R&R In The FASTLANE 012

Welcome to the 12th 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

Flower O, Finfer S. Glucose control in critically ill patients. Intern Med J. 2012 Jan;42(1):4-6. doi: 10.1111/j.1445-5994.2011.02631.x. PubMed PMID: 22276558 – [Fulltext]

• A short and sweet summary of where we are today in the glucose control in ICU saga.
• Recommended by Chris Nickson

Imazio M, Brucato A, Ferrazzi P, Rovere ME, Gandino A, Cemin R, Ferrua S, Belli R, Maestroni S, Simon C, Zingarelli E, Barosi A, Sansone F, Patrini D, Vitali E, Trinchero R, Spodick DH, Adler Y; COPPS Investigators. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011 Nov 22;124(21):2290-5. Epub 2011 Nov 16. PubMed PMID: 22090167.

• Colchicine used for a month after cardiac surgery decreases the incidence of new onset AF and the recovery time. It did not affect mortality or reduce stroke. Food for thought but probably not good enough to recommend as routine care yet…
• Recommended by: Oliver Flower

Geelhoed GC, de Klerk NH. Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust. 2012 Feb 6;196:122-6. PMID:  22304606 – [Fulltext]

• Introducing the 4 hour rule in WA in 2009 was associated with reduced ED overcrowding and, in the tertiary hospitals studied, reduced hospital mortality, in the subsequent year, despite rising presentation numbers. Hawthorn effect?
• Overcrowding started to fall in the period immediately preceding the introduction of the 4 hour rule – the staff knew it was coming.
• Implications for other ED populations?
• No description of mechanisms to facilitate the 4 hour rule – Need stakeholder buy-in. Goes well with the accompanying MJA paper on implementing a 4-hour rule.
• Implications for ED career longevity if it is reduced to a mere triage service.
• Recommended by: Matthew Mac Partlin

Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K.  Morphine and Ketamine Is Superior to Morphine Alone for Out-of-Hospital Trauma Analgesia: A Randomized Controlled Trial. Ann Emerg Med. 2012 Jan 11. [Epub ahead of print] PubMed PMID: 22243959

• Ketamine plus morphine is better than morphine alone for trauma pain in the pre-hosp setting. More “adverse effects” in the ketamine group if you count increased heart rate as a SE. No reason why we can’t do the same thing in the ED if needed.
• Recommended by: Andy Neill
• Learn more: Emergency Medicine Ireland — Morphine and ketamine for prehospital analgesia

Roback MG, Wathen JE, MacKenzie T, Bajaj L. A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency  department orthopedic procedures. Ann Emerg Med. 2006 Nov;48(5):605-12. Epub 2006 Aug 14. PubMed PMID: 17052563.

• I’ve only ever used ketamine IV in kiddies and adults but a lot of guidelines suggest IM is great too. This is an unblinded RCT of IV v IM which seems to me to show that IV is better. There was a lot more vomiting than usual in this trial (18% in one group and 35% in the other) Was stopped early at “nursing request” when the nurses thought the IM was crap.
• Recommended by: Andy Neill
• Learn more: Emergency Medicine Ireland — Ketamine IV versus IM

Teoh DL, Reynolds S. Diagnosis and management of pediatric conjunctivitis. Pediatr Emerg Care. 2003 Feb;19(1):48-55. Review. PubMed PMID: 12592117.

• Great review of a common problem with highlights of some often overlooked issues. Sometimes it is good to review what we think is “simple.”
• Recommended by: Sean Fox

Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: analysis of the ideal breast. J Plast Reconstr Aesthet Surg. 2012 Jan;65(1):8-16. Epub 2011 Aug 24. Review. PMID: 21868295

• Hmmm… Perhaps useful for emergency presentations of the future. I can see the triage note now: “Patient presents with non-ideal breasts”. Also of note, the authors are from ‘The Cadogan Clinic”…
• Recommended by: Chris Nickson

Urdang M, Mallek JT, Mallon WK. Tattoos and piercings: a review for the emergency physician. West J Emerg Med. 2011 Nov;12(4):393-8. PubMed PMID: 22224126; PubMed Central PMCID: PMC3236178.

• Tattoos and piercings can give significant clues to a person’s lifestyle and risk factors, and also cause specific complications such as dental trauma (oral piercings) and failure of barrier contraception (genital piercings).
• Recommended by: Leon Gussow

Fox JC, Richardson AG, Lopez S, Solley M, Lotfipour S. Implications and approach to incidental findings in live ultrasound models. West J Emerg Med. 2011 Nov;12(4):472-4. PubMed PMID: 22224140; PubMed Central PMCID: PMC3236140.

• When teaching hand-on ultrasound, how should you deal with the possibility that incidental findings may show up when models are scanned? An important topic I had not seen discussed previously.
• Recommended by: Leon Gussow

Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a  case series of 98 patients. Mayo Clin Proc. 2012 Feb;87(2):114-9. PubMed PMID: 22305024.

• Somewhat vague in its definitions, but the largest case series of cannabinoid hyperemesis syndrome to date.<
• Recommended by: Leon Gussow