Research and Reviews in the Fastlane 152

Research and Reviews in the Fastlane

Welcome to the 152nd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

Critical CareR&R Hall of Famer - You simply MUST READ this!                               

 

Bernard SA et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline (The RINSE Trial). Circulation. 2016. PMID: 27562972

  • This multi-centre randomised control trial just added another nail in hypothermia’s coffin. Adults with out of hospital cardiac arrest undergoing CPR were randomised to either a rapid intravenous infusion of up to two-litres cold saline or standard care. Due to changes in temperature management at receiving hospitals the trial was ceased early. Patients who received cold saline with an initial shockable rhythm had a decreased rate of ROSC compared to standard care and did not display a trend to improved outcome at hospital discharge.
  • Recommended by: Nudrat Rashid

The Best of the Rest

Emergency Medicine
R&R Game Changer? Might change your clinical practiceR&R Hot Stuff - Everyone’s going to be talking about thisHermann LK, et al. The limited utility of routine cardiac stress testing in emergency department chest pain patients younger than 40 years. Ann Emerg Med. 2009. PMID: 19231025

  • Another great paper from SinaiEM: they looked at all stress tests in ED patients under 40 years old (220 patients from 2004-2007) and only 6 had a positive stress; only 4 went on to get cathed, and 2 of those were negative. More evidence suggesting stress tests are useless in younger patients.
  • Recommended by: Seth Trueger

Airway                                    R&R Hot Stuff - Everyone’s going to be talking about thisTeoh WH, Kristensen MS. Prediction in airway management: what is worthwhile, what is a waste of time and what about the future? Br J Anaesth. 2016. PMID: 27317701

  •  Very nice editorial on prediction of difficult airway management with thoughts on how to be become better prepared in a future of ever expanding airway devices.
  • Recommended by: Daniel Cabrera

Resuscitation
R&R Hot Stuff - Everyone’s going to be talking about thisR&R Hot Stuff - Everyone’s going to be talking about thisSemler MW, Rice TW. Saline Is Not the First Choice for Crystalloid Resuscitation Fluids. Crit Care Med. 2016. PMID: 27428117

  •  While there’s nothing new here in the age old debate between “normal” saline and balanced electrolyte solutions in resuscitation, the authors of these pro/con articles summarize the available literature on both sides of the debate succinctly. These review articles act as a succinct repository of our current understanding of the debate. A must add to any library.
  • Recommended by: Anand Swaminathan

Pediatrics                                       R&R Eureka - Revolutionary idea or conceptShavit I, et al. Sedation for children with intraoral injuries in the emergency department: a case-control study. Pediatr Emerg Care. 2014. PMID: 25343735

  •  Procedural sedation & analgesia for intra oral procedures (IOP) such as lacerations, I&D and aspirations is generally considered with a higher risk of Serious Adverse Events During Sedation (SAEDS). This papers compares 38 cases (sedation for IOP) with 41 controls (sedation for forearm fracture reduction) in terms of SAEDS (apnea, hypoxemia (oximetry <93%), hypoventilation, laryngospasmand other upper airway obstruction). Both groups have similar sedation strategies and events; 5 hypoxic/2 apneas in cases vs. 4 hypoxic/2 apneas in control. This papers appears to show that IOP have similar risk of SAEDS compared to sedation for non IOP procedures.
  • Recommended by: Daniel Cabrera

 

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Last update: Sep 22, 2016 @ 2:50 am

The post Research and Reviews in the Fastlane 152 appeared first on LITFL: Life in the Fast Lane Medical Blog.

LITFL Review 249

LITFL review

Welcome to the 249th 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 chuck of FOAM.

The Most Fair Dinkum Ripper Beauts of the Week

Nick Cummins

Swami discusses the process of thin-slicing in the ED: “the pathophysiology and relative illness of patients on the spectrum are different; [not] apply[ing] the concepts of management of one of the spectrum to the other end…allows us to tailor our management to our patients and maximize good outcomes”:. This SMACCDUB talk also saw the inception of the soon to be (in)famous term, BFC. [JS]

 

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

  • Extubate overnight or wait till morning? Josh Farkas discusses a recent observational paper and provides some insights. [SO]
  • Are nurses non-inferior to physicians when it comes to inter-hospital transport of patients? A recent paper on this topic is reviewed by the Bottom Line this week. [SO]
  • The Maryland Critical Care Project has a wonderful podcast on Family Intensive Care Syndrome. A real eye opener. [SO]
  • A lot of us will be performing echo’s to look for the presence of pericardial effusion, this post from Cliff Reid will help structure your management once you’ve found the effusion. [SL]

The Best of #FOAMed Resuscitation

The Best of #FOAMtox Toxicology

The Best of #FOAMus Ultrasound

The Best of #FOAMim Internal Medicine

The Best of Medical Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

Last update: Sep 19, 2016 @ 4:37 am

The post LITFL Review 249 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Funtabulously Frivolous Friday Five 159

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 159

Question 1

What is Metamorphopsia?

  • Metamorphopsia is a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank. People with this condition often first notice this when looking at mini-blinds in their home.
  • It is associated with macular degeneration [Reference]

metamorphopsia

 

Question 2

What is an Ashman Beat?

  • Ashman beats are described as wide complex QRS complexes that follow a short R-R interval preceded by a long R-R interval. This wide QRS complex typically has a right bundle branch block morphology and represents an aberrantly conducted complex that originates above the AV node.
  • See example six from Ed Burn’s AF ECG page. Normally diagnosed as a PVC but in fact they should be called Ashman’s beats if you want to be a pedant. 3rd QRS on the ECG below, they are clinically benign.

Ashman phenomenon

Question 3

Although we still do not know why we cry for emotional reasons (the only species to do so) what is the difference in timing between a female and a more manly cry?
man vs woman

  • On average when a woman cries it’s likely to be for five or six minutes, compared with two or three minutes for a manly weep.
  • Women cry on average 5.3 times a month, whereas men in all their manliness only allow eye leakage 1.3 times a month. [Reference]

Question 4

You notice that your patient, who had a sigmoidoscopy yesterday, now has two black eyes. What is going on?

  • Suspect amyloidosis. Periorbital purpura (‘black eye syndrome’) is a rare sign of amyloidosis. [Reference]

Question 5

What is Hofstadter’s law?

  • Hofstadter’s Law: It always takes longer than you expect, even when you take into account Hofstadter’s Law. [Reference]

Last update: Sep 16, 2016 @ 1:55 pm

The post Funtabulously Frivolous Friday Five 159 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Research and Reviews in the Fastlane 151

Research and Reviews in the Fastlane

Welcome to the 151st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

Emergency Medicine
R&R Hall of Famer - You simply MUST READ this!

 

Cameron JI, et al. One-Year Outcomes in Caregivers of Critically Ill Patients. N Engl J Med. 2016. PMID: 27168433

  • A great insight into the caregivers of patients who survive a critical illness showing that the caregivers own heath suffers. A larger percentage (70%) of these caregivers were women. 61% of caregivers were spouses. A high proportion of these care givers reported depressive symptoms which persisted in the period of assessment of a year. Depressive symptoms were associated with the caregivers being younger with less social supports or less control over life or with less personal growth.
  • Recommended by: Nudrat Rashid 

The Best of the Rest

Emergency Medicine
R&R Game Changer? Might change your clinical practiceFriedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016. PMID: 26320523

  • Looks like diphenhydramine doesn’t help all-comers with migraines in the ED. My bet is there might be a subset of patients it does help; if the patient has had it before and requests it, sure. But no longer a routine part of my migraine cocktail.
  • Recommended by: Seth Trueger

Trauma                                  R&R Hot Stuff - Everyone’s going to be talking about thisMoore LJ, et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg. 2015. PMID: 26402524

  •  REBOA appears to be the wave of the future for patients with massive hemorrhage. This study takes data from a trauma registry and shows a survival rate for resuscitative thoracotomy (RT) of 9.7% vs. 37.5% for REBOA. There are a number of issues with this study due to the retrospective design. Additionally, the RT group was more likely to be dead on presentation in comparison to the REBOA group (71% vs. 38% without vital signs). While this data supports REBOA use, a prospective study should be undertaken to gauge the benefit of this modality.
  • Recommended by: Anand Swaminathan

Retrieval, Pre-hospital and Disaster
R&R Hot Stuff - Everyone’s going to be talking about thisR&R Landmark paper that will make a differenceSadek S, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. 2016. PMID: 27377669

  •  Resuscitative Endovascular Ballon Occlusion of the Aorta (REBOA) has been gaining popularity for treating non-compressible hemorrhage in trauma patient although absolute indications are still debated. Technical advances have made prehospital REBOA possible. This case presentation from the London HEMS describes the first prehospital use of zone 3 REBOA in a patient with pelvic fracture. The case demonstrates the feasibility of prehospital REBOA, which in this case successfully controlled severe non-compressible hemorrhage.
  • Recommended by: Soren Rudolph

Emergency Medicine        R&R Game Changer? Might change your clinical practicePasupathy S, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015. PMID: 25587100

  •  This is a common and interesting topic; this paper is a systematic review of the characteristics of patients who presented with a suspected MI (based on enzymes) and end up having non-obstructive coronary arteries (MINOCA). The prevalence of MINOCA is about 6% and is more common in males, with median age of 55. When comparing patients with obstructive vs. non-obstructive, the latter have are more likely to be female, young and with less CV risk factors. Also important to consider other diagnoses such as myocarditis, thrombophilia, and coronary artery dissection/spasm.
  • Recommended by: Ryan P Radecki

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Last update: Sep 15, 2016 @ 4:04 am

The post Research and Reviews in the Fastlane 151 appeared first on LITFL: Life in the Fast Lane Medical Blog.

JellyBean 048 with Resa Lewiss

Resa Lewiss; Ultrasound Enthusiast Extraordinaire
Dr Resa Lewiss is another stand out woman in Medicine and she has become very well known particularly in Point Of Care Ultrasound. Resa was inspired by people that worked outside the USA health care system where she had started out. Since then she has been the first President of the Academy of Emergency Ultrasound and a founding member of WinFocus & Sono-Games. She has been at the forefront of ultrasound throughout her career. The ultrasound modality has moved from a poor cousin in the imaging world to a position of pre-eminence. It is now THE point of care imaging tool of choice available almost every where to almost everyone. It gets her close to her patients. This is good.

Resa has had an amazing journey which has brought her to Vietnam, Ghana, Rwanda and even Ireland.

Keep an eye out for her Ultrasound talk and her later Leadership talk from SMACC in Dublin.

(Matt McPartlin steps up and again proves that he is usually very well prepared when he does these interviews.)

JellyBean Large

Last update: Sep 14, 2016 @ 10:27 am

The post JellyBean 048 with Resa Lewiss appeared first on LITFL: Life in the Fast Lane Medical Blog.