R&R In The FASTLANE 085

Welcome to the 85th 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 6 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

Vourc’h et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med 2015. PMID:25869405

• An interesting paper if you adhere to NODESAT (Nasal Oxygenation During Efforts Securing a Tube) and believe that apneic oxygenation may help your patients avoid desaturation during intubation. The authors in this RCT compared High Flow Nasal Cannula (using a specialized cannula) to usual face mask preoxygenation in hypoxic ICU patients and found no difference in desaturation events between the two groups (despite having HFNC on throughout the procedure). I doubt it will change your practice, but may make you think twice about purchasing the specialized equipment needed for high flow nasal O2 for this indication – just keep using the good old nasal cannula for now and crank up the O2 once the pt is sedated.
• Recommended by: David Marcus

Fox CS et al. A randomized trial of social media from Circulation. Circulation 2015; 131(1): 2833. PMID: 25406308

• Great name: Intention to Tweet, a well-designed RCT in Circulation showing that tweets from journals don’t drive web traffic. Except they used a straw man intervention and cardiologists probably don’t use twitter as much as ER docs.
• Recommended by: Seth Trueger
• Read More: Letter by Thoma et al regarding article, “A randomized trial of social media from Circulation”. PMID: 25825403

Hakemi EU et al. The prognostic value of undetectable highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Chest 2015; 147(3): 685-94. PMID: 25079900

• High sensitive troponins (HST) are making its way into the field of acute coronary syndrome and now into pulmonary embolism. This study was a retrospective cohort study of 298 patients with confirmed PE. In this population, a 45% were HST negative while 55% were positive. From the HST-negative group, there were no death, CPR or need of thrombolysis compared with 6% of mortality and 9% of CPR or thrombolysis in the HST-positive group. It appears that HST is a good prognosis biomarker in patients with pulmonary embolism.
• Recommended by: Daniel Cabrera

Lin BW. A Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries. J Emerg Med 2015. PMID: 25886984

• Fingertip avulsion injuries are typically frustrating to repair. This article reviews a simple method for fixing these injuries using tissue adhesives.
• Recommended by: Anand Swaminathan

Loubani OM et al. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care 2015; 30(3): 653.e9-653.e17. PMID:25669592

• In critically ill patients, with hemodynamic instability, vasopressor infusion through a proximal PIV (antecubital fossa or external jugular vein), for <4hours of duration is unlikely to result in tissue injury and will reduce the time it takes to achieve hemodynamic stability.
• Recommended by: Salim R. Rezaie

Wears RL. Are We There Yet? Early Stopping in Clinical Trials. Ann Emerg Med 2015; 65(2):214-5. PMID: 25601251

• This is a brief editorial on the concerns and dangers of stopping trials early. Dr. Wears delves into appropriate reasons to stop trials early (lack of funding, futility, similar research published rendering the question moot) and inappropriate ones. He also explores ways we can improve the construction of research to make it more likely to yield usable findings. A must read for those critically appraising the literature.
• Recommended by: Anand Swaminathan