R&R In The FASTLANE 117

Welcome to the 117th 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

Lewis VJ et al. Towards a national model for organ donation requests in Australia: evaluation of a pilot model. Crit Care Resusc. 2015; 17(4): 233-8. PMID:26640057 

• This was a national observational study capturing staff observations of the organ donation requesting process which collected data from 201 family donation conversations. The model aimed to ensure that a trained health professional (to provide support alongside timely and sufficient information) was present when organ donation is first raised with the family and that families understand that death has occurred or is inevitable.
• The study showed that structural elements of the model was observed in most cases and that consent rates were higher when conversations were led by highly trained professionals who were not part of the patients treating clinical team. The accompanying editorial suggests it is no longer reasonable to assume that untrained Intensivists are best placed to independently manage family donation conversations. A select pool of requestors (medical and/or nursing) should be routinely called on to undertake this highly specialised conversation with families.
• Recommended by: Nudrat Rashid
• Read more: The family donation conversation: time to move to evidence based practise. Helen Opdam. Crit Care Resusc. 2015; 17(4): 231-2. PMID: 26640056

Hirsch M et al.The medical response to multisite terrorist attacks in Paris. Lancet. 2015; 6736(15): 1063-6. PMID: 26628327

• Fascinating and scary stuff. In this paper the prehospital and hospital management of the multisite attack in Paris in november 2015 are presented from the viewpoint of the prehospital emergency physician, the trauma surgeon, and the anaesthesiologist. Sharing these informations are crucial to build medical preparedness in other countries.
• Recommended by: Søren Rudolph

Tabbut M et al. High-frequency linear transducer improves detection of an intrauterine pregnancy in first-trimester ultrasonography. Am J Emerg Med. 2015 Nov 9. PMID: 26632019

• Traditionally, we are taught to use a curvilinear abdominal probe when performing transabdominal ultrasound to detect first trimester pregnancy. This study looked at adding the high frequency linear transducer after failure to identify IUP with the standard transducer. Of 81 initial scans, 27 patients did not have an IUP visualized with the curvilinear probe. Of those, 9 (33%) were found to have an IUP by using the linear probe. (It seems like it is helpful if you can see a probable gestational sac, but can’t identify a fetal pole or yolk sac).
• Recommended by: Justin Morgenstern

Tseng HJ et al. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015. PMID: 26320521

• An excellent, in depth review of finding and managing foreign bodies that are ingested, aspirated or inserted. The authors create some great tables that can act as rapid access guides on your smart device for just in time clinical guidance.
• Recommended by: Anand Swaminathan

Padua AP et al. Isotonic versus hypotonic saline solution for maintenance intravenous fluid therapy in children: a systematic review. Pediatr Nephrol. 2015; 30(7): 1163-72. PMID: 25576065

• Selection of IV Maintenance fluids is often not considered in the ED, but when you need to, don’t be cavalier! Favor Isotonic Fluids for Maintenance initially! This is especially true for pre/post-operative patients or patient in whom there is risk for them having elevated ADH levels (so, like all of the ones who need an IV in the hospital). Using Isotonic Fluids for Maintenance has proven to be safe, while Hypotonic Fluids have greater risk for hyponatremia. As with the maintenance volume, the electrolyte composition should be tailored for the individual and monitored closely. Don’t let fluids be on “auto-pilot.”
• Recommended by: Sean Fox
• Read More: Maintenance Fluids (Pediatric EM Morsels)

McCrory MC et al. Off-Hours Admission to Pediatric Intensive Care and Mortality. Pediatrics 2014; 134(5): e1345-53. 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