R&R In The FASTLANE 121

Welcome to the 121st 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

Pivetta E et al for the SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the Emergency Department – A SIMEU multicenter study. Chest. 2015 PMID 25654562

• The evidence in favor of the use of ultrasound for the diagnosis of acutely decompensated heart failure is increasing rapidly. This Italian study enrolled 1005 patients, on each of them the emergency physician made a clinical estimation of the diagnosis of ADHF and then performed a 6-windows US protocol based on a previous paper (Cibinel, 2012). After discharge, the etiology of the dyspnea was adjudicated by an independent reviewer who had access to all medical records. The sensitivity and specificity of ultrasound was better than clinical diagnosis and x-ray + BNP. The lung US approach permitted and additional 19.1% increase in the diagnosis of ADHF.
• Recommended by Daniel Cabrera

Lyons N et al. An alternative for rapid administration of medication and fluids in the emergency setting using a novel device. Am J Emerg Med 2015. PMID 25662805

• This article discusses a series of cases where fluids and medications were administered through a rectal catheter (Macy catheter) instead of via more traditional routes. The authors conclude that the successful management of the 3 included patients suggests that the device “may be an appealing alternative route.” I have a hard time believing that IV should be avoided in favor of rectal “access” or that IO sites are ever unavailable in patients with difficulty IV access.
• Recommended by Anand Swaminathan

Ilancheran A. Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? Yes. Emerg Med Aust 2015 PMID 25583400

Osborne R. Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No. Emerg Med Aust 2015 PMID 25582042

• This is a point-counterpoint pair of editorials looking at the issue of whether Emergency Medicine trainees should be responsible for teaching medical students who are assigned to rotate in the Emergency Department. Teaching medical students is much harder than teaching residents but is also a great way to hone skills as both a physician and educator. If not the residents/registrars, the duty must fall on to faculty. It is likely that the duty should be carried out by both parties.
• Recommended by Anand Swaminathan

Choo EK et al. Managing Intimate Partner Violence in the Emergency Department. Ann Emerg Med 2015. PMID 25533139

• Intimate partner violence is a significant issue throughout the world. This is a review article detailing how we should think about screening patients who present to the ED and how we should act on the information we obtain during screening.
• Recommended by Anand Swaminathan

Carlson JN et al. Does Intubation Improve Outcomes Over Supraglottic Airways in Adult Out-of-Hospital Cardiac Arrest? Ann Emerg Med 2015. PMID 26475247

• This Systematic Review Snapshot summarizes the findings of an important article examining the ROSC and neurologically intact survival differences between supraglottic airways (SGA) and endotracheal intubations (ETI) in out of hospital arrest patients. While there is clearly limited evidence of poor quality, what the authors were able to demonstrate is that there is a weak relationship between ETI and neurologically intact survival with an OR 1.33 (1.04–1.69). All studies looked at to determine this relationship were observational in nature and of low quality of evidence. Importantly, the authors remind us of the ongoing trials which will help determine the answer to this important clinical question.
• Recommended by Jeremy Fried

Shakti D et al. Idiopathic pericarditis and pericardial effusion in children: contemporary epidemiology and management. J Am Heart Assoc 2014; 3(6). PMID 25380671

• Pediatric Chest Pain is common… and fortunately, often due to benign causes. Before you announce that this is merely costochondritis, be sure to contemplate Pericarditis.
• Recommended by Sean Fox