interactions.
• Initially, case series appeared to be highly successful in terminating seizures as an add-on agent.
• A review of 2 prospective studies found efficacies of 44% as an add- on agent, and 75% as a primary agent. The studies had markedly different populations.
• In a retrospective study, the treatment failure rates were 3X higher than that of intravenous valproic acid as an add-on agent in terminating status epilepticus.
• Therefore, although it is used frequently, the evidence for use is limited and inconclusive in terminating status epilepticus.

The LITFL Review Shout Out of the Week

EM Journey

Shout this week goes to new Aussie Blog?EM Journey?By Chris Edwards (@EMtravellor). Chris? philosophy?for this blog is:?Given the wealth of blog and podcasts sites available, I am attempting to find a niche by providing a forum for a concept I thought of, called Crowd Learning and Problem Solving (CLaPS).?

The?GMEP?Cases of the week

GMEP Video of the week

Video of the week is By James Rippey on?Emergency Department Surgical Airway Pathway.

GMEP Image of the week

This patient came in septic with hypotension, tachycardia, obtunded mental status.?What?s the Diagnosis?

Twee Dee and Twitical Care

The medical photographer really doesn?t like it when I photobomb her pictures.

News from the Fastlane

The Final Words

• ?Every Turkey has a Terminal Event?

- Billy Mallon

• ?Critical Care should be a Philosophy- Not a Place?

- Haney Mallemat

LITFL Review EM/CC Educational Social Media Round Up

Show Reference list

Related posts:

Source: http://lifeinthefastlane.com/2013/04/the-litfl-review-102/

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This Magnificently Detailed Lego Oil Rig Will Be Spitting Brick Gold in No Time

Hopefully, this won't cause any ecological disasters in Legoland. This ridiculously massive Lego oil rig is more than 3 feet tall and wide, and weights over 92 pounds. According to The Brothers Brick, Lego master Tobias Vogt spent three months building this, and it shows in the detailed build-out. More »

Source: http://feeds.gawker.com/~r/gizmodo/full/~3/wkPkcYouKcQ/this-magnificently-detailed-lego-oil-rig-will-be-spitting-brick-gold-in-no-time

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SimCity update 2.0 hits April 22, offers bug fixes, enhancements -- still no offline mode

Although SimCity has become relatively stable following its problematic launch, there are naturally still ongoing bugs that the folks at EA Maxis have been working to fix. Thankfully, that version 2.0 update that was teased just over a week ago now has an arrival date of April 22 at 4PM ET. Included in the update are 26 bug fixes, along with data map color filters, a color-correct HUD for the colorblind setting and the action of mayors traveling from their mansions to their jobs. Sadly, an offline mode is still no more than wishful thinking, but at least that OS X version should still be on track for a June 11th release. You'll find all the details about your virtual city's soon-to-arrive enhancements at the source link -- expect some server downtime, by the way, when the update itself hits.

Filed under: Gaming

Comments

Via: Joystiq, VG 24/7

Source: EA Forums

Source: http://www.engadget.com/2013/04/20/simcity-2-0-update-release-info/?utm_medium=feed&utm_source=Feed_Classic&utm_campaign=Engadget

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Loup's 11th inning error sinks Jays vs. Yanks

By IAN HARRISON

Associated Press

Associated Press Sports

updated 5:39 p.m. ET April 20, 2013

TORONTO (AP) - The New York Yankees have been hitting home runs at an impressive rate. They earned their latest win though using some small ball.

Blue Jays reliever Aaron Loup made a two-run throwing error in the 11th inning and the Yankees beat Toronto 5-3 on Saturday for their ninth win in 11 games.

"Our guys are seizing opportunities and you have to do that," Yankees manager Joe Girardi said. "These games are hard to win but our guys have been resilient."

Shawn Kelley (1-0) got two outs in the 10th for the win and Mariano Rivera finished for his fifth save.

Vernon Wells hit New York's AL-leading 26th homer and finished with three hits, including a single to start the winning rally.

"Big day for Vernon to get us on the board and then in that 11th inning, to lead off with a single," Girardi said. "Just a big day."

New York has hit at least one homer in each of its first seven road games, their longest such streak since going deep in eight straight road games to start the 2002 season. But they didn't win this one with the longball.

"That's a sign of a good team, when you can take advantage of mistakes," Wells said. "Even though we have been hitting home runs, it's not something we're just going to rely on."

Wells and Francisco Cervelli singled off Loup (1-1) to open the 11th, and Ichiro Suzuki followed with a bunt to the third base side of the mound that Loup and third basemen Brett Lawrie both charged. Loup fielded it and wheeled to throw to third. But with Lawrie out of position as he retreated back to the bag, the ball sailed into foul territory and down the left field line, allowing both runners to score.

"I thought we had an easy play at third base," a downcast Loup said. "I didn't have enough awareness to realize Lawrie was crashing in on the play. By the time I realized he was backpedalling to the bag and wasn't there, it was too late and I'd already let go of the ball."

Wells said he was "shocked" to see Loup throw to third.

"You know what, you get in the moment and you make an aggressive play like that and sometimes it works out," Wells said. "You look great when it works out and bad when it doesn't."

The Blue Jays used a single and a sacrifice to put the winning run in scoring position with one out in the 10th but Kelley came on and got Rajai Davis to pop out, then got Melky Cabrera to ground out.

Toronto lost for the fifth time in seven games and fell a season-high four games below .500.

"You screw up the fundamentals, you're not supposed to win," Blue Jays manager John Gibbons said.

New York infielder Kevin Youkilis left after five innings with a sore lower back and was replaced by Lyle Overbay.

"His back locked up a little bit on the right side," Girardi said. "My guess is he's not a player for me (Sunday). I don't think it's anything serious but it's the tough part about playing indoors sometimes. The good part is it's warm today but sometimes that turf grabs at you a little bit."

Wells opened the scoring with a homer against Mark Buehrle in the second that hit the left field foul screen, his fifth of the season and second in two days. Wells has five homers in 15 career games against his former team.

Wells improved to 23 for 47 (.489) against Buehrle.

"He's a guy who throws strikes and I'm usually a guy who's swinging often," Wells said. "I've gotten a few to fall in."

New York made it 3-0 in the fifth. Jayson Nix led off with a single and went to third on Brett Gardner's double. One out later, Robinson Cano was walked to load the bases for Youkilis, who ripped a liner to third that bounced off Lawrie's glove and rolled into shallow left for a two-run single.

Wells singled to load the bases but Cervelli grounded into a double play.

Yankees starter Hiroki Kuroda, who beat Baltimore with a five-hit shutout in his previous start, allowed just two hits through the first seven innings, but was replaced by David Robertson after Colby Rasmus' one-out single under Overbay's glove in the eighth.

Maicer Izturis struck out and pinch hitter Adam Lind walked before Rajai Davis grounded an RBI single up the middle. The run snapped Kuroda's streak of shutout innings at 20 2-3 dating to his April 8 start at Cleveland.

Cabrera followed with a two-run single to center that bounced away from Gardner, tying it at 3-all. Jose Bautista walked but Robertson fanned Edwin Encarnacion to end the inning.

The two hits with runners in scoring position in the eighth were one more than the Blue Jays had in their previous six games combined, when they went 1 for 29.

Kuroda allowed one run and three hits in 7 1-3 innings. He walked one and struck out a season-high seven.

"His slider was really good today," Girardi said. "He used it really effectively against the right-handers. He used his split pretty effectively, threw some early curveballs. He just mixed his pitches. He gave us a great outing again."

Making the 400th start of his career, Buehrle allowed three runs and eight hits in a season-high seven innings. His only walk was intentional and his seven strikeouts were a season-high.

NOTES: Buehrle hasn't beaten the Yankees since 2004. ... Yankees manager Joe Girardi said LH Andy Pettitte had only "normal soreness" one day after beating Toronto. Pettitte had missed his previous start because of back spasms. ... Attendance was 46,095. ... Blue Jays RH Josh Johnson (0-1) faces New York RP Ivan Nova (1-1) in Sunday's series finale.

? 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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More newsJessica Rinaldi / Reuters

A strong return to Fenway

A defiant David Ortiz stood on the Fenway Park infield and told the crowd, "Stay Strong," bringing a rousing cheer from Bostonians weary from a week of bombings, stay-at-home orders and a manhunt that locked down the city for a day.

Source: http://nbcsports.msnbc.com/id/51607453/ns/sports-baseball/

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Defense starts Monday in Philly abortion trial

FILE - In this undated photo provided by the Philadelphia District Attorney's office, Dr. Kermit Gosnell is shown. Eight former employees of a run-down West Philadelphia abortion clinic now face prison time for the work they did for Gosnell. Three have pleaded guilty to third-degree murder. And Gosnell, 72, is on trial in the deaths of a patient and seven babies allegedly born alive. (AP Photo/Philadelphia Police Department via Philadelphia District Attorney's Office, File)

FILE - In this undated photo provided by the Philadelphia District Attorney's office, Dr. Kermit Gosnell is shown. Eight former employees of a run-down West Philadelphia abortion clinic now face prison time for the work they did for Gosnell. Three have pleaded guilty to third-degree murder. And Gosnell, 72, is on trial in the deaths of a patient and seven babies allegedly born alive. (AP Photo/Philadelphia Police Department via Philadelphia District Attorney's Office, File)

This undated photo released by the Philadelphia District Attorney's Office shows Karnamaya Mongar, left, and her husband, Mr. Mongar, no first name given. Karnamaya Mongar survived 20 years in a refugee camp after fleeing war-torn Bhutan, but died months after arriving in the U.S. in 2009 and seeking an abortion. Mongar, 41, is the subject of one of eight murder counts in the ongoing Philadelphia trial of Dr. Kermit Gosnell. Gosnell, an abortion provider, is also charged with killing seven babies allegedly born alive. (AP Photo/Philadelphia District Attorney)

PHILADELPHIA (AP) ? Over five weeks of testimony, Philadelphia prosecutors have painted Dr. Kermit Gosnell as an eccentric, detached boss who relied on untrained staff to perform abortions at his outdated, inner-city clinic.

But have they proven he murdered a woman and seven babies born alive? Or that the self-proclaimed do-gooder morphed into a greedy, criminally reckless businessman after returning to his downtrodden West Philadelphia neighborhood?

"There has been an incredible rush to judgment like I have never seen before," defense lawyer Jack McMahon told jurors in opening statements last month.

The defense begins its case Monday, and the most intriguing question is whether the 72-year-old Gosnell will testify.

He may want to give jurors a self-portrait similar to the one he gave the Philadelphia Daily News just after the 2010 FBI raid that shut down his 30-year practice.

"I wanted to be an effective, positive force in the minority community," Gosnell told the newspaper, explaining how he was an early supporter of therapeutic abortions and drug treatment in the late 1960s.

Trial witnesses have described an abortion clinic, and perhaps a man, growing increasingly chaotic over the years.

One staffer said Gosnell performed mostly first-trimester abortions when she arrived in 2000, and a few second-term procedures. But the breakdown started to flip, perhaps because first-trimester patients had other choices, while second-trimester patients did not.

The woman who died after a 2009 abortion had gone to several clinics near her Virginia home, starting when she was about 15 weeks pregnant. But each time, she was referred elsewhere, until she arrived at Gosnell's clinic in her 19th week. Bhutanese refugee Karnamaya Mongar, 41, died of a Demerol overdose the next day.

Gosnell's "nursing" staff included several women who were trained at a career school to be medical assistants, but were quickly shown how to perform ultrasounds and give anesthesia. To make the latter job easier, a 15-year-old worker used markers to draw up a color-coded chart that showed which drug cocktails should be given to which patients. Sometimes, it depended on how much they could pay, witnesses have said.

Prosecutors have filled the courtroom with Gosnell's office equipment, including a seemingly ancient ultrasound machine, a busted defibrillator and a ripped, aging examining table.

The 546 exhibits also include dozens of patient files, one of which was handled with latex gloves because of a still-odorous stain. And an FBI agent recalled Gosnell, on the night of the 2010 law enforcement raid, eating dinner while they interviewed him.

"He was still wearing his bloody latex gloves. They had some holes in them," Agent Jason Huff testified.

At the time of the raid, Gosnell had 47 fetuses stored in the freezer, authorities said, apparently because of a billing dispute with his medical waste company. The recovered bodies gave investigators a wealth of evidence to test, and prosecutors said in opening statements they could prove that at least seven babies were born alive.

Unlicensed doctor Stephen Massof and other staff members testified that Gosnell taught them to "snip" babies in the top of the spine after the abortion procedure.

"If you cut off the brain, the body will die. It's that simple," Massof testified.

Massof has pleaded guilty to two counts of third-degree murder.

"I trusted him. I believed he knew what he was talking about," said Massof, a Caribbean medical school graduate who could not get a U.S. residency. "I should have Googled."

Medical assistant Kareema Cross said she saw babies move even after their spines were severed. McMahon disputed that account.

McMahon is also expected to challenge prosecutors' claims that the autopsies of two of the recovered fetuses show they had taken a breath. The Philadelphia medical examiner stopped short of confirming that when he testified.

And only two of the 47 were arguably past the 24-week limit for abortions in Pennsylvania, McMahon has noted, attacking charges that Gosnell routinely performed illegal, late abortions.

Eight clinic employees have pleaded guilty in the case. The only remaining co-defendant, medical school graduate Eileen O'Neill, is fighting racketeering and false-billing charges, for allegedly billing as a licensed doctor.

She is expected to call several character witnesses on Monday.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-04-22-Abortion%20Clinic%20Deaths/id-7d7ad5e44ca24bb09976e1bd3725a3cf

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Arms deal with Middle East allies signal to Iran: Hagel

By David Alexander

TEL AVIV (Reuters) - Defense Secretary Chuck Hagel said on Sunday a $10 billion arms deal planned with Arab and Israeli allies sent a "very clear signal" to Iran that military options remain on the table over its nuclear program.

"The bottom line is that Iran is a threat, a real threat," Hagel, who arrived in Israel on Sunday on his first visit there as defense secretary, told reporters on his plane.

"The Iranians must be prevented from developing that capacity to build a nuclear weapon and deliver it," he said.

Hagel was due to meet Israeli Defence Minister Moshe Yaalon on Monday and Prime Minister Benjamin Netanyahu on Tuesday, with little progress reported at talks this month between Iran and world powers.

The first stop on Hagel's week-long Middle East trip came two days after the Pentagon said it was finalizing a deal to strengthen the militaries of Israel and two of Iran's key rivals - Saudi Arabia and the United Arab Emirates.

The deal includes the sale of KC-135 aerial refueling tankers, anti-air defense missiles and tilt-rotor V-22 Osprey troop transport planes to Israel as well as the sale of 25 F-16 Fighting Falcon jets to the UAE.

The UAE and Saudi Arabia would also be allowed to purchase weapons with so-called "stand-off" capabilities enabling them to engage an enemy with precision at a distance.

Asked if the arms deal sent a message that the military option was on the table if Tehran moved to build a nuclear weapon, Hagel said: "I don't think there's any question that that's another very clear signal to Iran."

But he added the military option had been "very clear to Iran for some time" and said the arms deal was a continuation of U.S. policy to maintain Israel's so-called "qualitative military edge" in the region, a general reference to the supply of advanced U.S.-made weaponry and technology to the Jewish state.

Iran denies Western allegations it is seeking to build nuclear arms, saying its efforts aim at electricity generation.

Israel, widely believed to be the Middle East's only nuclear power, has repeatedly voiced impatience with diplomatic efforts to curb Iran's enrichment of uranium, saying they should be coupled with a credible military threat.

Both Israel and the United States have said all options remain on the table for dealing with any nuclear threat.

U.S. COMMITMENT

Hagel, who faced resistance during his Senate confirmation hearing this year from lawmakers who questioned his support for Israel, said part of the purpose of his visit was to reassure Israelis "the United States is committed to their security".

Asked about renewed debate in the Israeli media that Israel might have to strike Iran by itself, Hagel said "every sovereign nation has the right to defend itself and protect itself".

"Iran presents a threat in its nuclear program and Israel will make the decisions that Israel must make to protect itself and defend itself," he said.

But Hagel added the United States and other countries believe there is still time for diplomacy and tough international sanctions to have an impact.

"The military option is one option that remains on the table, must remain on the table," he said. "But military options, I think most of us feel, should be the last option."

After Israel, Hagel will visit Egypt, Jordan, Saudi Arabia and the United Arab Emirates. His trip comes amid concerns about regional stability due to Iran's nuclear program, the rocky transition to civilian rule in Egypt and civil war in Syria.

(Editing by Jeffrey Heller and Jason Webb)

Source: http://news.yahoo.com/u-arms-deal-middle-east-allies-clear-signal-102325106.html

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Will the GOP Commit Suicide by Amnesty?

During President Eisenhower?s first term, 60 years ago, the?United States faced an invasion across its southern border.

Illegal aliens had been coming since World War II. But,?suddenly, the number was over 1 million. Crime was rising in Texas.?The illegals were taking the jobs of U.S. farm workers.

Under Gen. Joseph May Swing, the Immigration and?Naturalization Service launched ?Operation Wetback? and began rounding?up and deporting Mexican border-crossers by ship and bus. By the end?of Ike?s second term, illegal entries had fallen by 90 percent.

Eisenhower, who had tapped his nuclear hole card twice?first, to force the Chinese to agree to a truce in Korea, then to halt?their shelling of the offshore islands in 1958?was a no-nonsense?president.

Measured by population and gross national product,?Eisenhower?s America was but half the size of today?s America. Yet, in?the 1950s, we were in many ways a stronger and more self-confident?country.

We had universal military service, and few complained. As for?the deportation of the Mexicans, they had broken in, they did not?belong here, and they were going back. End of discussion.

Contrast the rigorous response of Ike?s America to an invasion?across our southern border to the hand-wringing moral paralysis of our?political elite in dealing with 11-12 million illegal aliens in our?midst.

We are to stop using terms like illegal aliens, we are told.?For it shows insensitivity. And compassion commands that we bring?these folks ?out of the shadows? and ?put them on a path to?citizenship.?

One understands Democrats? motives in pushing this amnesty.?Perhaps nine of 10 illegals are from Third World countries, and folks?of Asian, African and Hispanic descent voted 4-to-1 Democratic in?2012.

Sen. Chuck Schumer and Democrats are writing an immigration?bill that will create millions of new citizens who will vote to bury?the Party of Ronald Reagan forever.

But why are Republicans collaborating in erecting the?scaffolding on which their party is to be hanged?

A year ago, the GOP platform declared, ?We oppose amnesty?because it would have the effect of encouraging illegal immigration?and would give an unfair advantage to those who have broken our laws.?

What has changed since then?

Yet, today, with Cuban-American Sen. Marco Rubio providing?cover?a ?very positive force,? purrs President Obama?Republicans?are about to trash their platform and vote an amnesty for 11-12?million illegals. Why?

One reason is the fear, bordering on panic, since Mitt Romney?lost the Hispanic vote 71 to 27. Republicans attribute their?unpopularity among Latinos to their opposition to amnesty, rather than?their commitment to peel back the social programs on which minorities?heavily depend.

Another force for amnesty is corporate America. Thousands of?businesses have hired illegals in violation of U.S. law. Amnesty for?their illegal workers means, de facto, amnesty for them.

Moreover, U.S. corporations and agribusiness also want the?right to import foreign workers. And under this new immigration bill,?H1-B visas for highly skilled engineers and computer programmers will?double to 110,000 a year, and the cap can rise to 180,000. Visas for?H-2A agricultural workers will go to 337,000 over three years.

Silicon Valley is not interested in middle-aged Americans who?lost jobs in defense industries. They want young foreign students with?newly minted advanced degrees, who will work for less.

Thus, with 14 percent of our U.S. labor force?more than 21?million Americans?unemployed, working part-time but seeking?full-time work or having stopped looking, Congress is going to vote an?amnesty for 12 million illegals and bring in a million new immigrants?a year?and hand them green cards.

What happened to putting our own country and people first?

Moreover, under the new law, unlimited visas will be issued?for spouses, children and parents of permanent residents and citizens.

With all these workers and dependents pouring in, the downward?pressure on U.S. wages, stagnant since Gerald Ford was president, will?intensify. And the steady rise in the scores of millions of?beneficiaries of social welfare programs will continue.

What do Republicans get in return for capitulating and?embracing amnesty? The Democrats solemnly promise to secure the border?this time.

In short, the administration will do its duty and protect the?states from another invasion, if the Republican Party will abandon its?principled opposition to amnesty. The Republicans will be faithless to?those who voted for them on a pledge not to support amnesty, if only?Obama will promise a good-faith effort to do his constitutional duty.

Prediction: Once word goes out that the illegals will no?longer be sent back, there will commence a new stampede to the border.

And once the new law is on the books, Democrats will move to truncate?the time for the former illegals to become U.S. citizens.

And Republicans who resist will be accused of being?anti-Hispanic, and will then do what comes naturally?capitulate?again.

Source: http://www.theamericanconservative.com/will-the-gop-commit-suicide-by-amnesty/?utm_source=rss&utm_medium=rss&utm_campaign=will-the-gop-commit-suicide-by-amnesty

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