Welcome to the 25th 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 7 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

Reilly BM. Inconvenient truths about effective clinical teaching. Lancet. 2007 Aug 25;370(9588):705-11. PubMed PMID: 17720022

  • 30 years of teaching reduced to two great mnemonics: ‘TALK’ the talk and ‘WALK’ the walk. In the absence of a solid body of research telling us what make effective clinical teaching, this is gold. The inconvenient truth remains – we don’t really know how effective our clinical teaching is, or what really works. Infused with practical philosophy and hard earned wisdom this is a must read for all who teach on the floor or in the wards.
  • Recommended by Joe Lex and Chris Nickson

Fertel BS, Nelson LS, Goldfarb DS. Extracorporeal removal techniques for the poisoned patient: a review for the intensivist. J Intensive Care Med. 2010 May-Jun;25(3):139-48. Epub 2010 May 5. Review. PubMed PMID: 20444738.

  • This paper is by far the best thing I’ve seen on the topic. The authors (Baruch Fertel, Lewis Nelson, and David Goldfarb) represent emergency medicine, medical toxicology, and nephrology. The paper is so full of pearls that it is impossible to summarize — I found myself underlining and highlighting almost every paragraph.
  • Recommended by: Leon Gussow
  • Learn more: The Poison Review

Cooper RJ, Green SM. Don’t Hyperventilate Over Triage Respiratory Rates. Ann Emerg Med. 2012 Jul 26. [Epub ahead of print] PubMed PMID: 22841175.

  • Respiratory rates measured in ED triage are inaccurate – missing 77% of tachypnoea. This editorial discusses many of the issues surrounding this. It concludes stating that it probably doesn’t matter. This conclusion makes me uneasy – of all the vital signs, RR probably best correlates with need for ICU admission when patients are reviewed by the upstairs team. We need to find a way to get this right.
  • Recommended by: Chris Nickson

Weingart GS, Carlson JN, Callaway CW, Frank R, Wang HE. Estimates of sedation in patients undergoing endotracheal intubation in US EDs. Am J Emerg Med. 2012 Jul 4. [Epub ahead of print] PubMed PMID: 22770915.

  • Less than one-half of patients undergoing ETI in the ED receive sedative drugs while in the ED. These findings are congruent with prior smaller studies from single academic centers. Now I’m not sure if some of these patients were so deeply comatose that the team felt no sedation was necessary, but I can’t imagine it is a huge fraction of the patients that did not get sedation. This makes me so sad. The relief of pain and suffering should be our first priority as doctors. How can this still be going on?
  • Recommended by: Scott Weingart (NB. no connection to the first author of the paper)

Ater D, Shai H, Bar BE, Fireman N, Tasher D, Dalal I, Ballin A, Mandelberg A. Hypertonic saline and acute wheezing in preschool children. Pediatrics. 2012 Jun;129(6):e1397-403. Epub 2012 May 21. PubMed PMID: 22614767.

  • After years of bad press, salt is making a comeback! This is the first RCT of nebulized hypertonic saline in preschool viral induced wheeze. The study design is pragmatic and reflects current practice. The addition of 5% saline to albutamol nebs reduced both need for admission and length of stay.
  • Recommended by: Michael Baker

Easter JS, Vinton DT, Haukoos JS. Emergent pediatric thoracotomy following traumatic arrest. Resuscitation. 2012 Jun 13. [Epub ahead of print] PubMed PMID: 22705411

  • This case series of ED thoracotomy in paediatric blunt or penetrating trauma is the second largest ever and the only study published in the last 20 years. The conclusions are similar to adult studies, with no survivors in the blunt trauma group or if there were no signs of life. Overall 19% of patients survived in the penetrating trauma group, all neurologically intact.
  • Recommended by: Michael Baker

Perner A, et al; 6S Trial Group; Scandinavian Critical Care Trials Group. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012 Jul 12;367(2):124-34. Epub 2012 Jun 27. Erratum in: N Engl J Med. 2012 Aug 2;367(5):481. PubMed PMID: 22738085.

  • You don’t still use starch do you? Patients with severe sepsis who undergo fluid resuscitation with HES 130/0.42 are more likely die and need renal replacement therapy compared to those receiving Ringer’s acetate.
  • Recommended by: Chris Curry

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a 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 three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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