End of Life & Organ Donation

A 40 year old male, with no significant past medical history, has a severe head injury following a motor vehicle accident one week previously. It is deemed that he has a non-survivable injury, although he is not brain dead. His wife has raised the possibility of organ donation post cardiac death (DCD). In your conversation […]

Research and Reviews in the Fastlane 132

Research and Reviews in the Fastlane

Welcome to the 132nd 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

Research and Critical Appraisal
R&R Hall of Famer - You simply MUST READ this!

Saini P et al. Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews. BMJ  349:g6501. 2014. PMID: 25416499

  • These authors looked at how accurately harms are reported in studies. Looking at a general cohort of studies, the found that the studies either didn’t report harms, or only partially reported harms 76% of the time. It is an important reminder that we tend to minimize our discussions of harm. For most therapies, it is likely that the true harms are greater than those reported in clinical trials.
  • Recommended by: Justin Morgenstern

The Best of the Rest

Emergency Medicine, Urology
Schultz L et al. Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections. J Emerg Med 2016. PMID: 27066953

  • Misinterpretation of the urinalysis is a common issue in the Emergency Department. This article reviews 10 myths about the UA and UTIs. A common theme that permeates the article is that an abnormal UA is not diagnostic of a UTI: symptoms must be present as well since a significant portion of patients will have chronic colonization. A good lesson to keep in mind the next time you work clinically.
  • Recommended by: Anand Swaminathan

Emergency Medicine, Neurology
Friedman BW et al. The association between headache and elevated blood pressure among patients presenting to an ED. The American journal of emergency medicine. 32(9):976-81. 2014. PMID: 24993684

  • More data that BP & HA aren’t related. To be fair, the patients with headaches had higher BPs, but lowering BPs didn’t make a difference. One more reason to explain to the patient, the referring doc, the floor staff, etc, that no, their head is not about to explode.
  • Recommended by: Seth Trueger

Education, Psychiatry and Mental Health
R&R Eureka - Revolutionary idea or concept
Konopasek L, Slavin S. Addressing Resident and Fellow Mental Health and Well-Being: What Can You Do in Your Department? J Pediatr. 2015 Dec;167(6):1183-1184.e1. PMID: 26611453

  • Although some of our medical elders laugh about how easy residents have it as compared to the ‘good old days’, residency is still incredibly stressful and residents are at high risk for burnout and depression. We need to look after our own. Some suggestions from this article: try to decrease the stigma around mental health in medicine, role model healthy behaviours, make mental well being an emphasis during orientation, and specifically check in with residents to see how they are coping.
  • Recommended by: Justin Morgenstern

Emergency Medicine, Pediatrics, Gastroenterology
R&R Hot Stuff - Everyone’s going to be talking about thisTseng HJ et al. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015. PMID: 26320521

  • An excellent, in depth review of finding and managing foreign bodies that are ingested, aspirated or inserted. The authors create some great tables that can act as rapid access guides on your smart device for just in time clinical guidance.
  • Recommended by: Anand Swaminathan

Research and Critical Appraisal
R&R Eureka - Revolutionary idea or concept
Zipkin DA, et al. Evidence-based risk communication: a systematic review. Annals of internal medicine. 161(4):270-80. 2014. PMID: 25133362

  • Statistics are easily gamed and, are increasingly called upon as we engage patients in shared decision making, Communicating with patients – Think the number need to treat (NNT) is the best way? That’s not what this review found. They found that participants most accurately perceived risk when presented with absolute risk reduction but were most swayed by relative risk.
  • Recommended by: Lauren Westafer

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 132 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Funtabulously Frivolous Friday Five 143

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 143

Question 1

What is Fagan famous for in evidence-based medicine (nothing to do with Oliver Twist)?

  • The Fagan nomogram converts pre-test porbabilities into post-test probabilities using the likelihood ratio for any given test.



Question 2

What do a sloth bear and local people in the Central Indian Highlands get from Madhuca flowers?

  • A hangover.
  • They both eat them when they’ve fermented so as to get drunk.

Question 3

What was Dr Guedel’s dog called and what did he do to it?

  • His dog’s name was Airway.
  • He intubated it of course. He wanted to prove that a cuffed ETT tube would prevent aspiration so he famously submerged his dog with the cuffed ETT while it was anaesthetised. Pulled the dog out of the water and woke them up. “Airway” than ran out of the auditorium thus proving his invention was a success. [Reference]


Question 4

A patient presents one week after having a CTPA with tachycardia, hyper-reflexia, heat intolerance and loose bowel motions, labs indicate hyperthyroidism. What phenomenon has occurred?

  • The Jod-Basedow phenomenon. Jod is the German word for iodine and Karl Adolph von Based was the German physician who first described the effect.
  • It is hyperthyroidism following administration of iodine or iodide either dietary or as contrast medium. It does not occur in those patients with a normal thyroid but in those with Graves, toxic multi nodular loiter or thyroid adenomas as it needs a part of the gland that is not suppressed by the actions of the pituitary.
  • Wolf-Chaikoff effect is the opposite which can occur in patients with a normal or diseased thyroid whereby large quantities of iodine or iodide suppress thyroid function. [Reference]

Question 5

Dying on the throne can be embarrassing, who does the following describe?

    He rose at the usual hour of six o’clock. His German valet de chamber (Schroder) stating he ‘never looked better’ on receiving his cup of chocolate. He threw up at the window and looked onto the South-east gardens. He asked Schroder about the weather and wind direction. Since he received favourable answers he announced his intention of walking in the gardens. At quarter past seven, he retired to “a little closet’ to empty his bowels. After a time there was a “noise louder than the royal wind” followed by a groan and a thud.

tywin toilet

  • King George the Second.
  • He died of a rupture in his right ventricle causing a pericardial tamponade.
  • Blood letting was the done thing and his doctor complained he was not able to perform this due to lack of circulation once he got to the king. Probably was not going to help. [Reference]


The post Funtabulously Frivolous Friday Five 143 appeared first on LITFL: Life in the Fast Lane Medical Blog.