R&R In The FASTLANE 019

Research and Reviews in the Fastlane 600

Welcome to the 19th 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

Kelly LE, Rieder M, van den Anker J. More codeine fatalities after tonsillectomy in north american children. Pediatrics. 2012 May;129(5):e1343-7. Epub 2012 Apr 9. Pubmed PMID: 22492761

  • You may have used codeine safely so far – but it’s a flawed medication and should be replaced in your practice.
  • Recommended by: Ryan Radecki
  • Learn more: EM Lit of Note — Codeine, Potentially Unpredictably Lethal

RR WTF

Suzuki H, Nakajima W, Aoyagi M, Takahashi M, Kuzuta T, Osaki M. [A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient]. Masui. 2012 Apr;61(4):384-6. Japanese. PubMed PMID: 22590940.

  • Why restrict intubation to supine, semifowler’s, or tomahawk, when you can make the face-plane parallel to the floor? n=1 study of patient intubated while prone in the OR. Abstract-only – my library doesn’t have access to Masui (Japanese for Anesthesia) and I can’t read Japanese regardless.
  • Recommended by: Seth Trueger

RR Game Changer

Venezia D, Wackett A, Remedios A, Tarsia V. Comparison of Sitting Face-to-Face Intubation (Two-Person Technique) with Standard Oral-tracheal Intubation in Novices: A Mannequin Study. J Emerg Med. 2012 May 3. [Epub ahead of print] PubMed PMID: 22560270

  • We should all know the limitations of airway studies simulation (e.g. Airtraq is great on models, terrible in the field; see this Resus.ME post) but this is a good proof-of-concept paper that shows laryngoscopists can be reasonably trained to perform face-to-face tomahawk intubations. I’ve only done this on models and people/patients without passing a tube, but it’s always good to have an extra arrow in the quiver.
  • Recommended by: Seth Trueger

RR Game Changer

Paul AM, Young NH, Price GC. Emergency tracheal intubation without drugs: outcome and one-year survival of medical patients not in cardiac arrest. Scott Med J. 2012 May;57(2):84-7. PubMed PMID: 22555228

  • More evidence that if the patient you’re intubating has a pulse, you want to paralyze them. The crash airway for the nearly-dead had longer intubation times and more first-pass failures. (n.b. my library doesn’t have access to the Scottish Medical Journal so I’ve only seen the abstract)
  • Recommended by: Seth Trueger

RR Eureka

Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: a variation on a theme. Acad Emerg Med. 2008 Jul;15(7):683-7. PubMed PMID: 18691216.


RR Game Changer

Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as First-line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice. World J Surg. 2012 May 9. [Epub ahead of print] PubMed PMID: 22569747.

  • This is a real world study that shows that antibiotics first is a viable option for the treatment of appendicitis, confirming previous RCTs. Complications were less for those receiving primary antibiotics compared to those receiving primary surgery. A difficulty is that not all cases were ‘confirmed appendicitis’ – ‘early appendicitis’ can be hard to confirm.
  • Recommended by: Chris Curry

RR WTF

Rossen R, Kabat H, Anderson J. P. Acute arrest of cerebral circulation in man. Arch Neurol Psychiat; 1943(50): 510-28 – [Fulltext] – [Commentary]

  • The Rossen study is shocking in its design, literally eye-popping in its technique and with consequently remarkable findings that obviously will never be duplicated in humans. The commentary by Smith (2007) is well worth reading.
  • Recommended by: Reuben Strayer

RR WTF

Panesar NS, Graham CA. Does the death rate of Hong Kong Chinese change during the lunar ghost month? Emerg Med J. 2012 Apr;29(4):319-21. Epub 2011 Dec 28. PubMed PMID: 22205780.

  • Emergency Physicians examine death rates in Hong Knog. How about their awesome conclusion:”To protect their family, the Chinese women postpone death until after the hungry ghosts have been fed and hopefully banished forever.”
  • Recommended by: Cliff Reid

RR Eureka

Korniyenko A et al. Visceral angioedema due to angiotensin-converting enzyme inhibitor therapy. Cleve Clin J Med 2011 May;78(5):297-304. Pubmed PMID: 21536824

  • Visceral angioedema caused by ACE inhibitors in another obscure, easily missed toxicologic cause of cryptic abdominal pain and vomiting, to be considered along with narcotic bowel syndrome and cannabinoid hyperemesis.
  • Recommended by: Leon Gussow
  • Learn more: The Poison Review — Puzzling abdominal pain and vomiting?

RR WTF

Mc Laughlin P, Neill SO, Fanning N, Mc Garrigle AM, Connor OJ, Wyse G, Maher MM. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad. Emerg Radiol. 2012 Apr;19(2):127-33. Epub 2011 Dec 16. PubMed PMID: 22173819.

  • Radiologists have been tele-reading for a while and this is a little study from Cork examining how well the iPad did for reading CT Heads. Bottom line – it did OK. This was with the original iPad and I imagine the newer one might pull it off even better.<
  • Recommended by: Andy Neill
  • Learn more: EM Ireland — iPad for radiology reads

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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