R&R In The FASTLANE 022

Research and Reviews in the Fastlane 600

Welcome to the 22nd 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

Williamson K, Mattu A, Plautz CU, Binder A, Brady WJ. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006 Nov;24(7):864-74. Review. PubMed PMID: 17098112

  • Great review of the utility of AVR from a few years ago — notable authors include Amal Mattu & Bill Brady. They give us 4 uses for AVR: STE in ACS meaning LMCA (or vessel) occlusion; prominent terminal R wave in TCA toxicity (sodium channel blockade); and STE in narrow complex tachycardia suggestive of WPW.
  • Note: They also include PR elevation in acute pericarditis which Dr. Mattu has recently suggested is not specific enough to separate pericarditis from NSTEMI.
  • Recommended by Seth Trueger, Chris Nickson

RR Eureka

Hilbert G, Clouzeau B, Bui HN, Vargas F. Sedation during non invasive ventilation. Minerva Anestesiol. 2012 May 11. [Epub ahead of print] PubMed PMID: 22580593

  • Basic lit review on sedation for NIV. interesting how much data there are considering how much opposition there is to the concept.
  • Recommended by Seth Trueger

RR Eureka

Aguilar SA, Davis DP. Latency of pulse oximetry signal with use of digital probes associated with inappropriate extubation during prehospital rapid sequence intubation in head injury patients: case examples. J Emerg Med. 2012 Apr;42(4):424-8. Epub 2012 Feb 1. PubMed PMID: 22305148

  • Pulse ox doesn’t always mean want you think it means.
  • Recommended by Mike Jasumback

RR Game Changer

Guilbert MC, Elkouri S, Bracco D, Corriveau MM, Beaudoin N, Dubois MJ, Bruneau L, Blair JF. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg. 2008 Oct;48(4):918-25; discussion 925. Epub 2008 Aug 13. Review. PubMed PMID: 18703308.

  • OK, the patient has a central venous catheter inadvertently placed in his carotid. Do you pull-and-push? If so pray – this small case series suggests leaving it in and getting vascular repair is a better approach.
  • Recommended by Chris Nickson

RR Game Changer

Lim T, Ryu HG, Jung CW, Jeon Y, Bahk JH. Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization. Crit Care Med. 2012 Feb;40(2):491-4. PubMed PMID: 21983370.

  • Could received wisdom be wrong? This RCT suggests having the needle bevel down (not up) has less complications for CVC insertion in the internal jugular vein.
  • Recommended by Chris Nickson

RR Mona Lisa

Louw L, Hodgson E. Ujuzi: An unconventional ring removal technique for hard-to-remove rings. AfJEM 2012, 2 (2) 81-83. DOI: 10.1016/j.afjem.2012.04.001 Fulltext

  • The manly way of removing re-enforced steel rings from fingers.
  • Recommended by Stevan Bruijns

RR Eureka

Brenner M, Stein DM, Hu PF, Aarabi B, Sheth K, Scalea TM. Traditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury. J Trauma Acute Care Surg. 2012 May;72(5):1456-7. PubMed PMID: 22673290.

  • Interesting analysis from Scalea et al at Shock Trauma- they looked at a-line tracings and used sophisticated (oversophisticated?) analysis to demonstrate that SBP >90 may not be an optimal goal for severe TBI patients. Hypotension=bad, but at what level?
  • Recommended by Seth Trueger

RR WTF

Shalom A, Bryant A, Smith-Meek M, Parsons LR, Munster A. Noodles stay hotter longer. J Burn Care Res. 2007 May-Jun;28(3):474-7. PubMed PMID: 17438502

  • Surprisingly good study showing that Noodle Soup is more likely to burn you than Other Soup.
  • Recommended by Seth Trueger

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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