R&R In The FASTLANE 149

Welcome to the 149th 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

Carson SS, et al. Effect of Palliative Care-Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial. JAMA. 2016. PMID: 27380343

• This is a really interesting study of families of patients with chronic critical illness conducted in the United States. This randomised controlled trial included 365 family decision makers for 256 adult patients and assessed if “palliative care led interventions” in the form of informational and emotional support meetings in addition to family meetings as per usual practise of the Intensive care clinician improved symptoms of  anxiety and depression (HADS symptom score) for family decision makers of patients with chronic critical illness. These support and information meetings targeted 2 key time points separated usually by 10 days. The first was conducted usually after 7 days on mechanical ventilation when a tracheostomy was being considered and the second a time period after the tracheostomy in which mechanical ventilation is usually weaned. No statistically significant difference was found between the 2 groups and this intervention is not routinely required.
• Recommended by: Nudrat Rashid

Cortellaro F et al. Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study. Intern Emerg Med 2016. PMID: 27236328

•  POCUS for the win in sepsis? This prospective study found increased accuracy of determining the source in septic patients of POCUS in addition to clinical evaluation in comparison to clinical evaluation alone. While the study has a number of issues (it was small, single center and performed by expert sonographers) it has face validity and should be seen as a challenge to all of us “non-experts” to improve our skills to deliver better care.
• Recommended by: Anand Swaminathan

Wiener RS, et al. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med. 2011. PMID: 21555660

•  Since the introduction of CTPA, we’ve diagnosed a ton more PEs, but we’ve barely touched mortality. And, sadly, we make people bleed a lot more.
• Recommended by: Seth Trueger

Lasoff D, et al. Psychiatric Emergencies for Clinicians: Detection and Management of Anti-N-Methyl-D-Asparate Receptor Encephalitis. The Journal of emergency medicine. 2016. PMID: 27431869

• Anti-NMDA encephalitis has probably been mentioned here before, but repetition is essential, as this is a new diagnosis to most of us, is treatable, but lethal if missed, and probably more common than other forms of encephalitis we diagnosis (such as HSV). Key points: There is no aspect of the history or physical that is specific. These patients generally progress through 4 phases: general viral prodrome, then psychiatric symptoms (agitation, hallucinations), then neurologic symptoms (seizures, confusion, movement disorders), and finally autonomic instability. No imaging test is all that helpful. The test of choice is CSF looking for the anti-NMDA antibodies. In the ED, management is going to be symptomatic, but it is essential that we think about the condition, so that IVIG can be started if the CSF tests positive.
• Recommended by: Justin Morgenstern

Sanfilippo F, et al. Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2016. PMID: 27496262

•  Amidarone and Lidocaine are included in current guidelines for treatment of out-of-hospital cardiac arrest with shockable rhythm. Evidence from this systematic review and meta-analysis show the two drugs are equally good/bad at making patients survive to admission, but better than placebo. Although this survival benefit over placebo is not seen at survival to discharge
• Recommended by: Soren Rudolph

Moshtaghion H, et al. The Efficacy of Propofol vs. Subcutaneous Sumatriptan for Treatment of Acute Migraine Headaches in the Emergency Department: A Double-Blinded Clinical Trial. Pain Pract. 2015. PMID: 25040321

•  One wouldn’t have thought that these would be two meds you’d find being compared in the same trial but these guys in Iran did a blinded RCT of propofol v sumatriptan for migraine. Not entirely clear how they enrolled their 90 patients and some of the other details are a bit scanty but they found a slight benefit at 30 mins in the propofol group. Ultimately everyone did great in this trial with the VAS improving rapidly in everyone.
• Recommended by: Andy Neill