R&R In The FASTLANE 013

Welcome to the 13th 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

Halstead S, Roosevelt G, Deakyne S, Bajaj L.  Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis.  Pediatrics. 2012 Feb 13. [Epub ahead of print] Pubmed PMID: 22331343

• Treating the numbers in bronchiolitis – well, if we can make the numbers look better with a little supplemental O2, can’t they go home?
• Recommended by Ryan Radecki
• Learn more: Discharging bronchiolitis on home oxygen

Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012 Feb 27;2(1):e000850. Print 2012. PubMed PMID: 22371848.

• When I first saw this study, my eyes just about popped out of my head. My first job out of residency was all nights and I could never fall asleep before shifts, so by the 4th night in a row, I was really tired. Then I took a zolpidem at 5pm, woke up at 10 and it was night shift 2.0. Wide awake and ready to roll. It was like a cold glass of water on a hot summer day. But just as the Joe Jackson song goes, everything, it seems, gives you cancer…
• Recommended by: Rob Orman

Abo A, Chen L, Johnston P, Santucci K. Positioning for Lumbar Puncture in Children Evaluated by Bedside Ultrasound.  Pediatrics 2010 125: e1149-e1153. PubMed PMID: 20403933 – [Full text]

• Study numbers very small, but food for thought… Neck flexion to be abandoned in the positioning for paediatric LP?
• Recommended by: Sa’ad Lahri

Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W; NETT Investigators. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012 Feb 16;366(7):591-600. PubMed  PMID: 22335736.

• For prehospital status epilepticus IM Midazolam went head to head with IV lorazepam to see which would stop seizure activity more quickly… Tried it in hospital this week! Thumbs up!
• Recommended by: Sa’ad Lahri

Lawrey E, Jones P. Prosthetic hip dislocations: Is relocation in the emergency department by emergency medicine staff better? Emergency Medicine Australasia. DOI: 10.1111/j.1742-6723.2011.01517.x

• Seems to have been designed to settle a fight… I mean answer the question of who should relocate hips in the ED. Chart review with good methods and it seems that the ED can reduce hips just fine thank you very much. There are of course some potential confonuders here but good none the less.
• Recommended by: Andy Neill

Kline JA, Corredor DM, Hogg MM, Hernandez J, Jones AE. Normalization of vital  signs does not reduce the probability of acute pulmonary embolism in symptomatic  emergency department patients. Acad Emerg Med. 2012 Jan;19(1):11-7. doi: 10.1111/j.1553-2712.2011.01253.x. PubMed PMID: 22251189.

• If at first it sounds like PE, look for it, even if the numbers get better.
• Recommended by: Ioana Vlad

Khalid MS, Ahmad N, Moin S, El-Faedy O, Gaffney P. Spontaneous pneumomediastinum: a rare complication of acute asthma. Ir J Med Sci. 2008 Dec;177(4):393-6. Epub 2007 Jul 6. PubMed PMID: 17619095.

• Rare complication of asthma but I’ve seen two within a month. Nice review of spontaneous pneumomediastinum
• Recommended by: Ioana Vlad

Zanella A, Cressoni M, Epp M, Hoffmann V, Stylianou M, Kolobow T. Effects of tracheal orientation on development of ventilator-associated pneumonia: an experimental study. Intensive Care Med. 2012 Feb 18. [Epub ahead of print] PubMed PMID: 22349422

• Positioning ventilated patients 30-45 degrees head up is widely accepted as the thing to do to prevent ventilator-associated pneumonia. Yet the evidence for this practice is limited. This editorial summarises the state of play nicely and commments on a study by Zanella et al in the same issue showing that a slightly head down position drastically reduced VAP…. in pigs.
• Recommended by: Chris Nickson

Tobin MJ. Extubation and the myth of “minimal ventilator settings”. Am J Respir Crit Care Med. 2012 Feb 15;185(4):349-50. PubMed PMID: 22336673.

• Anything that Martin Tobin touches is gold in my book and this perspective on vent weaning/extubation is no different:”The challenge of clinical medicine is not about taking care of the great majority of patients who do well irrespective of the methods employed by their physicians. Instead, the goal is to take feasible steps that have a high likelihood of circumventing a catastrophe in a small number of instances.”
• Recommended by: Robert Arntfield

Marini JJ. Unproven clinical evidence in mechanical ventilation. Curr Opin Crit Care. 2012 Feb;18(1):1-7. PubMed PMID: 22157253.

• Yay! … critical care medicine has not been reduced to a set of protocols and guidelines; there is still an art to it. One size does not fit all! Not much new in this review, more of an acknowledgement of the obvious, which might be of assistance in those awkward M&M meetings … it’s in print, so it can back a practice.
• Recommended by: Matthew Mac Partlin