R&R In The FASTLANE 087

Welcome to the 87th 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

Chakraverty S et al. CIRSE Guidelines: Quality Improvement Guidelines for Endovascular Treatment of Traumatic Hemorrhage. Cardiovasc Intervent Radiol 2012; 35: 472–482. PMID 22271075

• I once heard a lecture where Professor Ken Boffard, SA stated ” There are 14 clotting factors….13 intrinsic and the surgeons finger!”. Here is the 15th clotting factor – the interventional radiologist. This guideline outlines the place of interventional radiology (IR) in trauma management as a complementary technique to damage control surgery and indicates how imaging and IR can be used in the context of hemorrhage in the severely injured patient, and when embolization, stent grafting, or balloon occlusion of vascular, solid organ and pelvic injury is appropriate and when it is contraindicated.
• For your listening pleasure – check out the RCEM FOAmed podcast on IR
• Recommended by Soren Rudolph

Marik PE. The demise of early goal-directed therapy for severe sepsis and septic shock. Acta Anaesthesiologica Scandinavica. 59: 561–567. PMID 25656742

• Paul Marik has written a great piece on the post-EGDT era, where to from here and a cautionary note about how we read the evidence.
• Recommended by Casey Parker

Flato UA et al. Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest. Resuscitation 2015; 92: 1-6. PMID 25891961

• Should performance of POC cardiac US be standard care in patients who present with cardiac arrest with asystole or PEA? This ICU study of 49 patients found that 27 had “pseudo-PEA” with 70.4% achieving ROSC. 7 patients (14.8%) survived to 6 months all of whom were in the “pseudo-PEA” group. The authors believed that in 51% of the patients, TTE contributed to diagnosing the patient. Bottom line here is that in skilled hands, TTE can help determine the cause of cardiac arrest and help identify a portion of patients with a better prognosis (pseudo-PEA).
• Recommended by Anand Swaminathan

Hoffman TC et. Patients’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests A Systematic Review. JAMA Int Med 2015; 175(2): 274-286. PMID 25531451

• As medical costs continue to rise, it is important to understand patients’ understanding concerning benefits and harms of treatments, tests and screening as these beliefs can drive physician behavior as well as patient choices. This systematic review finds that in general, patients overestimate benefits and underestimate harms. A critical question in this area is where do these expectations come from? Health care providers are a major driving force as our understanding of harms and benefits is flawed as well.
• Recommended by Anand Swaminathan

Elder JW. et al. Wound Debridement: Lessons Learned of When and How to Remove “Wild” Maggots. J Emerg Med 45(4): 585 – 587 PMID 23623148

• Maggots – friend or foe? We all have stories about them – but here is a nice paper outlining how we might Hoover them up and keep the department free of wriggling warriors. Interestingly in the UK they are putting them on faster than Swami replies to emails!
• Recommended by Casey Parker

Shaw I et al. What Is the Time to Muscle Relaxation After Intramuscular Administration of Neuromuscular Blockers? Ann Emerg Med 2015. PMID 25964083

• Knowing the onset and duration of intramuscular administration of neuromuscular blocking agents may be useful in selected situations. This is a review of the scant evidence of the topic. The authors conclude that when using succinycholine, a dose of 4 mg/kg may has a time of onset that is appropriate for RSI. The available literature does not allow for a recommendation on the appropriate dose of rocuronium.
• Recommended by Anand Swaminathan