R&R In The FASTLANE 152

Welcome to the 152nd 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 5 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

Bernard SA et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline (The RINSE Trial). Circulation. 2016. PMID: 27562972

• This multi-centre randomised control trial just added another nail in hypothermia’s coffin. Adults with out of hospital cardiac arrest undergoing CPR were randomised to either a rapid intravenous infusion of up to two-litres cold saline or standard care. Due to changes in temperature management at receiving hospitals the trial was ceased early. Patients who received cold saline with an initial shockable rhythm had a decreased rate of ROSC compared to standard care and did not display a trend to improved outcome at hospital discharge.
• Recommended by: Nudrat Rashid

Semler MW, Rice TW. Saline Is Not the First Choice for Crystalloid Resuscitation Fluids. Crit Care Med. 2016. PMID: 27428117

•  While there’s nothing new here in the age old debate between “normal” saline and balanced electrolyte solutions in resuscitation, the authors of these pro/con articles summarize the available literature on both sides of the debate succinctly. These review articles act as a succinct repository of our current understanding of the debate. A must add to any library.
• Recommended by: Anand Swaminathan

Teoh WH, Kristensen MS. Prediction in airway management: what is worthwhile, what is a waste of time and what about the future? Br J Anaesth. 2016. PMID: 27317701

•  Very nice editorial on prediction of difficult airway management with thoughts on how to be become better prepared in a future of ever expanding airway devices.
• Recommended by: Daniel Cabrera

Hermann LK, et al. The limited utility of routine cardiac stress testing in emergency department chest pain patients younger than 40 years. Ann Emerg Med. 2009. PMID: 19231025

• Another great paper from SinaiEM: they looked at all stress tests in ED patients under 40 years old (220 patients from 2004-2007) and only 6 had a positive stress; only 4 went on to get cathed, and 2 of those were negative. More evidence suggesting stress tests are useless in younger patients.
• Recommended by: Seth Trueger

Shavit I, et al. Sedation for children with intraoral injuries in the emergency department: a case-control study. Pediatr Emerg Care. 2014. PMID: 25343735

•  Procedural sedation & analgesia for intra oral procedures (IOP) such as lacerations, I&D and aspirations is generally considered with a higher risk of Serious Adverse Events During Sedation (SAEDS). This papers compares 38 cases (sedation for IOP) with 41 controls (sedation for forearm fracture reduction) in terms of SAEDS (apnea, hypoxemia (oximetry <93%), hypoventilation, laryngospasmand other upper airway obstruction). Both groups have similar sedation strategies and events; 5 hypoxic/2 apneas in cases vs. 4 hypoxic/2 apneas in control. This papers appears to show that IOP have similar risk of SAEDS compared to sedation for non IOP procedures.
• Recommended by: Daniel Cabrera