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R&R In The FASTLANE 007

January 19, 2012 By 3 Comments

The seventh edition of our weekly series of eminence-based evidence (back after the festive season hiatus):

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A free weekly 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 18 recommended reads. Find out more about the R&R in the FASTLANE project here and check out the team of contributors from all around the world.

This week’s ‘R&R Hall of Famer’

  • Croskerry P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Academic Medicine 2003;78:775-780. PMID: 12915363.
R&R In The FASTLANE 007 RR Hall of fame 64 R&R In The FASTLANE 007 RR Landmark 64 R&R In The FASTLANE 007 RR Eureka 64 You won’t be able to avoid cognitive errors such as anchoring, confirmation bias, psych-out error, and Yin-Yang out unless you’re aware of them. Pat Croskerry gives suggestions on tuning up your medical decision-making.

Recommended by Leon Gussow

This week’s R&R recommendations

  • Magder SA. The ups and downs of heart rate. Crit Care Med. 2012 Jan;40(1):239-45. PMID: 22179340.
R&R In The FASTLANE 007 RR Mona Lisa 64 How heart rate affects Everything!… and why tachycardia isn’t always bad.

Recommended by Mike Jasumback

  • McPherson PA, McEneny J. The biochemistry of ketogenesis and its role in weight management, neurological disease and oxidative stress. J Physiol Biochem. 2011 Oct 8. [Epub ahead of print] PMID: 21983804.
R&R In The FASTLANE 007 RR WTF 64 Ketosis in all its glory! The biochemical basis to manage all forms of ketosis!!

Recommended by Mike Jasumback
Fulltext

  • Walkey AJ, Soylemez Wiener R, Ghobrial JM & al. Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis. JAMA. 2011;306(20):2248-2254.
    PMID: 22081378.
R&R In The FASTLANE 007 RR Eureka 64 Severe sepsis + new onset AF increases mortality. Should we then do something about the AF? Or is it simply a marker of sepsis-induced myocardial dysfunction?

Recommended by Ioana Vlad


  • Croskerry P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Academic Medicine 2003;78:775-780. PMID: 12915363.
R&R In The FASTLANE 007 RR Hall of fame 64 R&R In The FASTLANE 007 RR Landmark 64 R&R In The FASTLANE 007 RR Eureka 64 You won’t be able to avoid cognitive errors such as anchoring, confirmation bias, psych-out error, and Yin-Yang out unless you’re aware of them. Pat Croskerry gives suggestions on tuning up your medical decision-making.

Recommended by Leon Gussow

  • Dhaliwal G. The Mechanics of Reasoning. JAMA 2011;306:918-919. PMID: 21900128.
R&R In The FASTLANE 007 RR Eureka 64 You’ll be surprised at who the best diagnostician(s) on television or radio is. (Hint: it’s not Dr. House or Dr. Oz)

Recommended by Leon Gussow
Learn more: The Poison Review — The Mechanics of Reasoning


  • Jain S, Ting HT, Bell M, Bjerke CM, Lennon RJ, Gersh BJ, Rihal CS, Prasad A. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Am J Cardiol. 2011 Apr 15;107(8):1111-6. Epub 2011 Feb 4. PMID: 21296327.
R&R In The FASTLANE 007 RR Hot Stuff 64 Time for a change in the guidelines…? Perhaps “New LBBB” at predicting acute MI will have a class downgrade.

Recommended by Sa’ad Lahri

  • Keller T, Zeller T, Ojeda F, et al. Serial changes in highly sensitive troponin I assay and early diagnosis of myocardial infarction. JAMA. 2011 Dec 28;306(24):2684-93. PMID:
    22203537.
R&R In The FASTLANE 007 RR Hot Stuff 64 Magical thinking with increased sensitivity and no decrease in specificity – picked up by the popular media as the greatest thing since sliced bread.

Recommended by Ryan Radecki
Learn more: Emergency Medicine Literature of Note — Yet another highly sensitive troponin

  • Kanani A, Schellenberg R, Warrington R. Urticaria and angioedema. Allergy, Asthma & Clinical Immunology 2011 Nov.;7(Suppl 1):S9. PMID: 22165855.
R&R In The FASTLANE 007 RR Mona Lisa 64 Someone on Twitter linked this and I can’t remember who but it’s a nice summary of urticaria. Even better it justifies that what i do (1st gen, 2nd gen anti-hist, H2 blockers and steroids) are all ok to give together.

Recommended by Andy Neill


  • Norman E et al. Rapid Sequence Induction is Superior to Morphine for Intubation of Preterm Infants: A Randomized Controlled Trial. J Pediatr 2011;159:893-9. PMID: 21798556.
R&R In The FASTLANE 007 RR GameChanger 64 Many neonatologists use no drugs for intubating preemies (…and they seem like such nice people!). This is a small RCT but well done study that shows an RSI drug combo was not only safe, it was much better than morphine and atropine alone.

Recommended by Clay Smith
Learn more: Keeping Up with Emergency Medicine — RSI drugs for neonates

  • Chumpitazi BP et al. Creation and Initial Evaluation of a Stool Form Scale for Children. J Pediatr 2010;157(4):594-7. PMID: 20826285PMCID:
    PMC2937014.
R&R In The FASTLANE 007 RR GameChanger 64 Wow! The pictures and descriptions of pediatric poo in this article will leave you laughing for a long time!

Recommended by Clay Smith
Fulltext

  • Zier JL, Liu M. Safety of high-concentration nitrous oxide by nasal mask for pediatric procedural sedation: experience with 7802 cases. Pediatr Emerg Care. 2011 Dec;27(12):1107-12. PMID: 22134227.
R&R In The FASTLANE 007 RR GameChanger 64 Nitrous oxide – it’s time we had this routinely available as a safe, non-invasive tool for sedation.

Recommended by Ryan Radecki
Learn more: Emergency Literature of Note — Why aren’t you using nitrous yet?


  • Stanaway FF, Gnjidic D, Blyth FM, Le Couteur DG, Naganathan DG, Waite L, Seibel MJ, Handelsman DJ, Sambrook PN, Cumming RG. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ. 2011 Dec 15;343:d7679. doi: 10.1136/bmj.d7679. PMID: 22174324 PMCID: PMC3240682
R&R In The FASTLANE 007 RR WTF 64 Clever trial with practical advice … as long as your sense of humour is intact.

Recommended by Matthew Mac Partlin
Fulltext


  • Schultz JC, Segal N, Caldwell E, et al. Sodium nitroprusside-enhanced cardiopulmonary resuscitation improves resuscitation rates after prolonged untreated cardiac arrest in two porcine models. Crit Care Med. 2011 Dec;39(12):2705-10. PMID: 21725236.
R&R In The FASTLANE 007 RR Eureka 64 It’s coming – nitroprusside as a component of ACLS.

Recommended by Ryan Radecki
Learn more: Emergency Medicine Literature of Note — Nitroprusside saves pigs, how about people?

  • Walden AP, Nielsen N, Wise MP. Does the evidence support the use of mild hypothermia after cardiac arrest? No. BMJ. 2011 Sep 23;343:d5889. doi:10.1136/bmj.d5889. PMID: 21948589.
R&R In The FASTLANE 007 RR GameChanger 64 Viva agnosticism! Paving the way for the TTM trial

Recommended by Oliver Flower


  • Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008 Feb 16;371(9612):597-607. Review. PMID: 17706760; PMCID: PMC2493390.
R&R In The FASTLANE 007 RR Landmark 64 Landmark summary paper on Organophosphate poisoning

Recommended by Oliver Flower
Fulltext


  • Craig M, Jeavons R, Probert J, Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emergency Medicine Journal 2011 Mar.; PMID: 21362724.
R&R In The FASTLANE 007 RR Hot Stuff 64 I always really doubted that this stuff works but there’s a couple now suggesting that at least it’s not terrible. Bigger trial needed definitely. Personally I’d want morphine though!

Recommended by Andy Neill

  • Kwon A, Sorrells DL Jr, Kurkchubasche AG, Cassese JA, Tracy TF Jr, Luks FI. Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity. J Pediatr Surg. 2006 Jan;41(1):78-82; discussion 78-82. PMID: 16410112.
R&R In The FASTLANE 007 RR GameChanger 64 Pulm Contusion is the #1 thoracic injury sustained in Pediatric trauma patients. Depending on the amount of lung involved, it may lead to substantial M&M. How should you image it? CXR wins in this study. CT did define the injury early and more precisely; however, clinical outcomes like ICU days and ventilator days did not correlate with CT findings, but rather did so with CXR findings.

Recommended by Sean Fox
Learn more: Pediatric EM Morsels — Pulmonary contusion

  • Zonfrillo MR, Roy AD, Walsh SA. Management of pediatric penetrating oropharyngeal trauma. Pediatric Emergency Care. 2008 Mar;24(3):172-5. PMID: 18347498.
R&R In The FASTLANE 007 RR GameChanger 64 Seriously, why do kids run around with sticks in their mouths? And what do you do when the stick stabs the tonsil?

Recommended by Sean Fox
Learn more: Pediatric EM Morsels — Pediatric oropharyngeal trauma

The R&R iconoclastic sneak peek icon key

R&R In The FASTLANE 007 RR Authors 64 The list of contributorsR&R In The FASTLANE 007 RR Vault 64 The R&R ARCHIVE
R&R In The FASTLANE 007 RR Hall of fame 64 R&R Hall of fame
You simply MUST READ this!		R&R In The FASTLANE 007 RR Hot Stuff 64 R&R Hot stuff!
Everyone ‘s going to be talking about this
R&R In The FASTLANE 007 RR Landmark 64 R&R Landmark paper
A paper that made a difference		R&R In The FASTLANE 007 RR GameChanger 64 R&R Game Changer?
Might change your clinical practice
R&R In The FASTLANE 007 RR Eureka 64 R&R Eureka!
Revolutionary idea or concept		R&R In The FASTLANE 007 RR WTF 64 R&R WTF!
Weird, transcendent or funtabulous!
R&R In The FASTLANE 007 RR Boffin 64 R&R Boffintastic
High quality research		R&R In The FASTLANE 007 RR Trash 64 R&R Trash
Must read, because it is so wrong!
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Brilliant writing or explanation

That’s it for now…

That should keep you busy for a week at least… Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

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Filed Under: Emergency Medicine, Featured, Health, Intensive Care, R&R in the FASTLANE Tagged With: , , , , , ,
About Chris Nickson

An oslerphile suffering from a bad case of knowledge dipsosis. Key areas of interest include: emergency medicine, critical care, toxicology, tropical medicine, clinical epidemiology, history, literature and the internet-learning revolution. @precordialthump | + Chris Nickson | Contact

Comments

  1. Rogue Medic says:
    January 21, 2012 at 2:57 pm

    We need to be much more open-minded about resuscitation treatments, but we also need to be much more rigorous in studying treatments BEFORE we make them routine.

    High dose nitroglycerin treatment in a patient with cardiac arrest: a case report.
    Guglin M, Postler G.
    J Med Case Reports. 2009 Aug 10;3:8782.
    PMID: 19830240 [PubMed]
    http://www.ncbi.nlm.nih.gov/pubmed/19830240

    The full text is available for free at PubMed Central.

    We need to stop panicking about the potential side effects of high-dose nitrates and actually study the effects and side effects.

    .

    Reply

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  1. The LITFL Review 054 - Life in the Fast Lane Medical Blog says:
    January 23, 2012 at 3:59 pm

    [...] 2012 6:09 pm via Twitter for iPhoneReplyRetweetFavorite@4hrEmergencyDocED DocNews from the FastlaneR&R In The FASTLANE 007 is back from its festive break -- found out what the experts in EM have been [...]

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