R&R In The FASTLANE 180

Welcome to the 180th 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

Anderson DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017. PMID: 28104287

• This cluster randomised control trial looked at terminal cleaning of rooms from which a patient with infection or colonisation with a target organism was discharged. 4 different cleaning strategies were tried: reference group (quartenary ammonium disinfectant), UV group, bleach group and UV +bleach group. Patients admitted to rooms previously occupied by patients harbouring a multi-resistant organism or C Difficile were 10-30% less likely to acquire the same organism if the room was disinfected using an enhanced strategy. The most effective of these strategies was when disinfecting ultraviolet was added to a standard disinfectant strategy.
• Recommended by: Nudrat Rashid

Donkor J,et al. Analysis of Gastric Lavage Reported to a Statewide Poison Control System. J Emerg Med 2016. PMID: 27595368

• Gastric lavage used to be frequently and inappropriately used but, better understanding of it’s utility as well as the development of other treatment modalities (including antidotes) has led to decreased use. This article reviews lavage cases called in to a state poison center and finds that while numbers are down, many of the ones performed were inappropriate. Bottom line, better education needs to be done to stress when and where it’s useful. Ingestions within 60 minutes of presentation of enough drug to have a serious toxic effect and where there’s no available antidote should prompt consideration for lavage in conjunction with a toxicologist when possible.
• Recommended by: Anand Swaminathan

Talan DA, et al. Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management. Ann Emerg Med 2016. PMID: 27974169

• Even though the results are very promising for using an antibiotic first strategy in acute uncomplicated appendicitis, a much larger trial would need to be performed before generalizability. Even so, this trial did show that outpatient ED management of uncomplicated appendicitis is feasible.
• Recommended by: Salim R. Rezaie

Hobbs WR, et al. Online social integration is associated with reduced mortality risk. Proc Natl Acad Sci U S A. 2016;113(46):12980-4. PMID: 27799553

• This is a fun little study. They looked at the activity of 12 million facebook accounts in California and compared that to state health records. Having more friends on facebook was associated with decreased risk of mortality. However, you can’t just have friends – they have to request you. If you send out more friend requests, you are actually more likely to die. Being tagged in photos means you will live longer whereas posting more status updates means you will die sooner. (They guess that this might correlate with real life social interactions: being tagged in a photo means you were probably with someone else, whereas constantly adding more status updates means you are probably are currently alone, and might stay that way forever.) So, get more friends on facebook, but make sure they add you and not vice versa, and go tag yourself in some photos. (Do I really need to comment on association not being causation?)
• Recommended by: Justin Morgenstern

Nelson CJ et al. Morbidity and mortality associated with medications used in the treatment of depression: an analysis of cases reported to US poison control centers 2010-2014. Am J Psychiatry 2017. PMID: 28135844

• Use of TCAs and MAOIs for treatment of depression has largely given way to the more popular and safer SSRIs. Overdose of SSRIs are comparatively well tolerated and managed relatively easily with good supportive care. With the emergence of the newer antidepressants, particularly the DNRIs (bupropion) and SNRIs (venlafaxine, duloxitine), more serious and even fatal toxicities are not uncommon. Though causality cannot be inferred due to limitations in poison center data, this article highlights the increased attention and caution EM providers should give to overdoses of newer antidepressant medications.
• Recommended by: Meghan Spyres