R&R In The FASTLANE 140

Welcome to the 140th 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

Inaba K et al. FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy. Ann Surg 2015. PMID 26258320

• Resuscitative thoracotomy has a low yield of good outcomes and it can be hard to predict which patients will successfully be resuscitated. In this study of 187 traumatic arrest patients, the survival rate was 3.2%. The authors found that if the patient had no cardiac motion AND no pericardial effusion, the mortality was 100%. This potentially identifies a group in which providers should not be subjected to the risks of thoracotomy.
• Recommended by Anand Swaminathan

Duffy C et al. Social media and Anaesthesia Journals. BJA 2015. PMID 26582860

• Short correspondence in BJA highlighting not only the educational benefits from FOAM resources but also a possible correlation between scientific journal impactor factor and online Twitter presence.
• Recommended by Soren Rudolph

Doluoglu OG et al. Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study. Urology. 2015. PMID 26142575

• Could it be the best way to reduce time to stone passage in ureterolithiasis is sexy-time?
• Recommended by RPR

Cheng YJ et al. The Role of Macrolide Antibiotics in Increasing Cardiovascular Risk. J Am Coll Cardiol. 2015. PMID 26564594

• The harm is small – 1 in ~25,000 prescriptions – but this is another call to avoid unnecessary use of macrolide antibiotics when feasible.
• Recommended by RPR

Body R et al. The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes. Resuscitation. 2010. PMID 20036454

• Great paper by the Manchester group (ft Rick Body & Simon Carley) on what HPI features make ACS more likely. The winners: radiating to arms, vomiting ,central chest pain, and sweating observed. Rest pain or left arm radiation aren’t helpful. Obviously ACS workup and diagnosis is complicated and these aren’t changing my management a ton. I find them most helpful when negative to document discharge for low risk chest pain, and when positive to ratchet up my concern (more repeat ECGs, etc).
• Recommended by Seth Trueger

Brown CA III et al. Techniques, Success, and Adverse Events of Emergency Department Adult Intubations. Ann Emerg Med. 2015. PMID 25533140

• This paper is far from disruptive, but is important as a summary of the current state of Emergency Airway Management in US EDs. The National Emergency Airway Registry runs a online database with 18 EDs across the US where data is collected from every single intubation. From the 18 centers, only 13 reported high enough quality data and were included. A total of 17853 intubations were analyzed.
  A 65% of intubations are medical and 31% for trauma, 85% underwent RSI, 95% were managed by EPs (79% learners), DL was use in 84%, while VL increased from 3% in 2002 to 27% in 2012. The first attempt intubation rate was 83% and the overall success rate was 99.4%.
• Recommended by Daniel Cabrera