Welcome to the 95th 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 5 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
Brewer JM, et al. Can Vasopressors Safely Be Administered Through Peripheral Intravenous Catheters Compared With Central Venous Catheters? Ann Emerg Med 2015. PMID: 26210381
- This systematic review snapshot examines the issue of vasopressor use through peripheral lines, and concludes that “Although the safety profile of peripheral administration of vasopressors remains uncertain, most reported adverse events are associated with a distal peripheral site or prolonged duration of administration.”
- The average time of pressor infusion before local tissue injury occurred was 56 hours.
- The take home point is that it seems to be safe and most likely better for the patient to avoid delays in administration of vasopressors by initiating through a peripheral line. If pressors are more than a short term need a central line should be placed.
- Recommended by: Jeremy Fried
Mervak BM et al. Rates of Breakthrough Reactions in Inpatients at High Risk Receiving Premedication Before Contrast-Enhanced CT. Am J Roent 2015; 205(1):77-84. PMID: 26102383
- This article reveals the lack of knowledge about contrast reactions, but also reinforces the real risk of repeat reactions despite treatment. The authors found that despite premedication, patients with a history of a prior reaction were still at a significantly increased risk of a recurrent reaction. The bottom line is that premedication may not work. Be ready to treat these patients aggressively if symptoms occur.
- Recommended by: Daman Langguth
Raja AS, et al. Effects of Performance Feedback Reports on Adherence to Evidence-Based Guidelines in Use of CT for Evaluation of Pulmonary Embolism in the Emergency Department: A Randomized Trial. Am J Roentgenol. 2015;1-5. PMID: 26204114
- We know we order too many CTPAs for pulmonary embolism (PE) in the United States but changing provider behavior is difficult. These authors randomized providers to a control group or to an intervention of quarterly, individualized feedback on adherence to guidelines for CTPA ordering. They found a statistically significant 6.9% absolute increase in ordering adherence in the intervention group, with 85% adhering to the guidelines following the intervention. Timely, individualized feedback is likely one component to improving the implementation of evidence based guidelines for PE workup.
- Recommended by: Lauren Westafer
Hew-Butler T et al. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med. 2015; 25(4): 303-20. PMID: 26102445 (FREE OPEN ACCESS ARTICLE)
- A consensus guideline from a meeting of experts that encapsulates the state-of-the-art in understanding exercise-associated hyponatraemia (EAH). Athletes are still at risk of potentially fatal consequences from drinking too much water during exercise. Disturbingly, more cases of EAH are occurring with ‘non-endurance’ physical activity – even Bikram Yoga! This free-to-access paper tells you everything you need to know about how to diagnose and manage EAH, and includes explanations of the physiology that underpins this enigmatic condition. Don’t drink too much during exercise, “drink to thirst”!
- Recommended by: Chris Nickson
- Read More: Test yourself on LITFL’s updated Environmental Enigma 001
Furyk JS et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Ann Emerg Med. 2015. PMID: 26194935
- Tamsulosin (Flomax) has been prescribed to patients with renal colic for the better part of a decade despite minimal good evidence to support its use. This is another paper showing no benefit in all comers with ureteral colic to medical expulsive therapy (MET) with tamsulosin. There is a suggestion of benefit in a small subgroup (distal stones > 5 mm) but this group can only be identified by CT; a study that’s typically unnecessary in standard ureteral colic management.
- Recommended by: Anand Swaminathan
- Read More: The Adventure of the Impassable Stone (EM Nerd); And the Stoning Continues (EM Lit of Note); Medical Expulsion Therapy with Tamsulosin in Ureteral Colic (emdocs.net)