R&R in the FASTLANE 013

The thirteenth 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 10 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

  • Halstead S, Roosevelt G, Deakyne S, Bajaj L.  Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis.  Pediatrics. 2012 Feb 13. [Epub ahead of print] Pubmed PMID: 22331343
R&R in the FASTLANE 009 RR Hall of fame 64 R&R in the FASTLANE 009 RR Eureka 64 Treating the numbers in bronchiolitis – well, if we can make the numbers look better with a little supplemental O2, can’t they go home?

Recommended by Ryan Radecki
Learn more: Dsicharging bronchiolitis on home oxygen

  • Marini JJ. Unproven clinical evidence in mechanical ventilation. Curr Opin Crit Care. 2012 Feb;18(1):1-7. PubMed PMID: 22157253.
R&R in the FASTLANE 009 RR Hall of fame 64 R&R in the FASTLANE 009 RR Mona Lisa 64 Yay! … critical care medicine has not been reduced to a set of protocols and guidelines; there is still an art to it. One size does not fit all! Not much new in this review, more of an acknowledgement of the obvious, which might be of assistance in those awkward M&M meetings … it’s in print, so it can back a practice.

Recommended by Matthew Mac Partlin

This week’s R&R recommendations

  • Tobin MJ. Extubation and the myth of “minimal ventilator settings”. Am J Respir Crit Care Med. 2012 Feb 15;185(4):349-50. PubMed PMID: 22336673.
R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Mona Lisa 64 Anything that Martin Tobin touches is gold in my book and this perspective on vent weaning/extubation is no different:“The challenge of clinical medicine is not about taking care of the great majority of patients who do well irrespective of the methods employed by their physicians. Instead, the goal is to take feasible steps that have a high likelihood of circumventing a catastrophe in a small number of instances.”

Recommended by Robert Arntfield

  • Marini JJ. Unproven clinical evidence in mechanical ventilation. Curr Opin Crit Care. 2012 Feb;18(1):1-7. PubMed PMID: 22157253.
R&R in the FASTLANE 009 RR Hall of fame 64 R&R in the FASTLANE 009 RR Mona Lisa 64 Yay! … critical care medicine has not been reduced to a set of protocols and guidelines; there is still an art to it. One size does not fit all! Not much new in this review, more of an acknowledgement of the obvious, which might be of assistance in those awkward M&M meetings … it’s in print, so it can back a practice.

Recommended by Matthew Mac Partlin

  • Zanella A, Cressoni M, Epp M, Hoffmann V, Stylianou M, Kolobow T. Effects of tracheal orientation on development of ventilator-associated pneumonia: an experimental study. Intensive Care Med. 2012 Feb 18. [Epub ahead of print] PubMed PMID: 22349422.
R&R in the FASTLANE 009 RR Hot Stuff 64 Postioning ventilated patients 30-45 degrees head up is widely accepted as the thing to do to prevent ventilator-associated pneumonia. Yet the evidence for this practice is limited. This editorial summarises the state of play nicely and commments on a study by Zanella et al in the same issue showing that a slightly head down position drastically reduced VAP…. in pigs.

Recommended by Chris Nickson

  • Khalid MS, Ahmad N, Moin S, El-Faedy O, Gaffney P. Spontaneous pneumomediastinum: a rare complication of acute asthma. Ir J Med Sci. 2008 Dec;177(4):393-6. Epub 2007 Jul 6. PubMed PMID: 17619095.
R&R in the FASTLANE 009 RR Mona Lisa 64 Rare complication of asthma but I’ve seen two within a month. Nice review of spontaneous pneumomediastinum.

Recommended by Ioana Vlad

  • Kline JA, Corredor DM, Hogg MM, Hernandez J, Jones AE. Normalization of vital  signs does not reduce the probability of acute pulmonary embolism in symptomatic  emergency department patients. Acad Emerg Med. 2012 Jan;19(1):11-7. doi: 10.1111/j.1553-2712.2011.01253.x. PubMed PMID: 22251189.
R&R in the FASTLANE 009 RR GameChanger 64 If at first it sounds like PE, look for it, even if the numbers get better.

Recommended by Ioana Vlad

  • Lawrey E, Jones P. Prosthetic hip dislocations: Is relocation in the emergency department by emergency medicine staff better? Emergency Medicine Australasia. DOI: 10.1111/j.1742-6723.2011.01517.x
R&R in the FASTLANE 009 RR Boffin 64 Seems to have been designed to settle a fight… I mean answer the question of who should relocate hips in the ED. Chart review with good methods and it seems that the ED can reduce hips just fine thank you very much. There are of course some potential confonuders here but good none the less.

Recommended by Andy Neill

  • Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W; NETT Investigators. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012 Feb 16;366(7):591-600. PubMed  PMID: 22335736.
R&R in the FASTLANE 009 RR Landmark 64 R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Hot Stuff 64 For prehospital status epilepticus IM Midaz went head to head with IV lorazepam to see which would stop seizure activity more quickly… Tried it in hospital this week! Thumbs up!

Recommended by Sa’ad Lahri

  • Abo A, Chen L, Johnston P, Santucci K. Positioning for Lumbar Puncture in Children Evaluated by Bedside Ultrasound.  Pediatrics 2010 125: e1149-e1153. PubMed PMID: 20403933.
R&R in the FASTLANE 009 RR Boffin 64 Study numbers very small, but food for thought… Neck flexion to be abandoned in the positioning for paediatric LP ?

Recommended by Sa’ad Lahri
Fulltext

  • Halstead S, Roosevelt G, Deakyne S, Bajaj L.  Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis.  Pediatrics. 2012 Feb 13. [Epub ahead of print] Pubmed PMID: 22331343
R&R in the FASTLANE 009 RR Hall of fame 64 R&R in the FASTLANE 009 RR Eureka 64 Treating the numbers in bronchiolitis – well, if we can make the numbers look better with a little supplemental O2, can’t they go home?

Recommended by Ryan Radecki
Learn more: Dsicharging bronchiolitis on home oxygen

  • Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012 Feb 27;2(1):e000850. Print 2012. PubMed PMID: 22371848.
R&R in the FASTLANE 009 RR GameChanger 64 R&R in the FASTLANE 009 RR Hot Stuff 64 When I first saw this study, my eyes just about popped out of my head. My first job out of residency was all nights and I could never fall asleep before shifts, so by the 4th night in a row, I was really tired. Then I took a zolpidem at 5pm, woke up at 10 and it was night shift 2.0. Wide awake and ready to roll. It was like a cold glass of water on a hot summer day. But just as the Joe Jackson song goes, everything, it seems, gives you cancer…

Recommended by Rob Orman
Learn more: ERCAST blog — Can Ambien Kill You?

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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Comments

  1. Matthew says

    Love the Tobin paper on myths of minimal ventilator settings. Great to know I can back up my opinion. Love the indestructible many versus the delicate few quote too.

  2. Shata Hari says

    Marini JJ. Unproven clinical evidence in mechanical ventilation. Curr Opin Crit Care. 2012 Feb;18(1):1-7. PubMed PMID: 22157253.

    shows

    EBM is good,
    But one shoe does not fit all …

Comments