Research and Reviews in the Fastlane 192

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

 

Research and Reviews in the Fastlane

Welcome to the 192nd 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, Justin Morgenstern and 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

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

Brazil V. Translational simulation: not ‘where?’ but ‘why?’ A functional view of in situ simulation. Advances in Simulation. 2017; 2(1). DOI: 10.1186/s41077-017-0052-3

  • This free-to-access article in Advances in Simulation is a MUST READ if, like me, you share Victoria Brazil’s philosophy that simulation should be a service, not a center, and should translate into improved care of patients and patient outcomes. This article defines the concept of ‘translational simulation’ and is the perfect succinct, academic overview of this exciting area.
  • Recommended by: Chris Nickson

The Best of the Rest

Emergency MedicineR&R Game Changer? Might change your clinical practice
Crowell EL, et al. Accuracy of Computed Tomography Imaging Criteria in the Diagnosis of Adult Open Globe Injuries by Neuroradiology and Ophthalmology. Acad Emerg Med. 2017. PMID: 28662312 

  • Some people rely on CT scan of the orbits to rule in or rule out an open globe. This retrospective chart review, in which CT scans were reviewed independently by a blinded neuroradiologist and ophthalmologist (x2) argues that CT cannot be trusted as the sensitivity was 51% to 77%. The specificity was good at 97% but given this is a diagnosis we don’t want to miss, clinical exam by an ophthalmologist is warranted if you actually think a patient may have a ruptured globe.
  • Recommended by: Lauren Westafer

Critical Care
R&R Hot Stuff - Everyone’s going to be talking about this
Allingstrup MJ, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive care medicine. 2017; 43(11):1637-1647. PMID: 28936712

  • In acute, mechanically ventilated, adult ICU patients, delivering individualised nutrition (based on indirect calorimetry and urinary urea measurements) did not result in improved patient centred outcomes at 6-months, as compared to standard nutrition.
  • Recommended by: Andrew Udy

Emergency Medicine
R&R Mona Lisa -Brilliant writing or explanation” width=
O’Hagan Lucy. Narrating Our Selves: Eric Elder Lecture Presented at the annual conference of the Royal New Zealand College of General Practitioners, July 2016. Journal of Primary Health Care.  1017;9:100-104. DOI: 10.1071/HC15925

  • This in an incredible piece of writing, specifically about general practice, but really just about being a doctor and a human. Must read whatever your specialty.
  • Recommended by: Justin Morgenstern

Emergency Medicine
R&R Hot Stuff - Everyone’s going to be talking about this
Zahed R et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Acad Emerg Med 2017. PMID: 29125679

  • This randomized, open-label study comparing topical TXA to anterior packing demonstrated a 44% absolute difference in cessation of epistaxis at 10 minutes in the group receiving topical TXA. This NNT of ~2 may be too good to be true but, after application of pressure, TXA should be considered as a next line therapy before the use of packing.
  • 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.

Last update: Jan 18, 2018 @ 1:53 am

 

Research and Reviews in the Fastlane 192
Justin Morgenstern

Medmastery: The appendix

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

The team at Medmastery fresh from a second Comenius Award from the Society for Pedagogy, Information and Media (GPI) are providing LITFL readers with a series of FOAMed courses from across their website.

First we take a dive into the Abdominal Ultrasound Essentials course and review strategies to help identify appendicitis with the help of ultrasound imaging

Further reading:

Guest post: Nikolaus Mayr, MD. Chief Resident of Radiology, Department of Radiology, and Nuclear Medicine at the Hospital of the Brothers of St. John of God in Salzburg.

Medmastery: The appendix
Mike Cadogan

Research and Reviews in the Fastlane 191

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

 

Research and Reviews in the Fastlane

Welcome to the 191st 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, Justin Morgenstern and 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

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

ART Trial Investigators. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017; 318(14):1335-1345. PMID: 28973363

  • A multi-center non-blinded randomised controlled trial that found higher mortality in patients with moderate-to-severe ARDS who received an open lung ventilation strategy compared with those who got ARDSNet-style protective lung ventilation. The open lung approach involved higher PEEP settings and the use of a staircase recruitment manoeuvre. Questions remain about the external validity of the study and whether we can identify subgroups of patients who might benefit. Nevertheless, ART is a real shake up for ‘open lung’ practitioners.
  • Recommended by: Chris Nickson

The Best of the Rest

Emergency MedicineR&R Hot Stuff - Everyone’s going to be talking about this
Roldan CJ, et al. Randomized Controlled Double-blind Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis. Academic emergency medicine. 2017; 24(11):1307-1314. PMID: 28646590

  • This is a teeny tiny RCT of ED patients with previously diagnosed gastroparesis treated with either haloperidol 5 mg IV or placebo, in addition to conventional therapy (which were mostly PPIs, ondansetron, opioids, and metoclopramide and similar between groups). The mean pain score dropped by 5.37 in the haloperidol group compared to 1.11 in the placebo group, which was statistically significant. This is by no means a definitive trial but is a piece of literature in line with the current practice of many to give haloperidol to patients with this frustrating diagnosis (and may help with opioid sparing, although this is yet to be proven)
  • Recommended by: Lauren Westafer
  • Further reading: Gastroparesis – I Feel Like Throwing Up (The SGEM)

Systems and Administration
R&R Hot Stuff - Everyone’s going to be talking about this
Rosenbaum L. The Less-Is-More Crusade – Are We Overmedicalizing or Oversimplifying? The New England journal of medicine. 2017; 377(24):2392-2397. PMID: 29236644

  • Although I disagree with many of the individual points raised, the overall message of this essay is good: medical care is incredibly complex and all too often our conversations about it (and those of policy makers) are oversimplified. On the whole, I think it’s is clear that we are doing far too much in medicine; that over-treatment and over-diagnosis are far bigger problems than under-treatment and under-diagnosis. However, the author is spot on when she says, “the most accurate conclusion is that sometimes less is more, sometimes more is more, and often we just don’t know”. This article has spawned a lot of controversy. It is worth reading to understand why.
  • Recommended by: Justin Morgenstern

Emergency Medicine
R&R Eureka - Revolutionary idea or concept
Samuels EA, et al. “Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Annals of emergency medicine. 2017. PMID: 28712604

  • This is a qualitative study of transgender patients who visited an ED in the US. This article is a must read as providers often lack insight into the complexities of caring for transgender patients and systemic barriers to conscientious care. This article points to some things providers can change immediately including proper use of pronouns, comfort with inquiring about gender identity, lack of understanding of medical issues related to transgender health, and unfortunately intentional and unintentional shaming or disrespect. Other issues need systemic reform, such as reconciliation of sex and gender identity in EMRs and hospital bracelets and lack of privacy in crowded EDs.
  • Recommended by: Lauren Westafer
  • Further Reading: The Transgender Patient + more from ACEP (FOAMCast)

Resuscitation
R&R Hot Stuff - Everyone’s going to be talking about this
Holden D et al. Safety Considerations and Guideline-Based Safe
Use Recommendations for “Bolus-Dose” Vasopressors in the Emergency Department. Ann Emerg Med 2017. PMID: 28601272

Cole JB. Bolus-Dose Vasopressors in the Emergency Department: First, Do No Harm; Second, More Evidence Is Needed. Ann Emerg Med 2017 PMID: 28754354

  • The use of push-dose pressors has gained steam over recent years. This article is an excellent review of the reasons for use, the pharmacology of different agents as well as the scant literature investigating their use. An accompanying editorial calls for a systematic approach to research on the intervention simultaneously raising the issue of knowledge translation via social media based on expert recommendations. While the caution expressed by the authors is important, we must also ask whether withholding the treatment while awaiting a large randomized double-blind control trial that will likely never happen is responsible.
  • Recommended by: Anand Swaminathan
  • Further Reading: Sept 2017 Journal Club (BroomeDocs)

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: Jan 11, 2018 @ 3:26 am

 

Research and Reviews in the Fastlane 191
Justin Morgenstern