Research and Reviews in the Fastlane 072

Research and Reviews in the Fastlane

Welcome to the 72th 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan 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 Care
R&R Hall of Famer - You simply MUST READ this!Vincent JL et al. Ten big mistakes in intensive care medicine. Intensive Care Med. 2014. PMID 25502093

PediatricsR&R Game Changer? Might change your clinical practiceAdelgais KM et al. Intra-Abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries. J Pediatr. 2014; 165(6):1230-1235. PMID 25266346

  • The leading cause of mortality in children is accidental injuries. Fortunately, the majority of kids that you see after injuries will not have severe trauma, but sorting out those who are at risk of serious abdominal trauma can be difficult. This is a reminder that you can rely on your exam… when the child has a normal GCS. As the GCS declines, the reliability of your exam declines as well.
  • Recommended by Sean Fox

Research and Critical AppraisalR&R Mona Lisa -Brilliant writing or explanation” width=Sedgwick P. Sample size: how many participants are needed in a cohort study? BMJ. 2014 Oct 31;349:g6557. PMID 25361576

  • This is really just to highlight the excellent series that Phillip Sedgwick [@statistics_man] writes for the BMJ. Sadly not #FOAMed but a great resource for those looking to learn for the UK FCEM exam. Here’s a link to every single one below.
  • Recommended by: Andy Neil

AirwayR&R Hot Stuff - Everyone’s going to be talking about thisR&R Game Changer? Might change your clinical practiceSheren PB et al. Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill. Scand J Trauma Resusc Emerg Med. 2014; 22(1): 41. PMID 25209044

  • An excellent, evidence based review of the critical components of RSI. The authors use this evidence to build a standard operating procedure with an airway checklist and kit dump that can aid in building team dynamics and decrease the incidence of adverse events.
  • Recommended by Anand Swaminathan

Critical CareR&R Game Changer? Might change your clinical practiceLoubani OM, Green RS. A Systematic Review of Extravasation and Local Tissue Injury from Administration of Vasopressors through Peripheral Intravenous Catheters and Central Venous Catheters. J Crit Care 2015. PMID 25669592

  •  We’re taught to administer vasopressors through central lines and this may delay these medications. These authors searched the literature to find extravasation and local tissue complications of vasopressors and came up with case reports (n=305 from 270 patients). They found that local tissue injury attributable to peripheral administration tends to occur in distal IV sites following long durations of infusions (average infusion duration before extravasation: 35.2 h). If a patient needs a pressor, they can get it peripherally temporarily while you’re obtaining central access.
  • Recommended by Lauren Westafer

TraumaR&R Game Changer? Might change your clinical practiceMutschler M et al. The ATLS(®) classification of hypovolaemic shock: A well established teaching tool on the edge?.Injury 2014; 45 Suppl 3:S35-8. PMID 25284231

  •  The ATLS shock classification has been taking a beating lately. The classification in it self has very little scientific back up – studies have shown that more than 90% of all trauma patients could not be classified according to system. Irrespective of mechanism of injury the classification it may overestimate the degree of tachycardia associated with hypotension and underestimate mental disability in the presence of hypovolaemic shock. Does the ATLS faculty believe it? – Doesn’t seem so. In a survey among 383 European ATLS course instructors and directors the actual appreciation and confidence in this tool during daily clinical trauma care was assessed. Less than half (48%) of all respondents declared that they use the system in their own practice. Overall it seems that the ATLS shock classification today serves only on purpose – namely to test the students attending the course. Hopefully future ATLS manuals will revise the current classification.
  • Recommended by Søren Rudolph

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.

The post Research and Reviews in the Fastlane 072 appeared first on LITFL.

DL Terminated

Of all the things that emergency physicians do, rapid sequence induction has to be the most sinister.

To paralyse a man, or a woman, or a child, with a lethal serum – and then bring them back, from the point of death, with seconds to spare! With nothing more than a trusty metal blade, held in the left hand, and air blown through a tube!

It is an amazing magic trick. Surely some sort of voodoo. And frightening, very frightening, when it goes wrong. About 1% of rapid sequence inductions, conducted in the ED, kill the patient within 10 minutes. Which makes RSI about 25 times more dangerous than BASE jumping.

This is why some have suggested that RSI should also stand for Really Stupid Idea.

Now imagine if something came along, a technological breakthrough, a new machine, that transformed RSI. That made it, well, easy. And safe. Actually, a Really Sensible Idea. How would you feel?

And what would you say if this machine were coming very soon, coming at you – from the near future. In fact – it’s just arrived. And that trusty metal blade that you are holding in your left hand – is now scheduled for termination.

What do you do? Give up? Or fight?

I’ll be back.

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LITFL Review #170

LITFL review

Welcome to the 170th 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

resizerRory Spiegel offers an in-depth look at the endovascular study triad recently released (MR CLEAN, EXTEND-IA and ESCAPE) to treat acute ischemic strokes, and why we should be cautiously optimistic that a small subset of patients have been identified in whom this therapy can be greatly beneficial. [AS]

 

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

  • Beware the RV spiral of death!  Want to understand the crashing PE patient better?  EMCRIT this week has a great lecture from their conference by Oren Friedman. [CC]
  • Here’s a lovely little tip on laryngoscopy from the folks at the Alfred ICU. Remember to engage the hypoepiglottic ligament, folks… [SO]
  • Burnout and psychological illness occur at a significant rate amongst intensivists. Deb Chalmers writes an incredibly thoughtful post reminding us how important it is to look after ourselves. “The flame that burns twice as bright burns half as long”… [SO]

The Best of #FOAMtox Toxicology

  • Leon Gussow reviews the latest from the EXTRIP workgroup on the use of haemodialysis for acute methanol poisoning [JAR]
  • The next episode of ToxTalk is out and it’s on one of the most infamous Toxoversies: Intralipid! [JAR]
  • How often do toxicologists use physostigmine? An article from the TOXIC registry is reviewed by Dr Gussow [JAR]
  • What’s the optimal method of cooling patients with severe hyperthermia? The Poison Review discusses a case series of patients treated with ice water bath immersion. [AS]

The Best of #FOAMus Ultrasound

  • Does the use of POCUS for assessing the IVC predict fluid responsiveness? An interesting review from HEFTEMcast [CC]
  • Beautiful images from Ultrasound of the Week #38, with a case of a lady brought in after a road traffic accident. Can you spot the sign? [SO]
  • Echopraxis.com is a wonderful new critical care echo resource from a bunch of echo-mad intensivists in Australia. It’s brilliant. Why not get started with this post on a lady struggling to get to her letterbox? (thanks to Oli Flower and Adrian Wong for the tip) [SO]

#The Best of #FOAMped Pediatrics

The Best of Medical Education and Social Media

  • Looking for a fantastic resource for OSCE revision or clinical skills? Check out this awesome resource from Nick Smith at CMFTUGME. [SL]

News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

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Research and Reviews in the Fastlane 071

Research and Reviews in the Fastlane

Welcome to the 71st 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 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan 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

TraumaR&R Hall of Famer - You simply MUST READ this!Holcomb JB et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015; 313(5):471-82. PMID 25647203

Emergency MedicineR&R Eureka - Revolutionary idea or conceptKline JA et al. Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting. Emerg Med J 2015; 32(1): 3-8. PMID: 25022275

  • An important pilot study attempting to objectify what we mean when we use the word “gestalt”. Kline and others looked at facial expression variability and their findings suggest a relationship between a lack thereof, and serious disease. While this may not be a shocking finding, it’s an important first step in an attempt to be able to quantify, teach, and possible objectively use this data in the clinical setting. A preliminary study which will hopefully generate further research into this important area of work.
  • Recommended by Jeremy Fried

Emergency MedicineR&R Eureka - Revolutionary idea or conceptShahrami A, et al. Comparison of therapeutic effects of magnesium sulfate vs. dexamethasone/metoclopramide on alleviating acute migraine headache. J Emerg Med 2015; 48(1): 69-76. PMID 25278139

  • Does IV magnesium have a role in the management of acute migraine headache in the ED? A new study says yes. Compared to dexamethasone + metoclopramide (fair comparator?), magnesium sulfate was more effective in decreasing pain severity at 20-min and 1-h and 2-h intervals after treatment (p < 0.0001).
  • Recommended by Bryan Hayes

Emergency MedicineR&R Game Changer? Might change your clinical practiceElif Yaka et al. Comparison of the Glasgow-Blatchford and AIMS65 Scoring Systems for Risk Stratification in Upper Gastrointestinal Bleeding in the Emergency Department. Acad Emerg Med 2014; 22: 23–30. PMID 25556538

  • A comparison of the Glasgow-Blatchford (GBS) and AIMS65 scoring systems in UGIB patients in the ED population found the GBS to be more sensitive and have a higher negative predictive value for needed interventions in the low risk population. Like many studies examining clinical decision tools and scoring instruments, it was unfortunately not compared to the clinician’s prediction of expected clinical course, or gestalt. A well done study comparing the two scores, and important for ED providers to be aware of, nonetheless.
  • Recommended by Jeremy Fried

PediatricsR&R Game Changer? Might change your clinical practiceThomas DG et al. Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics 2015. PMID 25560444

  • Despite sparse evidence of long-term outcome improvement in pediatric patients, cognitive rest, coupled with physical rest and graduated return to play, is the mainstay of concussion treatment and recommended by major societies. How strict this “rest” should be is debatable, but this RCT in patients age 11-22 showed no benefit in short term outcomes from “strict” rest versus usual care (varied, but 1-2 days rest and then graduated return to activities). This contribution suggests that restrictions (no school, work, or physical activity) patients feel from strict rest may engender more emotional symptoms than general rest. Prescribe rest to patients and make sure they follow up, but maybe we don’t have to be quite so strict.
  • Recommended by Lauren Westafer

ResuscitationR&R Eureka - Revolutionary idea or conceptBenato P et al.Ultrasound guided chest compressions during cardiopulmonary resuscitation. Resuscitation. 2015; 87: e13-4. PMID 25497391

  • Findings from transesophageal echocardiography during CPR suggest that narrowing of the base of left ventricle and of the aorta root may be an indicator of quality of chest compressions. This small case series analyse 6 patients with non-traumatic cardiac arrest using transthoracic US to evaluate the possibility to check the efficacy of chest compressions and to guide changes of hands position in order to improve heart contractility. In 3 out of 6 cases chest compressions were deemed not satisfactory and changes of hands positions guided by US subsequently improved the quality of chest compressions. In the other 3 cases the compression of left ventricle was deemed good and no changes were made. Importantly all US examinations were conducted without interferences with normal standard of care. The authors state that these observations indicate that changes of hands position guided by US could improve the quality of CPR and this area deserves attention and consideration in the future.
  • Recommended by Søren Rudolph

Pediatrics

R&R Game Changer? Might change your clinical practiceShavit I et al. Sedation for children with intraoral injuries in the emergency department: a case-control study. Pediatr Emerg Care 2014; 30(11): 805-7. 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

EducationR&R Hot Stuff - Everyone’s going to be talking about thisPatel MS et al. Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients. JAMA 2014; 312(22): 2364-73. PMID 25490327

  • Duty hour rules and regulations are pervasive in US medical training. This study looks at the effect of institution of duty hour restrictions on the outcome of Medicare patients. Although the study is retrospective and derived from large database information, it gives us a peak into the bigger picture of duty hours regulations: patient outcomes. The study authors found no difference in any important outcomes. It is similarly unclear whether these restrictions have improved resident quality of education or quality of life. Large system wide changes duty hour restrictions should, in the future, be implemented not based on theory but actual data of improved outcomes. An accompanying editorial delves into this issue and others.
  • Recommended by Anand Swaminathan

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.

The post Research and Reviews in the Fastlane 071 appeared first on LITFL.

LITFL Review 169

LITFL review

Welcome to the 169th 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

resizer EMOttawa shares their top EBM papers from 2014 in this really useful blog post. [SL]

A fantastic resource of Paediatric Trauma Pearls and Pitfalls from emDocs. [SL]

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

The Best of #FOAMtox Toxicology

#The Best of #FOAMped Pediatrics

  • Are you afraid of pediatric EKGs? Take the Don’t Forget the Bubbles quiz to see what you know and what you don’t. [AS]
  • What’s the best way to fix a Pulled (aka Nursemaid’s) Elbow? Read Broomedocs to find out why hyperpronation is preferred to supination-flexion. [AS]

News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

The post LITFL Review 169 appeared first on LITFL.

Research and Reviews in the Fastlane 070

Research and Reviews in the Fastlane

Welcome to the 70th 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan 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

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

Shah VP et al. Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults. JAMA Peds 2013; 167(2): 119-25. PMID 23229753

  • A number of studies demonstrate the utility of POC US for the diagnosis of pneumonia. This study demonstrated a high sensitivity (86%) and very high specificity (97%) when looking for consolidations > 1 cm on US compared to chest X-ray as the standard. The study was done quickly (mean 7 minutes) and by non-experts (1 hour of training) increasing the likelihood that the findings can be generalized to non-study settings.
  • Recommended by: Anand Swaminathan

The Best of the Rest

ResuscitationR&R Eureka - Revolutionary idea or conceptOlaussen A, et al. Return of consciousness during ongoing Cardiopulmonary Resuscitation: A systematic review, Resuscitation 2014; 86: 44-48. PMID 25447435

  • After introduction of mechanical CPR device CPR induced consciousness seems more prevalent. Though CPR induced consciousness may be distressing for the rescuers (and maybe the patient) it is often percieved as a good prognostic sign of outcome. The current guidelines on advanced cardiopulmonary resuscitation focus on delivering high quality chest compressions with minimal interruptions only pausing for rhythm check or if the patient shows signs of life. Thus CPR induced consciousness may be mistanken for signs of life interupting the sequence of CPR and influence the quality of care. This systematic review only identified reports on 10 patients. The incidence, implications and prognostic value of CPR-induced consciousness remains unknown and should be eveluated.
  • Recommended by: Søren Rudolph

Pediatrics, Trauma
R&R Hot Stuff - Everyone’s going to be talking about thisEckert MJ et al. Tranexamic acid administration to pediatric trauma patients in a combat setting: The pediatric trauma and tranexamic acid study (PED-TRAX). J Trauma Acute Care Surg 2014; 77(6): 852-8. PMID: 25423534

  • The use of TXA in severe trauma is current standard practice, but its benefit in Peds trauma is not clear. This study is a retrospective review of TXA use in pediatric civilian victims managed by NATO in Afghanistan. From 766 patients, 66 received TXA; this patients had severe torso or extremity trauma. The TXA group was significantly sicker than control (ISS 18 vs 10). The unadjusted mortality was not statically significant but higher in the TXA group (15 vs 8%), however the severity adjusted mortality was lower in TXA with an OR 0.27; with no adverse events. The study has several limitations, particularly a relatively low number of events and the differences between TXA and control (being the TXA way sicker), but appears to show TXA is beneficial is severe pediatric trauma.
  • Recommended by Daniel Cabrera

Trauma
R&R Hot Stuff - Everyone’s going to be talking about thisRowell AE et al. Moderate elevations in international normalized ratio should not lead to delays in neurosurgical intervention in patients with traumatic brain injury. J Trauma Acute Care Surg 2014; 77(6): 846-51. PMID 25423533

  • Should we delay neurosurgical intervention in patients with traumatic intracranial bleeds due to slight INR elevations? This study looks at the delays that occur from mild elevations and found that patients with INR < 1.4 had their neurosurgical intervention 174 minutes earlier on average than those with an elevated INR. Additionally, they found that mild INR elevations were not correlated with abnormal coagulation based on TEG measurement. Although patient outcomes were not a primary outcome, this study should make us reconsider the utility of INR and delayed intervention based on it.
  • Recommended by Anand Swaminathan

 Emergency Medicine
R&R Hot Stuff - Everyone’s going to be talking about thisR&R Game Changer? Might change your clinical practiceHoppe JA et al. Association of Emergency Department Opioid Initiation With Recurrent Opioid Use. Ann Emerg Med 2014. PMID 25534654

  • A retrospective observational study which examines the link between opioid prescriptions given in the ED to opioid naive patients (as defined by no filled rx in the past year) and opioid use one year later. A well done study which used the state prescription monitoring program to determine opioid use, and found an important link between filled ED prescriptions and later use. An adjusted odds ratio of 1.8 for recurrent use was found. Limited by the design of the study, this is still important information for ED providers as we consider the implications of providing opioids to our patients for their acute pain issues.
  • Recommended by Jeremy Fried

Pediatrics
R&R Trash - Must read, because it is so wrong!
Tapiainen T et al. Effect of antimicrobial treatment of acute otitis media on the daily disappearance of middle ear effusion: a placebo-controlled trial. JAMA Pediatr. 2014;168:(7)635-41. PMID 24797294

  • This RCT compared amoxicillin-clavulanate with placebo in children 6mo – 15 years old with acute otitis media (AOM) (n=84). The authors conclude “antimicrobial treatment of AOM in children is beneficial because it significantly reduces the duration of Middle Ear Effusion (MEE).” These findings seemingly contradict the AAP and Cochrane recommendations against antibiotics for most cases of AOM. Why? The primary and secondary outcomes were not clinically relevant, MEE and time to improved tympanogram findings, respectively. Let’s stop looking for small improvement in surrogate measures, particularly when the intervention (antibiotics) is associated with harm (NNH 1 in 9 for diarrhea).
  • Recommended by Lauren Westafer

Airway
R&R Hot Stuff - Everyone’s going to be talking about thisRaymondos K et al. The intubation scoop (i-scoop) – a new type of laryngoscope for difficult and normal airways. Anaesthesia. 2014; 69(9): 990-1001. PMID: 24894025

  • The evolution of laryngoscopy began with devices designed to maximally displace the tongue and other soft tissues of the mouth to establish a direct line of sight between the operator’s eye and the patient’s glottis. Video laryngoscopy allows for less tissue displacement, by eliminating the need for direct line of sight, but because of the distance between the camera and the tip of the blade, and the absence of a channel for delivering the ETT, varying degrees of tissue displacement is still needed. The authors of this paper developed a laryngoscope shaped to follow the curve of the airway, with an ETT channel and the camera mounted at the tip of the blade, which allows for visualization of the glottis and delivery of the tube without tissue displacement. It worked extremely well in this small manikin study, though the failure rates they report with other devices are incongruous with the rest of the literature and undermine face validity. I am also concerned about how this device will perform with soiled airways, common in EM. Though this paper only describes a prototype, this may be the shape of things to come in laryngoscopy.
  • Recommended by Reuben Strayer

 

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.

 

The post Research and Reviews in the Fastlane 070 appeared first on LITFL.