R&R In The FASTLANE 018

Welcome to the 18th 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

Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. Epub 2010 Jul 31. Review. PubMed PMID: 20674088

• Levitan et al get into some great technical aspects of video and alternative devices for laryngoscopy. The point here is that while VL may make laryngoscopy easier, tube delivery and placement may paradoxically become more difficult, primarily because of the sharper angle between the blade and the trachea. Porn for airway enthusiasts.
• Recommended by Seth Trueger

Segal N, Yannopoulos D, Mahoney BD, Frascone RJ, Matsuura T, Cowles CG, McKnite SH, Chase DG. Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation. 2012 Mar 28. [Epub ahead of print] PubMed PMID: 22465807.

• Supraglottic devices (SGDs) have been all the rage in emergency settings lately. For lots of good reasons. But this tiny study questions the use of SGDs in cardiac arrest. Without any blood pressure, SGDs compress the carotids and restrict cerebral blood flow. And the flow measurements are convincing. But – it’s on pigs. Still, this will be talked about.
• Recommended by: Thomas Dolven
• Learn more: ScanCrit.com — Supraglottic airway devices in the critically ill

Green RS Reflections from a Canadian visiting South Africa: Advancing sepsis care in Africa with the development of local sepsis guidelines. African Journal of Emergency Medicine (2012), http://dx.doi.org/10.1016/j.afjem.2012.03.004

• Sepsis is a killer worldwide… but needs champions to pioneer it’s death. An excellent overview from Dr Green who is a world Guru on the topic.
• Recommended by: Sa’ad Lahri

Nomura, Jason T, Genes N, Bollinger HR, Bollinger M, and  Reed JF. “Twitter Use During Emergency Medicine Conferences.” The American Journal of Emergency Medicine (March 16, 2012). PMID 22424992

• I’ve always been jealous watching my timeline on twitter fill with hashtags from folk at big conferences. @takeokun pulled the tweets from one conference to get an idea of what people were saying. I look forward to filling your timeline when I’m at ICEM2012!
• Recommended by: Andy Neill

Homma S, et al; the WARCEF Investigators. Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm. N Engl J Med. 2012 May 2. [Epub ahead of print] PubMed PMID: 22551105 – [Fulltext]

• WARCEF trial – For patients with severe heart failure (LVEF < 25%), Warfarin was no better than Aspirin for the combined outcome of any stroke or death. There was a significant reduction in the incidence of ischaemic stroke, but at the expense of major haemorrhage. Patients with pre-existing AF were excluded.
• Recommended by: Matthew Mac Partlin

Matthaiou DK, Ntani G, Kontogiorgi M, Poulakou G, Armaganidis A, Dimopoulos G. An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med. 2012 Apr 27. [Epub ahead of print] PubMed PMID: 22538461.

• Procalcitonin levels – not much good for diagnosing bacterial sepsis, but handy for shortening duration of therapy without increasing 28-day negative outcome rates.
• Recommended by: Matthew Mac Partlin

Smith SW, Khalil A, Henry TD, Rosas M, Chang RJ, Heller K, Scharrer E, Ghorashi M, Pearce LA. Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction. Ann Emerg Med. 2012 Apr 18. [Epub ahead of print] PubMed PMID: 22520989.

• This is Steve Smith’s (yes that guy) big idea about distinguishing BER from STEMI on ECG criteria. This type of thing is really important as the classic STEMI criteria just aren’t cutting the mustard. It’s a dense enough paper to follow and even if you don’t understand the calculation the concept is priceless.
• Recommended by: Andy Neill

Ranchord AM, Argyle R, Beynon R, Perrin K, Sharma V, Weatherall M, Simmonds M, Heatlie G, Brooks N, Beasley R. High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: a pilot randomized controlled trial. Am Heart J. 2012 Feb;163(2):168-75.

• No difference in this pilot study of titrated oxygen therapy for STEMIs – but wide confidence intervals… more studies needed.<
• Recommended by: Andy Brainard

Chiang HK, Zhou Q, Mandell MS, Tsou MY, Lin SP, Shung KK, Ting CK. Eyes in the needle: novel epidural needle with embedded high-frequency ultrasound transducer–epidural access in porcine model. Anesthesiology. 2011 Jun;114(6):1320-4. PubMed PMID: 21519228; PubMed Central PMCID: PMC3104409.

• Tech porn. One-crystal ultrasound transducer placed on the tip of a stylette that fits in the lumbar needle! Never miss an epidural again. And when they get smaller, they will fit in a spinal needle. Maybe.
• Recommended by: Thomas Dolven

Walter S, Kostopoulos P, Haass A, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012 May;11(5):397-404. Epub 2012 Apr 11. PubMed PMID: 22497929

• Taking the crazy on the road – mobile stroke response units with an MD and a scanner in order to save a few minutes for TPA administration. Not sure this is the best resource outlay…
• Recommended by: Ryan Radecki
• Learn more: EM Lit of Note — Mobile Stroke units – Probably Not Helpful