R&R in the FASTLANE 019

• Paul AM, Young NH, Price GC. Emergency tracheal intubation without drugs: outcome and one-year survival of medical patients not in cardiac arrest. Scott Med J. 2012 May;57(2):84-7. PubMed PMID: 22555228

More evidence that if the patient you’re intubating has a pulse, you want to paralyze them. The crash airway for the nearly-dead had longer intubation times and more first-pass failures. (n.b. my library doesn’t have access to the Scottish Medical Journal so I’ve only seen the abstract)

Recommended by Seth Trueger

• Suzuki H, Nakajima W, Aoyagi M, Takahashi M, Kuzuta T, Osaki M. [A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient]. Masui. 2012 Apr;61(4):384-6. Japanese. PubMed PMID: 22590940.

Why restrict intubation to supine, semifowler’s, or tomahawk, when you can make the face-plane parallel to the floor? n=1 study of patient intubated while prone in the OR. Abstract-only – my library doesn’t have access to Masui (Japanese for Anesthesia) and I can’t read Japanese regardless.

Recommended by Seth Trueger

• Venezia D, Wackett A, Remedios A, Tarsia V. Comparison of Sitting Face-to-Face Intubation (Two-Person Technique) with Standard Oral-tracheal Intubation in Novices: A Mannequin Study. J Emerg Med. 2012 May 3. [Epub ahead of print] PubMed PMID: 22560270

We should all know the limitations of airway studies simulation (e.g. Airtraq is great on models, terrible in the field; see this Resus.ME post) but this is a good proof-of-concept paper that shows laryngoscopists can be reasonably trained to perform face-to-face tomahawk intubations. I’ve only done this on models and people/patients without passing a tube, but it’s always good to have an extra arrow in the quiver.

Recommended by Seth Trueger

• Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: a variation on a theme. Acad Emerg Med. 2008 Jul;15(7):683-7. PubMed PMID: 18691216.

How to teach medical students in the ED to concisely present a patient.

Recommended by Chris Nickson
Learn more: LITFL — ED Case Presentation for Medical Students
Fulltext

• Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as First-line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice. World J Surg. 2012 May 9. [Epub ahead of print] PubMed PMID: 22569747.

This is a real world study that shows that antibiotics first is a viable option for the treatment of appendicitis, confirming previous RCTs. Complications were less for those receiving primary antibiotics compared to those receiving primary surgery. A difficulty is that not all cases were ‘confirmed appendicitis’ – ‘early appendicitis’ can be hard to confirm.

Recommended by Chris Curry

• Rossen R, Kabat H, Anderson J. P. Acute arrest of cerebral circulation in man. Arch Neurol Psychiat; 1943(50): 510-28

The Rossen study is shocking in its design, literally eye-popping in its technique and with consequently remarkable findings that obviously will never be duplicated in humans. The commentary by Smith (2007) is well worth reading.

Recommended by Reuben Strayer
Fulltext and Commentary

• Panesar NS, Graham CA. Does the death rate of Hong Kong Chinese change during the lunar ghost month? Emerg Med J. 2012 Apr;29(4):319-21. Epub 2011 Dec 28. PubMed PMID: 22205780.

Emergency Physcians examine death rates in Hong Knog. How about their awesome conclusion:”To protect their family, the Chinese women postpone death until after the hungry ghosts have been fed and hopefully banished forever.”

Recommended by Cliff Reid

• Mc Laughlin P, Neill SO, Fanning N, Mc Garrigle AM, Connor OJ, Wyse G, Maher MM. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad. Emerg Radiol. 2012 Apr;19(2):127-33. Epub 2011 Dec 16. PubMed PMID: 22173819.

Radiologists have been tele-reading for a while and this is a little study from Cork examining how well the iPad did for reading CT Heads. Bottom line – it did OK. This was with the original iPad and I imagine the newer one might pull it off even better.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — iPad for radiology reads. WARNING – NO FREE IPAD/VIRUS WITH THIS LINK….!

• Kelly LE, Rieder M, van den Anker J. More codeine fatalities after tonsillectomy in north american children. Pediatrics. 2012 May;129(5):e1343-7. Epub 2012 Apr 9. Pubmed PMID: 22492761

You may have used codeine safely so far – but it’s a flawed medication and should be replaced in your practice.

Recommended by Ryan Radecki
Learn more: EM Literature of Note — Codeine, Potentially Unpredictably Lethal

• Korniyenko A et al. Visceral angioedema due to angiotensin-converting enzyme inhibitor therapy. Cleve Clin J Med 2011 May;78(5):297-304. Pubmed PMID: 21536824

Visceral angioedema caused by ACE inhibitors in another obscure, easily missed toxicologic cause of cryptic abdominal pain and vomiting, to be considered along with narcotic bowel syndrome and cannabinoid hyperemesis.

Recommended by Leon Gussow
Learn more: The Poison Review — Puzzling abdominal pain and vomiting? Consider ACE inhibitor-induced visceral angioedema
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