R&R In The FASTLANE 142

Welcome to the 142nd 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

Ali S, et al. An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond. Pediatric emergency care 2016. PMID: 26720064

• This is a nice quick review that goes over the evidence behind the things we can do to limit procedural pain in kids (really, should be for everyone.) Hopefully most of this is review: things like sucrose, topical anesethics for needles and IVs, and distraction with music, toys, or watching cartoons. Parental presence helps kids, as does allowing them to breastfeed during the procedure. For lacerations, we should be buffering our lidocaine with bicarb and when possible using skin adhesives. One things I didn’t know and might change practice for people is that venipuncture is significantly less painful than heel lance.
• Recommended by Justin Morgenstern

Meltzer AC, et al. For Adults With Nausea and Vomiting in the Emergency Department, What Medications Provide Rapid Relief? Annals of emergency medicine 2016. PMID: 27130801

• This is a systematic review of RCTs looking at the treatment of nausea and vomiting in the emergency department. They found 8 trials that covered 952 patients. The ONLY medication that demonstrated a statistically significant decrease in nausea at 30 minutes was droperidol. Metoclopramide, ondansetron, prochlorperazine, and promethazine were all statistically nondifferentiable from placebo. Bottom line: Once again, droperidol is a very valuable drug, that was taken away from us (or at least a lot of us) for no good reason.
• Recommended by Justin Morgenstern

Patterson BW, et al. Cherry Picking Patients: Examining the Interval Between Patient Rooming and Resident Self-assignment. Acad Emerg Med 2016. PMID: 26874338

• You know in your heart which chief complaints are the most compelling to pick out of the rack – and these authors have quantified it. Quick dispos and the critically ill get people moving the fastest, while vague symptoms and vaginal bleeding seem to be less exciting.
• Recommended by RPR
• Further reading Excitement and Ennui in the ED (EM Literature of Note)

Gulen B, et al. Serum S100B as a surrogate biomarker in the diagnoses of burnout and depression in emergency medicine residents. Acad Emerg Med 2016. PMID: 27018399

• Burnout and biomarkers are hot topics in EM. The biomarker S100-B has been touted for many processes – traumatic brain injury, depression, and now, burnout. These researchers compared S100-B levels with depression and burnout inventory scores and found out that they correlate. How a biomarker adds value to these inventories to identify at-risk providers is totally unclear.
• Recommended by Lauren Westafer

Hollander JE. Managing Troponin Testing. Ann Emerg Med 2016. PMID: 27353283

• It’s always nice to have an expert write down good practice in a good journal. This is Judd Hollander’s great, concise overview of troponin testing, in Annals Expert Clinical Management series. Key features: any troponin is worse than no troponin, more troponin is worse than less troponin. If you’re concerned about ACS, then troponin = bad. If ACS isn’t the primary concern (ie Type II MI, like in sepsis) then trend the troponin, don’t thin the blood.
• Recommended by Seth Trueger

Roolvink V et al. Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention. J Am Coll Card 2016. PMID: 27050189

• Beta blockers have two major benefits in STEMI patients: reduction in early development of lethal ventricular dysrhythmias and long-term improved left ventricular remodeling. There’s little question about either of these but relevance of timing of beta blocker administration continues to be debated. This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better.
• Recommended by Anand Swaminathan