LITFL | Medical Specialty | Emergency Medicine | R&R in the FASTLANE 022

R&R in the FASTLANE 022

June 21, 2012 by 2 Comments

The 22nd edition of our series of eminence-based evidence:

R&R in the FASTLANE 010 RR IN THE FASTLANE LOGO 21 590x213

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 8 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 Famers’

  • Williamson K, Mattu A, Plautz CU, Binder A, Brady WJ. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006 Nov;24(7):864-74. Review. PubMed PMID: 17098112.
R&R in the FASTLANE 009 RR Hall of fame 64 R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Eureka 64 Great review of the utility of AVR from a few years ago — notable authors include Amal Mattu & Bill Brady. They give us 4 uses for AVR: STE in ACS meaning LMCA (or vessel) occlusion; prominent terminal R wave in TCA toxicity (sodium channel blockade); and STE in narrow complex tachycardia suggestive of WPW.NB they also include PR elevation in acute pericarditis which Dr. Mattu has recently suggested is not specific enough to separate pericarditis from NSTEMI.

Recommended by Seth Trueger, Chris Nickson

This week’s R&R recommendations

  • Aguilar SA, Davis DP. Latency of pulse oximetry signal with use of digital probes associated with inappropriate extubation during prehospital rapid sequence intubation in head injury patients: case examples. J Emerg Med. 2012 Apr;42(4):424-8. Epub 2012 Feb 1. PubMed PMID: 22305148
R&R in the FASTLANE 009 RR Eureka 64  Pulse ox doesn’t always mean want you think it means.

Recommended by Mike Jasumback

  • Hilbert G, Clouzeau B, Bui HN, Vargas F. Sedation during non invasive ventilation. Minerva Anestesiol. 2012 May 11. [Epub ahead of print] PubMed PMID: 22580593
R&R in the FASTLANE 009 RR Eureka 64 Basic lit review on sedation for NIV. interesting how much data there are considering how much opposition there is to the concept.

Recommended by Seth Trueger
Fulltext

  • Guilbert MC, Elkouri S, Bracco D, Corriveau MM, Beaudoin N, Dubois MJ, Bruneau L, Blair JF. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg. 2008 Oct;48(4):918-25; discussion 925. Epub 2008 Aug 13. Review. PubMed PMID: 18703308.
R&R in the FASTLANE 009 RR GameChanger 64 OK, the patient has a central venous catheter inadvertently placed in his carotid. Do you pull-and-push? If so pray – this small case series suggests leaving it in and getting vascular repair is a better approach.

Recommended by Chris Nickson
Fulltext

  • Lim T, Ryu HG, Jung CW, Jeon Y, Bahk JH. Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization. Crit Care Med. 2012 Feb;40(2):491-4. PubMed PMID: 21983370.
R&R in the FASTLANE 009 RR GameChanger 64 Could received wisdom be wrong? This RCT suggests having the needle bevel down (not up) has less complications for CVC insertion in the internal jugular vein.

Recommended by Chris Nickson

  • Louw L, Hodgson E. Ujuzi: An unconventional ring removal technique for hard-to-remove rings. AfJEM 2012, 2 (2) 81-83. DOI: 10.1016/j.afjem.2012.04.001
R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Mona Lisa 64 The manly way of removing re-enforced steel rings from fingers.

Recommended by Stevan Bruijns
Fulltext

  • Williamson K, Mattu A, Plautz CU, Binder A, Brady WJ. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006 Nov;24(7):864-74. Review. PubMed PMID: 17098112.
R&R in the FASTLANE 009 RR Hall of fame 64 R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Eureka 64 Great review of the utility of AVR from a few years ago — notable authors include Amal Mattu & Bill Brady. They give us 4 uses for AVR: STE in ACS meaning LMCA (or vessel) occlusion; prominent terminal R wave in TCA toxicity (sodium channel blockade); and STE in narrow complex tachycardia suggestive of WPW. NB they also include PR elevation in acute pericarditis which Dr. Mattu has recently suggested is not specific enough to separate pericarditis from NSTEMI.

Recommended by Seth Trueger, Chris Nickson

 

  • Brenner M, Stein DM, Hu PF, Aarabi B, Sheth K, Scalea TM. Traditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury. J Trauma Acute Care Surg. 2012 May;72(5):1456-7. PubMed PMID: 22673290.
R&R in the FASTLANE 009 RR Boffin 64 Interesting analysis from Scalea et al at Shock Trauma- they looked at a-line tracings and used sophisticated (oversophisticated?) analysis to demonstrate that SBP >90 may not be an optimal goal for severe TBI patients. Hypotension=bad, but at what level?

Recommended by Seth Trueger

  • Shalom A, Bryant A, Smith-Meek M, Parsons LR, Munster A. Noodles stay hotter longer. J Burn Care Res. 2007 May-Jun;28(3):474-7. PubMed PMID: 17438502.
R&R in the FASTLANE 009 RR WTF 64 R&R in the FASTLANE 009 RR Boffin 64 Surprisingly good study showing that Noodle Soup is more likely to burn you than Other Soup.

Recommended by Seth Trueger

The R&R iconoclastic sneak peek icon key

R&R in the FASTLANE 009 RR Authors 64 The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE 009 RR Hall of fame 64 R&R Hall of fame
You simply MUST READ this!		 R&R in the FASTLANE 009 RR Hot Stuff 64 R&R Hot stuff!
Everyone ‘s going to be talking about this
R&R in the FASTLANE 009 RR Landmark 64 R&R Landmark paper
A paper that made a difference		 R&R in the FASTLANE 009 RR GameChanger 64 R&R Game Changer?
Might change your clinical practice
R&R in the FASTLANE 009 RR Eureka 64 R&R Eureka!
Revolutionary idea or concept		 R&R in the FASTLANE 009 RR WTF 64 R&R WTF!
Weird, transcendent or funtabulous!
R&R in the FASTLANE 009 RR Boffin 64 R&R Boffintastic
High quality research		 R&R in the FASTLANE 009 RR Trash 64 R&R Trash
Must read, because it is so wrong!
R&R in the FASTLANE 009 RR Mona Lisa 64 R&R Mona Lisa
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, 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, and the free open-access meducation (FOAM) revolution. @precordialthump | + Chris Nickson | Contact

Comments

  1. Jo Deverill says:
    June 24, 2012 at 11:04 am

    Re using an electric grinder for ring removal: we recently used the same technique for removal of a 10 inch drop forged ring spanner from the base of an engorged penis. Your local fire brigade should have the right tools for the job and their response time is usually great.

    Reply

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