R&R In The FASTLANE 183

Welcome to the 183rd 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

Seymour CW, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med 2017. PMID: 28528569.

• The authors performed a retrospective study examining the time to treatment of septic patients and mortality. They used data required to be collected and reported by the state to determine the relationship between mortality and time to completion of a sepsis bundle, fluid bolus administration, and antibiotic administration. Significantly, with almost 50,000 patients included in their analysis, they found an association between timing of both completion of a 3-hour bundle and broad spectrum antibiotic administration with mortality. In essence, early identification and treatment for these patients DOES matter.
• Recommended by: Jeremy Fried

Cox R et al. Yankauer Suction Catheters with “Safety” Vent Holes May Impair Safety in Emergent Airway Management. Am J Emerg Med 2017. PMID: 28457763

• This is a simple study demonstrating the importance of uniformity and simplicity in airway management. When residents were challenged with a suction device requiring occlusion of a vent hole that required occlusion for function, 76% failed to occlude the hole immediately and 60% didn’t occlude the hole after 20 seconds. Part of the issue may arise from the fact that different catheters were stocked at the different clinical settings the residents worked in. The answer, eliminate the vent hole or, at least, maintain uniformity across clinical settings. Of course, this information does nothing to remedy the poor quality of suction the Yankuer provides in the first place.
• Recommended by: Anand Swaminathan

Schriger DL et al. Structured Clinical Decision Aids Are Seldom Compared With Subjective Physician Judgment, and are Seldom Superior. Ann Emerg Med 2017. PMID: 28238497

• Every Emergency Provider loves a good decision instrument but are they better than the physician judgement they are attempting to replace? This brilliant study shows that most clinical decision tool studies fail to ask the most important question – is this better than what we’re already doing?
• Recommended by: Anand Swaminathan

Ramirez R et al. Haloperidol Undermining Gastroparesis Symptoms (HUGS) in the Emergency Department. AJEM 2017. PMID: 28320545

• In this small, retrospective study, 5mg IM Haldol decreased rates of admission and amounts of opioids administered in patients with diabetic gastroparesis. Haldol could be a potential addition to the armamentarium of treatment in this difficult to treat disease process.
• Recommended by: Salim R. Rezaie
• Read more: Diabetic Gastroparesis Needs HUGS (R.E.B.E.L. EM)

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