The 23rd edition of our series of eminence-based evidence:
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’
- Wunsch H. Is there a Starling curve for Intensive Care? Chest. 2012 Jun;141(6):1393-9. Pubmed PMID: 22670019
A topic constantly being considered, to which there may be no static answer and requires understanding of all the components by all of the stakeholders: the implications of having too few or too many ICU beds… Is there a right number of beds? Recommended by Matthew Mac Partlin
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This week’s R&R recommendations
- Wunsch H. Is the a Starling curve for Intensive Care? Chest. 2012 Jun;141(6):1393-9. Pubmed PMID: 22670019
A topic constantly being considered, to which there may be no static answer and requires understanding of all the components by all of the stakeholders: the implications of having too few or too many ICU beds… Is there a right number of beds? Recommended by Matthew Mac Partlin
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- Arora S, Swadron SP, Dissanayake V. Evaluating the sensitivity of visual xanthochromia in patients with subarachnoid hemorrhage. J Emerg Med. 2010 Jul;39(1):13-6. Epub 2008 Jun 24. PubMed PMID: 18572349.
It seems ridiculous to me that any hospital would still rely on visual inspection of CSF to determine if xanthochromia is present or absent in trying to rule out subrachnoid haemorrhage. In this study the sensitivity of visual inspection of CSF for detecting xanthochromia was 47.3% (95% confidence interval 24.4-71.1%). Recommended by Chris Nickson
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- Carman TL, Gegaj F. Management of Pulmonary Embolism: 2010 State-of-the-Art Update. Curr Treat Options Cardiovasc Med. 2010 Apr;12(2):168-84. Pubmed PMID: 20842554
A comprehensive well organised evidence-based overview of the management options for PE. Recommended by Joe Lex
- Hall AJ. Noroviruses: the perfect human pathogens? J Infect Dis. 2012 Jun;205(11):1622-4. Epub 2012 May 8. PubMed PMID: 22573872.
When asked to think of the perfect human pathogen, do you think of norovirus? If you don’t, then read this short editorial on the virus that causes half of all cases of gastroenteritis worldwide. Recommended by Chris Nickson
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- 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 Jun 23;379(9834):2352-63. Epub 2012 May 23. Pubmed PMID: 22632908 PMCID: PMC3386495
IST3 is strictly delusional. Despite negative results, the authors blithely push forward as though it proves their point. More deaths at 7 days in the treated group, same rate of disability at 6 months. What are they smoking? Recommended by Joe Lex
Editor’s note: this paper has featured in R&R previously — but Joe’s ‘recommendation’ deemed it necessary to mention this paper again.
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- Smulowitz PB, Honigman L, Landon BE. A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department. Ann Emerg Med. 2012 Jul 12. [Epub ahead of print] Pubmed PMID: 22795188
Great Annals piece about potential areas for cost savings (or not) in the ED), and some general overview of payment reform. The punchline: even if we figured out how to stop the URIs from showing up in the ED, it wouldn’t save any money. Recommended by Seth Trueger
- Venkatesh AK, Kline JA, Courtney DM, Camargo CA, Plewa MC, Nordenholz KE, Moore CL, Richman PB, Smithline HA, Beam DM, Kabrhel C. Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure: quantifying the opportunity for improvement. Arch Intern Med. 2012 Jul 9;172(13):1028-32. PMID: 22664742
“One-third of imaging performed for suspected PE may be categorized as avoidable.” That conclusion alone makes this worth reading. Recommended by Joe Lex
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- Lipman GS, Kanaan NC, Holck PS, Constance BB, Gertsch JH; PAINS Group. Ibuprofen Prevents Altitude Illness: A Randomized Controlled Trial for Prevention of Altitude Illness With Nonsteroidal Anti-inflammatories. Ann Emerg Med. 2012 Jun;59(6):484-90. Epub 2012 Mar 21. PubMed PMID: 22440488.
An NNT of 3.9 suggests ibuprofen is as good as acetazolamide and dexamethasone for preventing altitude sickness. Cynics might argue that it’s good for headaches and that’s the main feature of altitude sickness. Nevertheless, a good study with a postive result. The NSAID hangover trial to follow? Recommended by Chris Nickson
The R&R iconoclastic sneak peek icon key
The list of contributors The R&R ARCHIVE R&R Hall of fame
You simply MUST READ this!R&R Hot stuff!
Everyone ‘s going to be talking about thisR&R Landmark paper
A paper that made a differenceR&R Game Changer?
Might change your clinical practiceR&R Eureka!
Revolutionary idea or conceptR&R WTF!
Weird, transcendent or funtabulous!R&R Boffintastic
High quality researchR&R Trash
Must read, because it is so wrong!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.
About Chris Nickson
