R&R In The FASTLANE 030

Research and Reviews in the Fastlane 600

Welcome to the 30th 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. However…this one was compiled differently to the others — I challenged over 5,000 Twitter followers to tweet me the best or most useful EM/CC journal article they had read in the past year. Then I went away and read them, and these were the ones worthy of a place in the R&R pantheon (a number of other suggestions had already been included in previous R&Rs — every man and his dog wanted to vote for the Levitan and Weingart preoxygenation paper for instance!).Thanks to all who took part!


This Edition’s R&R Hall of Famer

RR Hall of FAMER

Smith R. Peer review: a flawed process at the heart of science and journals. J R Soc Med. 2006 Apr;99(4):178-82. Review. PubMed PMID: 16574968; PubMed Central PMCID: PMC1420798

  • Peer review – two words that confer a blessing on any published article and elevate it to a status worthy of academic merit. Yet it is a deeply flawed process. Former BMJ editor Richard Smith, who has blogged on the subject many times with great wisdom, tells us what is wrong with it and how it might be improved. Essential reading for anyone who believes (or is sick of hearing that) FOAM is flawed because it ‘lacks peer review’.
  • Recommended by Chris Nickson

RR Mona Lisa

Fuller BM, Mohr NM, Drewry AM, Carpenter CR. Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review. Crit Care. 2013 Jan 18;17(1):R11. [Epub ahead of print] PubMed PMID: 23331507.

  • Not an RCT, so definitive conclusions cannot be made, but this systematic review supports what many of us believe: any critically ill patient is at risk of lung injury when mechanically ventilated, so low tidal volumes should be used.
  • Recommended by: Chris Nickson via @TheTechDoc

RR Mona Lisa

Henderson WR, Griesdale DE, Walley KR, Sheel AW. Clinical review: Guyton – the role of mean circulatory filling pressure and right atrial pressure in controlling cardiac output. Crit Care. 2010;14(6):243. PMID: 21144008; PubMed Central PMCID: PMC3220048.

  • Arthur Guyton’s concepts of the determinative role of right heart filling in cardiac output are explained in this paper. Although controversial, the authors cite new human studies to support Guyton’s work.
  • Recommended by: Chris Nickson via @iceman_ex

RR Eureka

Marik PE. Surviving sepsis: going beyond the guidelines. Ann Intensive Care. 2011 Jun 7;1(1):17. doi: 10.1186/2110-5820-1-17. PubMed PMID: 21906348; PubMed Central PMCID: PMC3224476.

  • Marik’s paper goes beyond previous iterations of the Surviving Sepsis Campaign guidelines and are worth reading alongside the newest ones.
  • Recommended by: Chris Nickson via @iceman_ex

RR Game Changer

Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8. doi: 10.1378/chest.07-2331. Review. PubMed PMID: 18628220.

  • Unless you’re one of seven standing acutely haemorrhaging awake mares, CVP ain’t useful for monitoring fluid responsiveness.
  • Recommended by: Chris Nickson via @CriticalCareNow

RR Mona Lisa

Serinken M, Eken C, Turkcuer I, Elicabuk H, Uyanik E, Schultz CH. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial. Emerg Med J. 2012 Nov;29(11):902-5. doi: 10.1136/emermed-2011-200165. Epub 2011 Dec 20. PubMed PMID: 22186009.

  • Intravenous paracetamol works for renal colic – but should we use it?
  • Recommended by: Chris Nickson via @emlitofnote
  • Learn more: EMLON

RR Mona Lisa

Teismann NA, Knight RS, Rehrer M, Shah S, Nagdev A, Stone M. The Ultrasound-guided “Peripheral IJ”: Internal Jugular Vein Catheterization using a Standard Intravenous Catheter. J Emerg Med. 2013 Jan;44(1):150-4. doi: 10.1016/j.jemermed.2012.02.044. Epub 2012 May 11. PubMed PMID: 22579025

  • We can put a peripheral IV in the internal jugular – but should we?
  • Recommended by: Chris Nickson via @emlitofnote
  • Learn more: EMLON

RR HOT STUFF

Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, Flaws D, Hammett CJ, Beam DM, Ardagh MW, Troughton R, Brown AF, George P, Florkowski CM, Kline JA, Peacock WF, Maisel AS, Lim SH, Lamanna A, Richards AM. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012 Jun 5;59(23):2091-8. doi: 10.1016/j.jacc.2012.02.035. Epub 2012 May 9. PubMed PMID: 22578923.

  • An important step closer to the holy grail of emergency medicine – how to deal with low-risk chest pain?
  • Recommended by: Chris Nickson via @himynameisvince

RR Mona Lisa

Hanley JA, Lippman-Hand A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA. 1983 Apr 1;249(13):1743-5. PubMed PMID: 6827763.

  • If ‘no events’ occur in a study, does this mean there is zero risk of them happening? Hell no! This paper explains why, as well as how to think about a ‘zero numerator’ and what to do with it.
  • Recommended by: Chris Nickson via @kangaroobeach

RR Mona Lisa

Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012 Feb;147(2):113-9. doi: 10.1001/archsurg.2011.287. Epub 2011 Oct 17. PubMed PMID: 22006852 – [Free Fulltext]

  • Although a retrospective study, with all the warts that that entails, the MATTERs study adds weight to CRASH-2 led push for tranexamic acid administration for trauma patients at risk of significant bleeding. In MATTERs, the patients sustained military trauma in Afgahnistan, and were more likely to survive if given tranexamic acid even though this group was more seriously injured. The drug is cheap, safe and should be given.
  • Recommended by: Chris Nickson via @docvpb

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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