Research and Reviews in the Fastlane 600

Welcome to the 39th 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

The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time? Cai Q et al. Am Heart J. 2013 Sep;166(3):409-13. PMID 24016487

  • A proposed algorithm incorporating the Sgarbossa criteria to quickly and accurately identify, among patients presenting with chest pain and new or presumably new LBBB, those with acute coronary artery occlusion. This algorithm will also significantly reduce false catheterization laboratory activation and inappropriate fibrinolytic therapy
  • Recommended by: Salim R. Rezaie

A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVR. Goebel M, Bledsoe J, Orford JL, Mattu A.  Am J Emerg Med 2014; 32: e5-e8. PMID: 24176590

  • Prominent T wave and J-point depression in the precordial leads (de Winter T waves) associated with ST-segment elevation in lead aVR is a STEMI equivalent.
  • Recommended by: Anand Swaminathan
  • Read More: Look Out for de Winter T-waves (Amal Mattu)
RR Eureka

Effect of prehospital ultrasound on clinical outcomes of non-trauma patients–a systematic review. Rudolph SS et al. Resuscitation. Volume 85, Issue 1 , Pages 21-30, January 2014. PMID 24056394

  • Systematic review of prehospital ultrasound in non-trauma patients in regards to patient outcomes. To no surprise there are not a lot of high quality studies, but reports consistently support ultrasound as a valuable diagnostic tool in the prehospital setting. We need some high quality studies to win the hearts and minds of the ultrasound non-believers
  • Recommended by: Soren Steemann Rudolph
RR Game Changer

Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. Singer AJ, Talan DA. NEJM 2014; 370: 1039-47. PMID 24620867

  •  This is a review article updating the management of skin and soft tissue infections in the era of MRSA. Recommendations here are similar to prior ones and based on the best evidence, Singer and Talan continue to recommend NOT giving antibiotics for uncomplicated abscesses but rather reserving them for abscesses with significant overlying cellulitis after drainage.
  • Recommended by: Anand Swaminathan
RR Game Changer

Scissor-like manoeuvre of tracheal tube. Sivapurapu V. Br J Anaesth. 2014 Apr;112(4):769. PMID: 24645165

  •  A brief correspondence describing “scissor-like” movement of the endotracheal tube (similarly to a bougie) to pass the tube in anterior intubations. Fascinating stuff!
  • Recommended by: Jeremy Fried


The World Cup Flopping Rankings. WSJ

  • Soccer World Cup madness is hitting LITFL. Funny “statistical” review of the seemingly “injured” players from the Wall Street Journal. Not really scientific – but great fun.
  • Recommended by: Soren Steemann Rudolph

RR Game Changer

The neglected prehospital phase of head injury: apnea and catecholamine surge. Atkinson JL. Mayo Clin Proc. 2000 Jan;75(1):37-47. PMID: 10630756

  • This review from the turn-of-the-century emphasises the phases following traumatic brain injury (TBI): exponential, plateau and resolution phases. The exponential phase occurring prehospital is characterised by apnoea, through central and/or obstructive mechanisms, and a catecholamine surge. Brain impact apnoea, in particular, is a neglected cause of prehospital deaths from TBI. Enough reason to use the GoodSam app perhaps?
  • Recommended by: Chris Nickson

Lactate clearance as a target of therapy in sepsis: A flawed paradigm. Marik PE, Bellomo R. OA Critical Care 2013 Mar 01;1(1):3. Free Full Text

  • Rinaldo Bellomo and Paul Marik – two of the biggest names in the ICU business – teamed up to write this revelatory review. In particular the authors debunk the notion that hyperlactaemia in septic shock is due to impaired oxygen delivery to the tissues. They argue that hyperlactaemia is often driven by catecholamines as part of a stress response. Does this mean that we can still use lactate clearance to guide fluid resuscitation in septic shock, or not?
  • Recommended by: Chris Nickson
RR Landmark

Five Strategies to Effectively Use Online Resources in Emergency Medicine. Brent Thoma, MD, MA, Nikita Joshi, MD, N. Seth Trueger, MD, Teresa M. Chan, MD, Michelle Lin, MD. Ann Emerg Med. 2014;▪:1-4. PMID 24962889

  • Outstanding review for all, both new and experienced, in how to incorporate social media in their emergency medicine career!
  • Recommended by: Jeremy Fried
RR Game Changer

Myth: Atropine should be administered before succinylcholine for neonatal and pediatric intubation. Fleming B, McCollough M, Henderson HO.  CJEM. 2005 Mar;7(2):114-7. PMID: 17355661

  • It has long been standard of practice to administer atropine prior to succinylcholine to reduce the risk of bradycardia – but where is the evidence? In this “myth busting” literature review the authors found that most studies recommending atropine premedication were undertaken in the operating room setting and only pertained to repeated succinylcholine dosing. Furthermore there is almost no evidence that indicate that succinylcholine really causes clinically relevant bradycardia. The authors found no evidence supporting atropine’s use in pediatric patients prior to single-dose succinylcholine and call for this practice to cease.
  • Recommended by: Sean Fox
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Senior Consultant Anesthesiologist, Traumemanager and PHEM doctor. Dedicated to trauma resuscitation, prehospital care and airway management. Barometerbarn | @SorenRudolph |

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