Research and Reviews in the Fastlane 600

Welcome to the 45th 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

Scott KR et al. Integration of Social Media in Emergency Medicine Residency Curriculum. Ann Emerg Med 2014 PMID: 24957931

  • Social media and FOAM have changed and influenced our clinical practice. This paper highlights the basics as well as the barriers and challenges. It’s an outstanding look at the cutting edge of how residencies are using social media and FOAM content in their curriculum. The revolution is happening!
  • Recommended by: Sa’ad Lahri, Jeremy Fried

Nadelman RB et al. Tick Bite Study Group. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001 Jul 12;345(2):79-84. PMID: 11450675. (OPEN ACCESS ARTICLE)

  • The RCT that showed you can prophylax people with a single dose of doxycycline after removal of a deer tick.
  • Recommended by: Justin Hensley
  • Read more: So You’ve Pulled Off A Deer Tick (Justin Hensley)
RR Eureka

Beitler JR. Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis. Intensive Care Med 2014;40(3):332-341 PMID: 24435203

  • Overall, prone positioning was not associated with a lower mortality rate. However, in low baseline tidal volume subset, there was a reduced mortality rate. With longer and longer waiting times for ICU patients to go to an ICU bed, is this intervention ready for incorporation into ED practice?
  • Recommended by: Anand Swaminathan
RR Game Changer

Guerin C et al. Prone positioning in severe acute respiratory distress syndrome. NEJM 2013; 368: 2159-68. PMID: 23688302 (OPEN ACCESS ARTICLE)

  • In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality.
  • Recommended by: Salim Rezaie
RR Boffintastic

Littmann L et al. A simplified and structured teaching tool for the evaluation and management of pulseless electrical activity. Med Princ Pract. 2014; 23(1): 1-6. PMID: 23949188.

  • Wow – an actual practical algorithm for dealing with PEA in the Resus room. Easy decision points with ECG and bedside US.
  • Recommended by: Casey Parker
RR Boffintastic

Clay AS. Hyperammonemia in the ICU. Chest 2007; 132(4): 1368-78. PMID: 17934124

  • So the ammonia level is elevated …. What do I do with that nugget of information? Well, you could read this review article and become the resident hyperammonaemia guru for a little while. It’s an easy read and quite practical.
  • Recommended by: Matt MacPartlin
RR Eureka

Olfson M et al. Focusing suicide prevention on periods of high risk. JAMA. 2014; 311(11):1107-8. PMID: 24515285.

  • In this opinion piece in JAMA, Dr. Olfson laments the rising rate of suicide deaths, and, because of the shortage of mental health professionals, calls on emergency practitioners to augment their skillset in recognizing and managing patients at risk for self-harm. He is specifically concerned that when consultant psychiatry services are not available, emergency providers will focus on the medical aspects of care (trauma, ingestion, etc) and not adequately address the psychiatric/social concerns that in one study led to death in 0.9% of patients who presented to the ED with self-harm within three months.
  • Recommended by: Reuben Strayer
RR Eureka

Costa EL et al. Electrical impedance tomography. Curr Opin Crit Care. 2009 Feb;15(1):18-24. Review. PMID: 19186406.

  • Electrical impedance tomography. (EIT) is seriously cool. If you look after mechanically ventilated patients you’ll be amazed at the potential this technology has for real-time assessment of lung ventilation and perfusion. Time will tell if use becomes widespread.
  • Recommended by: Chris Nickson
RR Game Changer

Coxib and traditional NSAID Trialists’ (CNT) Collaboration, Bhala N et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analysis of individual participant data from ranomised trials. Lancet 2013; 382: 769-79 PMID: 23726390

  • When compared to placebo, coxibs (COX-2 inhibitors), diclofenac and ibuprofen all increased the risk of major coronary events but naproxen did not. While none of these medications are “safe” from a gastrointestinal bleeding standpoint, is this evidence that we should move away from ibuprofen and towards naproxen?
  • Recommended by: Anand Swaminathan
  • Read More: All NSAIDs are created equally . . . right? (Anand Swaminathan)

Shanafelt TD et al. Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population. Arch Int Med 2012: 172: 1377-85. PMID: 22911330.

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New Jersey Emergency Physician with academic focus on resident education and critical care in the ED. Strong supporter of FOAMed and its role in cutting down knowledge translation | @EMSwami |

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