R&R In The FASTLANE 020

Research and Reviews in the Fastlane 600

Welcome to the 20th 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 8 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

Ranieri VM, Thompson BT, Barie PS, Dhainaut JF, Douglas IS, Finfer S, Gårdlund B, Marshall JC, Rhodes A, Artigas A, Payen D, Tenhunen J, Al-Khalidi HR, Thompson V, Janes J, Macias WL, Vangerow B, Williams MD; PROWESS-SHOCK Study Group. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012 May  31;366(22):2055-64. Epub 2012 May 22. PubMed PMID: 22616830

  • PROWESS-SHOCK: Drotrecogin alpha is dead! Long live drotrecogin alpha!
  • Recommended by Matthew Mac Partlin

RR HOT STUFF

Wallace DJ, Angus DC, Barnato AE, Kramer AA, Kahn JM. Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med. 2012 May 31;366(22):2093-101. Epub 2012 May 21. PubMed PMID: 22612639.

  • If your ICU has dedicated specialist intensivists involved in the day-to-day management of critically ill patients in the ICU, there is no additional in-hospital mortality benefit to providing in-house night time intensivist cover. Having dedicated junior staff on the floor at night does seem to add benefit. So the current Australian model may be optimal as it is.
  • Recommended by: Matthew Mac Partlin

RR Game Changer

Rooks VJ, Eaton JP, Ruess L, Petermann GW, Keck-Wherley J, Pedersen RC. Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR Am J Neuroradiol. 2008 Jun;29(6):1082-9. Epub 2008 Apr 3. PubMed PMID: 18388219.

  • This is a slightly bonkers study that did MRI scans of a 100 asymptomatic infants and found that half of them had sub-durals. None of them needed intervention and most were resolved by 4 weeks.
  • Recommended by: Andy Neill

RR Game Changer

Gabaeff SC. Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome. West J Emerg Med. 2011 May;12(2):144-58. PubMed PMID: 21691518; PubMed Central PMCID: PMC3099599.

  • This guy challenges the mechanisms and original research on the link between retinal bleeds, SDH and non-accidental injury. Fascinating little review.
  • Recommended by: Andy Neill
  • Learn more: EM Ireland – Shaken baby syndrome and SDH at birth

RR Game Changer

Bamberg C, Rademacher G, Güttler F, Teichgräber U, Cremer M, Bührer C, Spies C, Hinkson L, Henrich W, Kalache KD, Dudenhausen JW. Human birth observed in real-time open magnetic resonance imaging. Am J Obstet Gynecol. 2012 Jan 13. [Epub ahead of print] PubMed PMID: 22425409.

  • Another slightly bonkers one where someone gave birth in a specially designed MRI scanner. Fascinating images and shows the deformation the skulls of us overly cortex heavy primates have to go through just to be born.
  • Recommended by: Andy Neill

RR Mona Lisa

Ding GK, Buckley NA. Evidence and consequences of spectrum bias in studies of criteria for liver transplant in paracetamol hepatotoxicity. QJM. 2008 Sep;101(9):723-9. Epub 2008 Jul 7. Review. PubMed PMID: 18606611.

  • The classic King’s College Criteria for choosing which paracetamol hepatotoxicity patients need liver transplant don’t seem to work. We need better criteria, or perhaps we liver transplant simply isn’t a worthwhile option for these critically ill patients.
  • Recommended by: Chris Nickson

RR Mona Lisa

Wilson MH, Wise D, Davies G, Lockey D. Emergency burr holes: “How to do it”. Scand J Trauma Resusc Emerg Med. 2012 Apr 2;20:24. PubMed PMID: 22469190; PubMed Central PMCID: PMC3352313.

  • Extradural hematomas with a mass effect and a deteriorating patient needs to be drained within 1-2 hours.. this paper gives an easy to follow, step-by-step procedure with reasonable and clear indications/contraindications.
  • Recommended by: Thomas Dolven
  • Learn more: ScanCrit — Emergency Burr Holes

RR Game Changer

Tayal VS, Hasan N, Norton HJ, Tomaszewski CA. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med. 2006 Apr;13(4):384-8. Epub 2006 Mar 10. PubMed PMID: 16531602.

  • Ultrasound really can make a big difference to simple skin infections
  • Recommended by: Casey Parker

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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