R&R In The FASTLANE 053

Welcome to the 53rd 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

Arsen D. Ristić et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal 2014; 35(34): 2279-2284. PMID: 25002749

• Diagnosis of cardiac tamponade is based on the integration of clinical symptoms, signs, and echo findings. This excellent article describes a 3 step scoring system for the triage of patients requiring urgent percutaneous or surgical drainage of pericardial effusion. In addition to this there are recommendations towards making a diagnosis, transferring the patient to a specialized or tertiary institution, guidance on how to perform pericardiocentesis, prevent complications and how long to leave the drain in for.
• Recommended by: Nudrat Rashid

Shahrami A et al. Comparison of Therapeutic Effects of Magnesium Sulfate vs. Dexamethasone/Metoclopramide on Alleviating Acute Migraine Headache. J Emerg Med 2014. PMID: 25278139

• Migraine headaches can be debilitating for patients and Emergency Departments as treatment failure, length of stay and revisits are all common. Successful treatment itself can often lead to prolonged ED times as the most commonly used medications are extremely sedating. In this small (n = 70) RDCT, MgSO4 was found to be superior to a combination of metoclopramide + dexamethasone for early pain relief. At 20 minutes, MgSO4 had a marked effect on pain relief. Unfortunately, the study doesn’t follow patients out past the 2-hour mark so we are unable to tell if MgSO4 had effects on rebound headaches.
• Recommended by: Anand Swaminathan

Thille AW et al. Comparison of the Berlin Definition for Acute Respiratory Distress Syndrome with Autopsy, Am J Resp Crit Care Med 2013. 187(7): 761-767. PMID: 23370917

• ARDS isn’t always ARDS. An ICU looked at the autopsy results for 356 patients who met clinical criteria for ARDS at time of death. The pathologic “hallmark” of ARDS, diffuse alveolar damage (DAD) was found in less than half (45%) of the patients that met the revised Berlin clinical criteria for ARDS. This non-specific clinical criteria (Sp 37% for all ARDS, 58% for moderate/severe) suggests that we are likely lumping a heterogenous array of pathophysiologic processes under the heading of this “syndrome.” This may explain some of the frustration with a lack of consistently effective therapies for ARDS, except general lung protection.
• Recommended by: Lauren Westafer
• Read More: ARDS: An Evidence Based Update (Rob MacSweeney)

Volkow ND et al. Adverse health effects of marijuana use. N Engl J Med 2014. 370(23): 2219-27. PMID: 24897085

• With the changing legal landscape in the U.S., this review article provides a nice general overview of the state of knowledge on marijuana use and it’s known benefits and risks.
• Recommended by: Jeremy Fried

Little, P et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management) BMJ 2013. PMID: 24467988

• Big trial out of the UK looking at the utility of a clinical decision score (FeverPAIN) vs rapid antigen detection test (RADT) for strep throat. The idea was to target antibiotics to these predictors.
  The FeverPAIN score performed as well as a RADT – and adding a RADT did not improve the symptomatic scores.
  The score use resulted in a significant reduction in antibiotic prescribing.
  So – NO more swabs? Just treat on symptoms?
• Recommended by: Casey Parker

Poon SJ, Greenwood-Ericksen MB. The Opioid Prescription Epidemic and the Role of Emergency Medicine. Ann Emerg Med. 2014. PMID: 25017821

• As part of ALiEM’s mission to help the Annals of Emergency Medicine discuss some of their articles, we read and reviewed a GREAT eye-opening paper about the Opioid Prescription Epidemic… and yes, it IS an epidemic.
• Recommended by: Poon, Greenwood-Ericksen
• Read More: The Opioid Prescription Epidemic (ALiEM)

Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extrication. J Emerg Med. 2014 Sep 23. PMID: 25256410

• Retrospective study comparing extrication by EMS vs. self-extrication in awake, alert, cooperative, neurologically intact drivers involved in IndyCar crashes. Patients who arrive in the ED with backboard and C spine collar receive dramatically more CT scans than otherwise. No firm conclusions can be drawn from this methodology, but it is likely that emergency clinicians are much more likely to use CT on patients arriving with backboard and collar, irrespective of other clinical features of the case. Most healthy blunt trauma patients with normal vitals and mentation should be taken off the backboard and their cervical spine cleared clinically at the outset of care.
• Recommended by: Reuben Strayer

Simes J et al. Aspirin for the Prevention of Recurrent Venous Thromboembolism: The INSPIRE Collaboration. Circulation 2014. PMID: 25156992

• Prophylactic treatment for VTE after a full anticoagulation course for unprovoked VTE continues to be debated. This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients.
• Recommended by: Anand Swaminathan

Pflaumer A1, Davis AM. Guidelines for the diagnosis and management of Catecholaminergic Polymorphic Ventricular Tachycardia. Heart Lung Circ 2012; 21(2): 96-100. PMID: 22119737

• Ok, so the school-aged kid presents with a syncopal episode. You aren’t worried because the kid looks well and the ECG is normal; however, did you consider Cataecholaminergic Polymorphic Vtach? This is life threatening and presents with a normal ECG and no structural abnormalities. Seriously, how am I supposed to diagnose this one? By thinking of it and asking the right questions!
• Recommended by: Sean Fox
• Read More: Catecholaminergic Polymorphic VTach (Pediatric EM Morsels)

Feng L et al. Clinical observation on 30 cases of transient cerebral ischemia attack treated with acupuncture and medication. J Tradit Chin Med 2007; 27(2): 100-2. PMID: 17710801

• Where to begin on this article. First, TIAs are supposed to completely resolve, otherwise they’re called CVAs. Second, to get significant differences in efficacy they had to go down to 20% effectiveness for the treatment. Third, are they attributing the treatment effect to the accupuncture, the leech capsules, the centipede capsules, or is it only if you combine all of them?
• Recommended by: Justin Hensley