Research and Reviews in the Fastlane 600

Welcome to the 52nd 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

WHO Ebola Response Team. Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. NEJM 2014 PMID: 25244186

  • Since the onset of the Ebola Virus Disease epidemic 7 months ago a total of 4507 confirmed and probable cases, as well as 2296 deaths from the virus had been reported from five countries in West Africa — Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. The disease is rapidly spreading with a case diagnosed in the United States this week. This is an excellent report on the clinical and epidemiologic characteristics of the epidemic and the analyses in this paper can be used to inform recommendations regarding control measures. Unfortunately the current epidemiologic outlook is bleak especially in Guinea, Liberia, and Sierra Leone. Control measures which include improvements in contact tracing, adequate case isolation, increased capacity for clinical management, safe burials, greater community engagement, and support from international partners need to improve quickly otherwise these countries will be reporting thousands of deaths each week. Experimental therapeutics and Vaccines are not available at present and certainly not in the quantities that are required. We must also face the prospect that Ebola Virus Disease may become Endemic to the human population in West Africa.
  • Recommended by: Nudrat Rashid

Hwang V et al. Are pediatric concussion patients compliant with discharge instructions? J Trauma Acute Care Surg 2014. PMID: 24977765

  • The short and long term morbidity associated with pediatric concussions is becoming better recognized. This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up.
  • Recommended by: Anand Swaminathan
RR Mona Lisa

Singleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163

  • Bleeding always catches our attention in the ED… especially when it won’t stop. Von Willebrand disease is often encountered in the Peds ED. Make sure that the patient and their family don’t know more about it than you do.
  • Recommended by: Sean Fox
  • Read More: Von Willebrand Disease (PED EM MORSELS)
RR Game Changer

Gorchynski J et al. The “Syringe” Technique: A Hands-Free Approach for the Reduction of Acute Nontraumatic Temporomandibular Dislocations in the Emergency Department. J Emer Med 2014. PMID: 25278137

  • Reduction of temporomandibular joint (TMJ) dislocations is difficult, time consuming and often requires procedural sedation. This article describes a novel method for reduction of atraumatic TMJ dislocations in the ED. The “syringe” technique successfully reduced 97% (30/31) of dislocations. 77% (24/31) reductions were completed in less than 1 min. While this is not proof of superiority to other techniques, the time to reduction here is stunning and it’s always nice to have another arrow in the quiver
  • Recommended by: Anand Swaminathan
RR Game Changer

Halm BM. Reducing the time in making the diagnosis and improving workflow with point-of-care ultrasound. Pediatr Emerg Care. 2013; 29(2): 218-21. PMID: 23546429

  • Ok, so this isn’t hard core research, but I wanted to use it to highlight the fact that intussusception does not commonly present in the “classic” fashion and that by using point of care ultrasound, you can augment your physical exam to help diagnosis the condition in the child who presents with “altered mental status.”
  • Recommended by: Sean Fox
  • Read More: Intussusception & Altered Mental Status (PED EM MORSELS)

Kline JA et al. Systematic Review and Meta-analysis of Pregnant Patients Investigated for Suspected Pulmonary Embolism in the Emergency Department. Acad Emerg Med. 2014; 21(9): 949-959. PMID: 25269575

  • This systematic review and meta analysis looked at the literature (and gray lit) for pregnant patients undergoing work-up for pulmonary embolism, a cohort historically classified as high risk. The shocking take-home: we probably over-investigate PE in pregnant patients. The VTE rate in pregnant patients was 4.1%, compared with a rate of 12.4% in non-pregnant patients. The pooled RR of pregnancy VTE was 0.60 (95% CI 0.41-0.87) and patients of childbearing age (≤45 years) had RR 0.56 (95% CI 0.34-0.93). Of note, this study highlights the miniscule number of pregnant patients included in PE studies (n=506) and the tiny number of these who actually had VTE (n=29).
  • Recommended by: Lauren Westafer
RR Eureka

Heidlebaugh M et al. Full Neurologic Recovery and Return of Spontaneous Circulation Following Prolonged Cardiac Arrest Facilitated by Percutaneous Left Ventricular Assist Device. Ther Hypothermia Temp Manag. 2014. PMID: 25184627

  • Case report of a novel solution to a patient who sustained intra-cardiac catheterization cardiac arrest. An Impella device (an intraventricular LVAD) was placed into the left ventricle to provide adequate forward flow. Case report only but may offer an alternative to ECLS.
  • Recommended by: Cliff Reid
  • Read More: Left Ventricular Assist Device for Cardiac Arrest? (RESUS.ME)
RR Landmark

Cheston CC et al. Social media use in medical education: a systematic review. Acad Med. 2013; 88(6): 893-901. PMID: 23619071

  • Systematic review of social media in medical education. They found 12 studies, mostly small, a lot of reflective work. Good to see a growing evidence base for integrating FOAM into formal curricula.
  • Recommended by: Seth Trueger

Moradi P et al. Sudden pseudoproptosis. Emerg Med J 2013; 31(8): 624. PMID: 24136120

  • Who knew there was such as thing as “Floppy eyelid syndrome”! Described in overweight middle-aged men. Interesting case with pictures described here. A disorder of unknown origin manifested by an easily everted, floppy upper eyelid and upper palpebral conjunctivitis. The upper eyelid everts during sleep, resulting in irritation, conjunctivitis and conjunctival keratinisation.
  • Recommended by: Jeremy Fried

Gu WJ et al. Single-Dose Etomidate Does Not Increase Mortality in Patients with Sepsis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Chest 2014. PMID: 25255427

  • Etomidate, once the only available induction agent for RSI in US Emergency Departments, has long been maligned for its transient adrenal suppression in spite of the absence of any detrimental patient oriented outcomes. This systematic review and meta-analysis including 18 studies (only 2 RCTs) and > 5,500 patients demonstrated no difference in mortality in septic patients. For now, at least, etomidate is a viable option as an induction agent in patients with sepsis.
  • Recommended by: Anand Swaminathan
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Intensivist and Donation Medical Specialist, Australia  | @NudratRashid |

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