R&R In The FASTLANE 102

Welcome to the 102nd 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

Adebayo R. Hypertensive Emergencies in the Emergency Department. Emerg Med Clin N Am. 2015; 33(3): 539-51 PMID 26226865

• A brief, but comprehensive review of all things elevated blood pressure. While the authors review many of the hypertensive emergencies we deal with as emergency providers (acute decompensated heart failure, aortic dissection), they also, and importantly, discuss the hypertensive patient in the ED without acute end organ damage. Referencing the lack of evidence of benefit for acute lowering of blood pressure in these patients, the authors recommend that optimal treatment for these patients is close outpatient follow up.
• Recommended by Jeremy Fried

Hasselqvist Ax I, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. NEJM 2015; 372: 2307-15. PMID 26061835

• This study reviewed data from over 30,000 OHCA and found that the initiation of early CPR (prior to EMS arrival) was associated with increased 30-day survival (10.5% vs. 4.0%). Unfortunately, the database has only limited information on neurologic function and thus, improved functional status cannot be assessed from this data set. However, this study further supports the need for increased lay person training as well as methods of bringing those lay providers to the patient (i.e. GoodSam application, mobile phone programs etc).
• Recommended by Anand Swaminathan

McCrory MC et al. Off-Hours Admission to Pediatric Intensive Care and Mortality. Pediatrics 2014. PMID 25287463

• This paper started with the premise that after business hours admissions had a higher mortality risk. The study showed that non-elective admits are sicker than electives ones and have a higher mortality, however, after multivariable regression the mortality of both groups were the same. Surprisingly the time of the day with the highest mortality was 6am to 11am. Why? difficult to say, maybe sicker post-op kids? or people is to busy rounding and the early morning admits wait more?
• Recommended by Daniel Cabrera

Reith G et al. Injury pattern, outcome and characteristics of severely injured pedestrian. Scand J Trauma Resusc Emerg Med 2015. PMID 26242394

• Although Farley and Waddel’s “fatal triad” (a combination of injuries of head, pelvis/hip, and knee region) could not be reproduced in this German trauma data registry, pedestrians are vulnerable and may suffer severe injuries and have higher subsequent mortality when involved in road traffic collisions. The authors stress that trauma teams should be aware of the “trigger term” pedestrian and anticipate the typical pedestrian motor vehicle collision victim as a very young or very old patient with significant head and lower extremity trauma and impaired level of consciousness and cardiovascular circulation.
• Recommended by Soren Rudolph

Juurlink DN et al. Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Ann Emerg Med 2015; 66(2):165-81. PMID 25986310

• This publication is from the Extracorporeal Treatments in Poisoning (EXTRIP) group and details the management of salicylate overdose. The group notes the scant presence of evidence to guide management but notes that salicylates are readily removed by hemodialysis, that intermittent hemodialysis is preferred and that dialysis should be initiated for high concentrations (> 100 mg/dL or > 90 mg/dL in patients with impaired renal function), altered mental status, ARDS, severe acidemia (pH < 7.20) and if standard treatment fails.
• Recommended by Anand Swaminathan

Chanques G. Five patient symptoms that you should evaluate every day.Intensive Care Med. 2015; 41(7): 1347-50. PMID 25758669

• Nice short paper on five symptoms that matters to the ICU patient and that you need to evaluate on a daily basis to deliver optimum care. These are pain, thirst, anxiety, dyspnea and sleep.
• Recommended by Soren Rudolph