R&R In The FASTLANE 194

Welcome to the 194th 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

Higgs A, et al. Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anesthesia. 2018; 120(2):323-352. doi: 10.1016/j.bja.2017.10.021

• Do you intubate critically ill patients? if, so this is an absolute MUST read! This comprehensive and modern approach to managing the airway of the critically ill provides simple and directly applicable recommendations for the entire proces of airway management.
• Recommended by: Soren Steemann Rudolph

Ridderikhof ML, et al. Acetaminophen or Nonsteroidal Anti-Inflammatory Drugs in Acute Musculoskeletal Trauma: A Multicenter, Double-Blind, Randomized, Clinical Trial. Ann Emerg Med. 2017 Oct 13. PMID: 29033294.

• A nice Dutch multi center double-blind randomized clinical trial trying to break the myth that NSAIDs are more effective in treatment of pain after minor musculoskeletal extremity trauma than Paracetamol.
• Recommended by: Senad Tabakovic

Driver BE et al. The association of Emergency Department treatments for hyperglycemia with glucose reduction and emergency department length of stay. J Emerg Med 2017. PMID: 28993036

• This study questions the effectiveness of standard therapies (SQ insulin, IV fluids) in lowering blood glucose in type II DM patients who present to the ED with hyperglycemia but are otherwise well-appearing. Across 566 such encounters there was only an association with modest blood sugar reductions while significantly increasing the ED length of stay (in regards to IV fluid administration). Prior work from this group (https://www.ncbi.nlm.nih.gov/pubmed/27353284) questioned the value of lowering the blood sugar at all in well-appearing hyperglycemic type II diabetics. Add this to a lack of significant reduction and it may be time to put this approach to rest.
• Recommended by: Anand Swaminathan

Alam A, Juurlink DN. The prescription opioid epidemic: an overview for anesthesiologists. Canadian journal of anaesthesia. 2016; 63(1):61-8. PMID: 26507535

• An excellent academic overview of the origins and extent of the prescription opioid crisis that Leon Gussow has called the “worst man-made epidemic in history”. The malign influence of drug companies and ‘thought leaders’ promoting the use of addictive drugs for a wide range of chronic pain conditions has been disastrous. The authors also review the evidence for the benefits and harms of longterm opioids.
• Recommended by: Chris Nickson

Schwartzstein RM, Roberts DH. Saying Goodbye to Lectures in Medical School – Paradigm Shift or Passing Fad? The New England journal of medicine. 2017; 377(7):605-607. PMID: 28813217

• I’m recommending this article because it nicely spells out my views on the place of lectures in education 😉 The traditional ‘sage on the stage’ speaking down to meek minions does little to help learners learn. The traditional lecture needs to move aside to make space for things like active learning sessions, team-based learning, flipped classrooms, and self-directed learning that help kickstart minds rather than anaesthetise them.
• Recommended by: Chris Nickson