R&R In The FASTLANE 097

Welcome to the 97th 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

Brooker JA et al. The Association Between Medicolegal and Professional Concerns and Chest Pain Admission Rates. Acad Emerg Med 2015; 22(7):883-6. PMID: 26118834

• This article looks at the role medicolegal concerns play in the management of patients with chest pain. The authors found that up to 30% of patients would not have been admitted if physicians had an established “acceptable miss-rate” or worked in a zero medicolegal risk environment. Maybe it’s time that we make some real headway in these areas in order to cut down on unnecessary healthcare spending.
• Recommended by: Anand Swaminathan
• Read More: Expunging “Zero-Miss” from Chest Pain Evaluations (EM Lit of Note)

Hutchinson BD et al. Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography. Am J Roentgenol. 2015; 205(2): 271-7. PMID: 6204274

• Pulmonary embolism (PE) is a favorite topic among emergency providers and recent efforts have focused on evidence based practices to combat overtesting. This retrospective, single center study from Ireland had 3 chest radiologists, blinded to clinical data and prior reads, look at 174 CTPAs positive for PE. These radiologist read 45 of these positive scans (25.9%) as negative, with excellent interrater reliability (k=0.83). False positive scans were more often solitary PE. Our “gold standard” is not imperfect and overtesting with an imperfect test is a good setup for downstream consequences.
• Recommended by:Lauren Westafer

Sin B et al. The Use of Subdissociative-dose Ketamine for Acute Pain in the Emergency Department. Acad Emerg Med 2015; 22(3): 251-7. PMID: 25716117

• Probably the vast majority of people reading this review is a fan of ketamine for multiple indications, from RSI to procedural sedation. The authors performed a systematic review of the current literature of sub-dissociative doses of ketamine (SDDK) for analgesia in the Emergency Department. Four papers, including 428 were identified. The data was fairly heterogeneous overall in terms of outcomes and its results. Two of the 4 studies failed to identify any benefit compared to opiates. The authors conclude that there is no good evidence to support or refute the use of SDDK for analgesia in the ED.
• Recommended by: Daniel Cabrera
• Read More: Comfortably Numb: Low Dose Ketamine as Adjunct for ED Pain Control (The SGEM)

Holmes JF et al Pediatric Emergency Care Applied Research Network (PECARN). Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013; 62(2): 107-116. PMID: 23375510

• We all know that we would like to avoid unneccessary ionizing radiation in the most radio-sensitive patients – kids. Abdominal trauma, though, is difficult to evaluate in children. Is there a set of clinical features that help define a low-risk pediatric population? Take a look and see what the evidence says.
• Recommended by: Sean Fox
• Read More: Low Risk for Intra-abdominal Trauma (Pediatric EM Morsels)

Legrand M et al. Ten tips for managing critically ill burn patients: follow the RASTAFARI! Intensive Care Med 2015; 41(6): 1107-9. PMID 25573501

• Short paper with 10 good tips for managing severe burn patients in the first 24-48 hours before transfer to at burn center including prehospital and early in-hospital care. The article gives some good pointers how to use the Parkland formula and how to modify the “rule of nines” in the prehospital setting. But most importantly – a VERY good mnemonic …..yeah man!
• Recommended by: Soren Rudolph

Malka ST, et al. Weapons Retrieved After the Implementation of Emergency Department Metal Detection. J Emerg Med 2015 PMID: 26153030

• Insane. Insane and likely not conceivable for those outside of the United States. This short and small study describes the type and quantity of weapons retrieved when one ED placed metal detectors at the front door for all ambulatory patients. They found, on average, 218 weapons/month, including:
  • firearms
  • knives
  • chemical sprays
  • other (brass knuckles, box cutters, etc…)
• One more stunning example of the issue of weapons and safety currently at play in our society at large.
• Recommended by: Jeremy Fried