R&R In The FASTLANE 185

Welcome to the 185th 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 4 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

Probst MA, et al. Shared Decisionmaking in the Emergency Department: A Guiding Framework for Clinicians. Ann Emerg Med 2017. PMID: 28559034.

• Shared decision making is a frequently cited concept in emergency medicine as an idealized approach of how to deal with the any of the innumerable clinical conundrums we deal with on a daily basis. There is often, however, some confusion as to what exactly that concept means in clinical practice and how to apply it. This practice of emergency medicine article outlines the basic concepts involved and provides a vignette of how to apply them in a clinical setting. Great read!
• Recommended by: Jeremy Fried

Sunden-Cullberg J et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Crit Care Med. 2017;45(4):591-599. PMID: 28141683

• First we thought fever was bad in sepsis, then we looked at only treating if the patient was uncomfortable and now it’s protective? Well, not exactly. This observational cohort study demonstrated an inverse linear relationship between increasing temperature on arrival to ED and mortality. In other words, the higher the temperature in sepsis, the more likely the patient survives. An interesting demonstration of the power of evolution.
• Recommended by: Anand Swaminathan

Yu EH et al. Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? Anaesthesia. 2016; 71(11):1347-1362. PMID: 27734470

• Remifentanyl, along with a few other agents, has rapidly become a bit of a critical care darling drug. It’s creeping into ED/EM as well. This article on remifentanyl tolerance and hyperalgesia is nerdy, focussed on perioperative anaesthesia, but good.
• Recommended by: Matthew MacPartlin

Verma AA et al, for the GEMINI Investigators. Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope: A Multicenter Cross-sectional Study in Toronto, Ontario, Canada. JAMA Intern Med. PMID: 28492876

• A quick update on PESIT. This retrospective chart review tried to replicate the PESIT inclusion criteria. They identified 1305 patients admitted with first time syncope. Ultimately, 11 were diagnosed with PE and 10 with DVT, resulting in a VTE prevalence of 1.4% (95%CI 0.9-2.2%). This is much lower than the number reported in PESIT, is much more realistic, and is also below the test threshold for workup.
• Recommended by: Justin Morgenstern
• Read more: Quick PESIT Update (First 10 EM)