R&R in the FASTLANE 005

Research and Reviews in the Fastlane 600

Welcome to the 5th 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 10 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 : Overview; Archives and Contributors


This Edition’s R&R Hall of Famer

RR Hall of FAMER

Burls A, Cabello JB, Emparanza JI, Bayliss S, Quinn T. Oxygen therapy for acute myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2011 Nov;28(11):917-23. Epub 2011 Feb 23. Review. PMID: 21346260

  • The authors looked in vain for articles showing that oxygen therapy was beneficial for patients with acute coronary syndromes.  Their conclusion: not only was supplemental oxygen not beneficial, it was probably harmful.  I think we will have a hard time making this one go away, though.
  • Recommended by Joe Lex

RR Mona Lisa

Janneck L, Koyfman A , Takayesu JK. Clinical review of malaria for the emergency physician. African Journal of Emergency Medicine Volume 1, Issue 3, September 2011, Pages 126-130. – [ Fulltext]

  • A fantastic review of malaria, especially pertinent to the Emergency Physician in the developing world.
  • Recommended by: Sa’ad Lahri

RR HOT STUFF

Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Emond M, Symington C, Sutherland J, Worster A, Hohl C, Lee JS, Eisenhauer MA, Mortensen M, Mackey D, Pauls M, Lesiuk H, Wells GA. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ. 2011 Jul 18;343:d4277. doi: 10.1136/bmj.d4277. PMID: 21768192;   PMCID: PMC3138338.

  • No LP needed to rule out SAH? This Canadian research suggests it might be so, IF the scan is done within 6 hours of onset, you use a fancy new CT scanner and have trained radiologist to look at the pictures.
  • Recommended by: Peter Allely

RR Game Changer

Burls A, Cabello JB, Emparanza JI, Bayliss S, Quinn T. Oxygen therapy for acute myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2011 Nov;28(11):917-23. Epub 2011 Feb 23. Review. PMID: 21346260.

  • The authors looked in vain for articles showing that oxygen therapy was beneficial for patients with acute coronary syndromes.  Their conclusion: not only was supplemental oxygen not beneficial, it was probably harmful.  I think we will have a hard time making this one go away, though.
  • Recommended by: Joe Lex

RR Game Changer

Grise EM, Adeoye O, Lindsell C, Alwell K, Moomaw C, Kissela B, Flaherty M, Ferioli S, Khatri P, Broderick J, Kleindorfer D. Emergency Department Adherence to American Heart Association Guidelines for Blood Pressure Management in Acute Ischemic Stroke. Stroke. 2011 Oct 27. [Epub ahead of print] PMID: 22033993.

  • Remember blood pressure shouldn’t be lowered acutely in acute ischemic stroke – we’re not doing a very good job of it.
  • Recommended by: Ryan Radecki
  • Learn more: Emergency Literature of Note – ED BP management in acute stroke

RR Game Changer

Herrin J, Miller LE, Turkmani DF, Nsa W, Drye EE, Bernheim SM, Ling SM, Rapp MT, Han LF, Bratzler DW, Bradley EH, Nallamothu BK, Ting HH, Krumholz HM. National performance on door-in to door-out time among patients transferred for primary percutaneous coronary intervention. Arch Intern Med. 2011 Nov 28;171(21):1879-86. PMID: 22123793.

  • Either change something about your processes for transferring STEMI for PCI – or get back on board the lytics train.
  • Recommended by: Ryan Radecki
  • Learn more: Emergency Literature of Note – Just do it: lytics for STEMI

RR Game Changer

Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Pace NL, Apfel CC; Perioperative Clinical Research Core. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011 Mar 15;342:d1110. doi:10.1136/bmj.d1110. Review. PMID: 21406529.

  • We do a lot of sedation with propofol so it’s nice to know something we can do to make it more pleasant. Good interventions include 1) a bit of opiate before injection, 2) a bit (5-20mg) lignocaine in an occluded vein prior to injection of the white stuff.
  • Recommended by: Andy Neill

RR Eureka

Rémi J, Pfefferkorn T, Owens RL, Schankin C, Dehning S, Birnbaum T, Bender A, Klein M, Adamec J, Pfister HW, Straube A, Feddersen B. The crossed leg sign indicates a favorable outcome after severe stroke. Neurology. 2011 Oct 11;77(15):1453-6.  PMID: 219876413198984.

  • For some time, I’ve been vowing to study the fact that if a patient crosses their legs while waiting to be seen, he will have no actual pathology. I always thought the IRBs would refuse to allow me to prove this important clinical sign. Well these folks managed to get it done. It is not an ED study; it is on stroke patients during admission. And there are all sorts of confounders for what I wanted to prove like you need to be able to move your legs in order to cross them, etc. But I don’t care, I now have more ammunition to get my study through the IRB.
  • Recommended by: Scott Weingart

RR Eureka

Yanaka K, Nose T. Braid dressing for hair-bearing scalp wound. Neurocrit Care. 2004;1(2):217-8. PMID: 16174919.

  • How do you apply bandages to scalp lacerations? Do they just fall off within minutes? This “hair-braid dressing” technique is a tip from the Neurosurgical literature.
  • Recommended by: Michelle Lin
  • Learn more: Academic Life in Emergency Medicine – Trick of the trade: Bandaging scalp wounds

RR Game Changer

Green T, Green H, Scandlyn J, Kestler A. Perceptions of short-term medical volunteer work: a qualitative study in Guatemala. Global Health. 2009 Feb 26;5:4. PMID: 19245698; PMCID: 2662818.

  • Read this if you are doing short term volunteer work in International Emergency Medicine
  • Recommended by: Chris Curry

Research and Reviews icon glossary

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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