R&R in the FASTLANE 021

• Wilcox SR, Bittner EA, Elmer J, Seigel TA, Nguyen NT, Dhillon A, Eikermann M, Schmidt U. Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications. Crit Care Med. 2012 Jun;40(6):1808-1813. PubMed PMID: 22610185.

I don’t care how many debates Scott Weingart loses, I’m still using neuromuscular blockers for rapid sequence intubation and this new prospective observational study is another reason why.

Recommended by Chris Nickson
Learn more: EMCrit Podcast 061 – Debate: Paralytics for ICU Intubations?

• Newman DH. Truth, and epinephrine, at our fingertips: unveiling the pseudoaxioms. Ann Emerg Med. 2007 Oct;50(4):476-7. Epub 2007 Aug 24. PubMed PMID: 17719691.

A great commentary by (R&Rer) David Newman on a paper debunking digital ischemia from adrenaline-containing local anesthetics. This serves as a call for clinicians, educators, researchers and journals to seek out the pseudoaxioms of medicine and bring about their downfall. Pseudoaxioms are “are false principles or rules often handed down from generation to generation of medical providers and accepted without serious challenge or investigation”.

Recommended by Chris Nickson
Fulltext

• The IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012 May 23. [Epub ahead of print] PubMed PMID: 22632908

More stroke data – this time no benefit was demonstrated for the primary outcome. Lots of subgroups, some did better with TPA, some did not. Incredibly rich dataset for us to analyze for the next few years. (RR) — The study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad. (DN)

Recommended by Ryan Radecki, David Newman
Learn more: EM Literature of Note — The Third International Stroke Trial: IST-3; SMARTEM —Delusions of Benefit in the International Stroke Trial

• Puskarich MA, Trzeciak S, Shapiro NI, Arnold RC, Heffner AC, Kline JA, Jones AE; Emergency Medicine Shock Research Network (EMSHOCKNET). Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Acad Emerg Med. 2012 Mar;19(3):252-8. doi: 10.1111/j.1553-2712.2012.01292.x. PubMed PMID: 22435856; PubMed Central PMCID: PMC3313083.

more good data from the EMSHOCKNET group – septic patients who cleared lactate but didn’t reach SCVO2 goal did better than if SCVO2 improved but didn’t clear lactate. (This is likely more prognostic than anything, but another it’s another piece in the foundation for noninvasive sepsis management for patients who don’t require pressors.

Recommended by Seth Trueger

• Wiler JL, Beck D, Asplin BR, Granovsky M, Moorhead J, Pilgrim R, Schuur JD. Episodes of care: is emergency medicine ready? Ann Emerg Med. 2012 May;59(5):351-7. Epub 2011 Sep 29. PubMed PMID: 21963317.

Discussion of payment models isn’t particularly exciting, but there are a lot of changes under way and if we don’t get paid, we can’t buy new CMAC’s with disposable blade sheaths. There is a push from the current fee-for-service model to “episodes of care” (similar to capitation) and this article explains the basics, the reasoning, and why it may or may not be relevant for emergency care. Payment changes are coming (to the USA), and we need to be ready.

Recommended by Seth Trueger

• Campagna JD, Bond MC, Schabelman E, Hayes BD. The Use of Cephalosporins in Penicillin-allergic Patients: A Literature Review. J Emerg Med. 2012 May;42(5):612-20. Epub 2011 Jul 13. PMID: 21742459

It’s probably time to leave 40 year-old data behind and go ahead and use 3rd-generation cephalosporins with impunity in patients with documented penicillin allergies. (RR) — I have no idea why this old myth needs to be re-killed every couple years, but people still seem to believe in it. The conclusion that cephalosporins and penicillins have negligible cross reactivity is backed up by decades worth of data.(AB)

Recommended by Ryan Radecki, Andrew Brainard
Learn more: EM Literature of Note: Cephalosporins can be used in penicillin allergy

• Randolph C. Baseline neuropsychological testing in managing sport-related concussion: does it modify risk? Curr Sports Med Rep. 2011 Jan-Feb;10(1):21-6. Review. PubMed PMID: 21228656.

Picks apart the validity of the ‘second impact syndrome’ in sports concussion and questions the validity of sideline neuropsychiatric tests like ImPACT, SCAT2 and King-Devick.

Recommended by Matthew Mac Partlin

• Wright DW, Kellermann AL, Hertzberg VS, Clark PL, Frankel M, Goldstein FC, Salomone JP, Dent LL, Harris OA, Ander DS, Lowery DW, Patel MM, Denson DD, Gordon AB, Wald MM, Gupta S, Hoffman SW, Stein DG. ProTECT: a randomized clinical trial of progesterone for acute traumatic brain injury. Ann Emerg Med. 2007 Apr;49(4):391-402, 402.e1-2. Epub 2006 Sep 29. PubMed PMID: 17011666

Progesterone for TBI – better evidence than most of what we do now? More studies needed…

Recommended by Casey Parker
Learn more: The Cochrane Library — Progresterone for acute brain injury