R&R In The FASTLANE 135

Welcome to the 135th 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

Kor DJ,  et al. Effect of Aspirin on Development of ARDS in At-Risk Patients Presenting to the Emergency Department: The LIPS-A Randomized Clinical Trial. JAMA. Published online May 15, 2016. doi:10.1001/jama.2016.6330.

• This multi-centred, double blind, placebo controlled RCT involving 390 patients was conducted in the US. It assessed the safety and efficacy of early administration of aspirin in preventing ARDS in patients determined to be at risk of ARDS (Lung Injury Prediction Score ≥4) in the Emergency department. For patients randomized to the intervention group, a 325-mg loading dose of aspirin was administered on day 1, followed by 81 mg of aspirin once daily up to day 7, hospital discharge, or death, whichever occurred first. No difference was observed in between groups on the incidence of ARDS or any of the secondary outcomes e.g. ventilator free days, ICU and hospital LOS.
• Recommended by: Nudrat Rashid
• Read more: Is It Possible to Prevent ARDS?

Donino MW et al. Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial. Crit Care 2016. PMID: 27038920

• Are you using corticosteroids in patients with refractory shock after cardiac arrest? This well-done RDCT demonstrated no benefit to this therapy for time to shock reversal. Clinical outcomes were no different either although this was a secondary outcome of the study.
• Recommended by: Anand Swaminathan

Gágyor I, et al. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ (Clinical research ed.). 2015. PMID: 26698878

• Despite being one of the greatest advances in modern medicine, antibiotics get a bad rap in EBM. Do they work in UTI? Probably, as this RCT shows lower rates of dysuria and less (though not statistically) pyelonephritis when comparing fosfomycin to ibuprofen. However, what I think is the interesting point is that 70% of the women in the ibuprofen group had their symptoms resolve and never required antibiotics. So they probably work, but they clearly aren’t essential. If you call someone back with a positive culture and they no longer have symptoms, they are probably cured – they don’t need antibiotics.
• Recommended by: Justin Morgenstern

Friedman BW, et al. Current management of migraine in US emergency departments: an analysis of the National Hospital Ambulatory Medical Care Survey. Cephalalgia. 2015. PMID: 24948146

• Wow, we use a lot of opioids — for headaches! The authors looked at ED visits in the big NHAMCS database, in both 2010 and 1998. The good news is we use a lot less meperidine than we used to. The bad news is we use hydromorphone instead. And, 59% of ED patients with headaches got opioids (which, incidentally, don’t work for headache). We need to do better.
• Recommended by: Seth Trueger

dwards DS et al. 40 years of terrorist bombings – A meta-analysis of the casualty and injury profile. Injury. 2015 Dec 31. PMID 26830126

• The last 40 years an average of 2000 terrorist bombings are recorded every year. The trend is increasing with 6665 incidens occuring in 2013, most of which occur in the Middle East. Although suicide bombs are very scary, receive much media attention and have profound psychological effects on the local societies they only account for arounf 5 % of incidents. This review provides knowledge about some specific details we as clinicians need when preparing for a mass casualty incident: – Was it a suicide bomb? Suicide bombs are 8,9 times more deadly than non-suicide bombs averaging 10 killed and 24 wounded compared to only 1,14 killed and 3,45 wounded in non-suicide bombings. – In what kind of enviroment did the bombing occur? eventhough open and close space bombs carry the same mortality rates they have different injury pattern profiles with close space bombs having more primary blast injuries and open space bombs have second and tertiary injuries. – Are there reports of collapsed buildings? As this increases death rates substantially
• Recommended by: Søren Rudolph

Shakti D, et al. Idiopathic pericarditis and pericardial effusion in children: contemporary epidemiology and management. J Am Heart Assoc. 2014. 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