The 26th 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’
- Green SM. A is for airway: a pediatric emergency department challenge. Ann Emerg Med. 2012 Sep;60(3):261-3. Epub 2012 Apr 19. PubMed PMID: 22520991.
A recent study in Annals of EM found that only half of pediatric emergency intubations were successful at the first attempt. This commentary is essential reading and leads to the “polarising political question: Who is best qualified to intubate a child in an emergency? A pediatric emergency physician who exclusively intubates children but does so only rarely (2 to 5 times per year, according to the above data) or a general emergency physician comfortable intubating adults who occasionally intubates children as well? “ Recommended by Chris Nickson
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This week’s R&R recommendations
- Green SM. A is for airway: a pediatric emergency department challenge. Ann Emerg Med. 2012 Sep;60(3):261-3. Epub 2012 Apr 19. PubMed PMID: 22520991.
A recent study in Annals of EM found that only half of pediatric emergency intubations were successful at the first attempt. This commentary is essential reading and leads to the “polarising political question: Who is best qualified to intubate a child in an emergency? A pediatric emergency physician who exclusively intubates children but does so only rarely (2 to 5 times per year, according to the above data) or a general emergency physician comfortable intubating adults who occasionally intubates children as well? “ Recommended by Chris Nickson
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- Winters ME, Mitarai T, Brady WJ. The critical care literature 2010. Am J Emerg Med. 2012 Sep;30(7):1268-73. Epub 2011 Nov 17. PubMed PMID: 22100483.
Concise summaries with insightful interpretation of some of the big critical care papers of 2010 – sepsis, vasopressors, trauma and cardiac arrest are all covered. It’s interesting that this paper was accepted in August 2011 and gets published in September 2012 and is about papers from 2010 (that were probably accepted 1-2 years earlier). Is it just me or is something wrong with the publishing process here? Recommended by Chris Nickson
- Abbasi K, et al. Four futures for scientific and medical publishing. BMJ. 2002 Dec 21;325(7378):1472-5. Review. PubMed PMID: 12493672; PubMed Central PMCID: PMC139045.
Although a little dated (e.g. pre-Twitter) this is a lucid overview of the forces that will determine the future of medical publishing, with four possible outcomes. There is resentment in the academic community that they have to pay for information that they create, marginal costs of electronic information are minimal, doctors are overwhelmed with information but can’t find what they need (‘information paradox’), most published scientific literature is low quality… The list of factors is endless. Change is inevitable. Oh, and the four future worlds are named after the Simpsons, brilliant. The Lisa world is here – vive la FOAM. Recommended by Joe Lex and Chris Nickson
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- Farzad, A. The Advancing Role of Technology in Emergency Medicine Education and Training: Interview with Scott Weingart, MD. Commonsense 2012; 19(4):24-27
This four page interview with Scott Weingart on education (especially FOAM) is pure brilliance. Recommended by Joe Lex
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- Naghshineh S, et al. Formal art observation training improves medical students’ visual diagnostic skills. J Gen Intern Med. 2008 Jul;23(7):991-7. PubMed PMID: 18612730; PubMed Central PMCID: PMC2517949.
With the approaching ACEM ASM in Hobart, it seems like a good time to explore articles that link art and medicine. As such, this little number from Harvard finds that exposure to formal art training improves clinical skills. I just love the idea of this! Recommended by Domhnall Brannigan
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- Patel K, et al. Lifespan and Cardiology. Br J Cardiol 2009;16:299–302
This is of interest to us as Emergency Physicians largely because of the wonderful Table 5 which shows that “Accident and Emergency” doctors have an average life expectancy of 57.5 years (+/-16.6) which is worse than every other specialty by 15-20 years. Delving deeper it becomes clear that the reason for this is one of two things: either they made it up, or using the obituary pages of the BMJ is a somewhat ad-hoc way to gather data. A great tongue-in-cheek read which probably tells us more about who values the place of the BMJ in medical circles than about true mortality rates!!! I can’t nail down the PMID for this one, but the link is to full text of the article. Recommended by Domhnall Brannigan
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- Cureton EL,et al. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. J Trauma Acute Care Surg. 2012 Jul;73(1):102-10. PubMed PMID: 22743379.
This study could be a game changer in traumatic arrest evaluation using ultrasound and its evaluation for cardiac activity. “ultrasound evaluation of cardiac motion in pulseless patients with trauma may be a rapid way to help determine which patients have no chance of survival in the setting of lethal injuries, so that futile resuscitations can be stopped” Recommended by Laleh Gharahbaghian
Learn more: Sonospot
- Reißig A, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. A prospective multicentre diagnostic accuracy study. Chest. 2012 Jun 14. [Epub ahead of print] PubMed PMID: 22700780.
This is a must read that could be the start of changing medical practice in the future once physicians become more savvy sonographers, possibly eliminating the chest radiograph as a diagnostic tool for pneumonia diagnoses. Recommended by Laleh Gharahbaghian
Learn more: Sonospot
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
Great article listed under “Education” -- Abbasi K, et al. Four futures for scientific and medical publishing. BMJ. 2002 -- thanks for recommending Chris and Jo!
Even though it is Pre-Twitter -- underlying message in my opinion is very relevant for todays medical community;-
“Sometimes Lisa needs information from beyond her special interests. She then either uses a search engine to direct her to the relevant electronic community or she asks somebody within her communities she thinks will know where to go. “I don’t know, but I know a man who does” is the mantra; and, even though the world has six billion inhabitants, we are all only five links from each other.”
practical relevance of the current state of play !
“Information exchange occurs predominantly not through “published” information but through conversation (much of it over the telephone), email, list serves, bulletin boards, and informal websites. A paediatric surgeon, Lisa, with a specialist interest in liver surgery who also happens to be interested in cricket, romantic poetry, and camels will be connected to a series of electronic communities who will keep her up to date with her interests.”
Love it !
thanks Chris for the highlight of that paediatric ED intubation article!
It made me reflect on the last two paediatric RSI I was involved in the ED recently. One I was the intubator in a 5 yo , the other I was assisting and giving drugs in a 7 yo.
I think the challenges are kids look easy but this breeds complacency. The more anterior larynx is an issue and in my case, it took a helpful assistant to do posterior ELM to get the tube in no problem. In the second case I assisted on, it took four attempts at intubation despite my application of posterior ELM. Most operators dont practice doing bougie assisted tubes in kids..as they look like easy tubes and paediatric designed bougies are not common.
VL devices are only now making headways into paediatric intubations and its interesting but the research to date shows not much advantages over DL in terms of overall intubation success. They are to the most not designed for paediatric airways.
Surgical airway is a formidable task in paediatrics for the most seasoned provider. ..so mentally if you get that unexpected difficult paedaitric intubation , you are already sweating
SGA and LMA in my view are overlooked in paediatric emergency airway managment. I have air transported babies ventilated fine on LMAs for hours. The new LMA Supremes down to baby size are awesome devices. ..and disposable. I predict that the RSA concept by Braude may well come to pass to be the better airway strategy in paediatric ED and prehospital care.
think about it, an uncuffed ETT and a LMA, both have some leak during IPPV, both dont provide total security against aspiration. Many still regard uncuffed ETT as standard of care in paediatric intubations.
Great comment Minh -- as always.
Thanks for sharing the cases.
The pediatric airway something we should all be rehearsing mentally a la Cliff Reid -- we just don’t do them enough.
Interesting thoughts re: DSA -- never seen it done on a child.
From the ICU perspective I’d consider cuffed ETTs the gold standard -- esp if ventilating for more than the short-term -- but I realise that this is probably not the majority view.
Chris