R&R In The FASTLANE 096

Welcome to the 96th 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

Roland D, Brazil V. Top 10 ways to reconcile social media and ‘traditional’ education in emergency care. Emerg Med J 2015. PMID: 26253148

• Social media has been viewed by some as a threat to traditional medical education. However the educational principles of social media, while sometimes innovative in their delivery, are often no different than long-standing techniques and methods. Bottom Line: Social Media is a medium, NOT a curriculum and a way to disseminate scholarly work on a world wide scale.
• Recommended by: Salim Rezaie

Leeuwenburg T. Airway management of the critically ill patient: modifications of traditional rapid sequence induction and intubation. Crit Care Horizons 2015; 1: 1-10. Free Open Access Link

• This is the first published article in the incredible free open access critical care journal launched by Rob MacSweeney
• Variations in RSI technique exist between individuals, specialties, institutions and countries. This paper by Kangaroo islands finest explores these variations practice and highlights specific measures for consideration in the critically ill. No specific recommendations are made but this paper may serve as basis for development of standard operation procedures at an institutional level.
• Recommended by:Soren Rudolph

Moreira ME et al. Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations. Ann Emerg Med 2015;66:(2)97-106.e3. PMID: 25701295

• Pediatric resuscitations are stressful at the best of times and pediatric dosing of resuscitation medications can be complicated, increasing the risk of medication errors. This group came up with an ingenious solution, in that single pre-filled syringes are color-coded in a rainbow pattern that corresponds to the Broselow tape we all know and love. All you have to do is discard down to the color that corresponds to the size of the child, and you are sure to be giving the right dose.
• This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds).
• Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obviously a simulation based study is not real life – but I would actually expect more stress and therefore more errors is a real resuscitation.
• Recommended by: Justin Morgenstern

Hussein W et al. Trends in Advanced Computed Tomography Use for Injured Patients in United States Emergency Departments: 2007-2010. Acad Emerg Med.2015; 22(6):663-9. PMID: 25996245

• Emergency CT imaging in trauma continues to increase, while yield unsurprisingly declines. Won’t somebody please think of the children?
• Recommended by: Ryan Radecki
• Read More: Still Not Choosing Wisely in Trauma Imaging (EM Lit of Note)

Claveau D, et al. Complications Associated With Nitrate Use in Patients Presenting With Acute Pulmonary Edema and Concomitant Moderate or Severe Aortic Stenosis. Ann Emerg Med 2015. PMID: 26002298

• An outstanding retrospective chart review and accompanying editorial which questions the (pseudo?-) axiom of avoiding nitrates in the patient in pulmonary edema with aortic stenosis
• In the study, the authors matched patients presenting in pulmonary edema who received nitrates without any AS to those with moderate and severe disease. They found no difference in episodes of significant hypotension and conclude that “Cautious use of nitroglycerin in patients with moderate or severe aortic stenosis and presenting with acute pulmonary edema may be safer strategy than traditionally thought.”
• While limited by the retrospective nature of the methodology, this study does provide the best current evidence on what happens when we give nitro to our AS patients in pulmonary edema. The accompanying editorial by David Newman is a great read regarding the interpretation of this new piece of evidence and how it fits into our current state of knowledge.
• Recommended by: Jeremy Fried

Calver L et al. The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Ann Emerg Med 2015. PMID: 25890395

• This is another study demonstrating the safety of droperidol in the ED for control of agitation. This prospective, observational study included over 1400 patients and found no episodes of torsades de pointes or other lethal dysrhythmias. Despite a handful of cases that were reported under suspicious circumstances, the overwhelming evidence appears to support the use of this drug. Unfortunately, the drug is no longer available in many places.
• Recommended by: Anand Swaminathan