• Paul AM, Young NH, Price GC. Emergency tracheal intubation without drugs: outcome and one-year survival of medical patients not in cardiac arrest. Scott Med J. 2012 May;57(2):84-7. PubMed PMID: 22555228

More evidence that if the patient you’re intubating has a pulse, you want to paralyze them. The crash airway for the nearly-dead had longer intubation times and more first-pass failures. (n.b. my library doesn’t have access to the Scottish Medical Journal so I’ve only seen the abstract)

Recommended by Seth Trueger

• Suzuki H, Nakajima W, Aoyagi M, Takahashi M, Kuzuta T, Osaki M. [A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient]. Masui. 2012 Apr;61(4):384-6. Japanese. PubMed PMID: 22590940.

Why restrict intubation to supine, semifowler’s, or tomahawk, when you can make the face-plane parallel to the floor? n=1 study of patient intubated while prone in the OR. Abstract-only – my library doesn’t have access to Masui (Japanese for Anesthesia) and I can’t read Japanese regardless.

Recommended by Seth Trueger

• Venezia D, Wackett A, Remedios A, Tarsia V. Comparison of Sitting Face-to-Face Intubation (Two-Person Technique) with Standard Oral-tracheal Intubation in Novices: A Mannequin Study. J Emerg Med. 2012 May 3. [Epub ahead of print] PubMed PMID: 22560270

We should all know the limitations of airway studies simulation (e.g. Airtraq is great on models, terrible in the field; see this Resus.ME post) but this is a good proof-of-concept paper that shows laryngoscopists can be reasonably trained to perform face-to-face tomahawk intubations. I’ve only done this on models and people/patients without passing a tube, but it’s always good to have an extra arrow in the quiver.

Recommended by Seth Trueger

• Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: a variation on a theme. Acad Emerg Med. 2008 Jul;15(7):683-7. PubMed PMID: 18691216.

How to teach medical students in the ED to concisely present a patient.

Recommended by Chris Nickson
Learn more: LITFL — ED Case Presentation for Medical Students
Fulltext

• Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as First-line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice. World J Surg. 2012 May 9. [Epub ahead of print] PubMed PMID: 22569747.

This is a real world study that shows that antibiotics first is a viable option for the treatment of appendicitis, confirming previous RCTs. Complications were less for those receiving primary antibiotics compared to those receiving primary surgery. A difficulty is that not all cases were ‘confirmed appendicitis’ – ‘early appendicitis’ can be hard to confirm.

Recommended by Chris Curry

• Rossen R, Kabat H, Anderson J. P. Acute arrest of cerebral circulation in man. Arch Neurol Psychiat; 1943(50): 510-28

The Rossen study is shocking in its design, literally eye-popping in its technique and with consequently remarkable findings that obviously will never be duplicated in humans. The commentary by Smith (2007) is well worth reading.

Recommended by Reuben Strayer
Fulltext and Commentary

• Panesar NS, Graham CA. Does the death rate of Hong Kong Chinese change during the lunar ghost month? Emerg Med J. 2012 Apr;29(4):319-21. Epub 2011 Dec 28. PubMed PMID: 22205780.

Emergency Physcians examine death rates in Hong Knog. How about their awesome conclusion:”To protect their family, the Chinese women postpone death until after the hungry ghosts have been fed and hopefully banished forever.”

Recommended by Cliff Reid

• Mc Laughlin P, Neill SO, Fanning N, Mc Garrigle AM, Connor OJ, Wyse G, Maher MM. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad. Emerg Radiol. 2012 Apr;19(2):127-33. Epub 2011 Dec 16. PubMed PMID: 22173819.

Radiologists have been tele-reading for a while and this is a little study from Cork examining how well the iPad did for reading CT Heads. Bottom line – it did OK. This was with the original iPad and I imagine the newer one might pull it off even better.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — iPad for radiology reads. WARNING – NO FREE IPAD/VIRUS WITH THIS LINK….!

• Kelly LE, Rieder M, van den Anker J. More codeine fatalities after tonsillectomy in north american children. Pediatrics. 2012 May;129(5):e1343-7. Epub 2012 Apr 9. Pubmed PMID: 22492761

You may have used codeine safely so far – but it’s a flawed medication and should be replaced in your practice.

Recommended by Ryan Radecki
Learn more: EM Literature of Note — Codeine, Potentially Unpredictably Lethal

• Korniyenko A et al. Visceral angioedema due to angiotensin-converting enzyme inhibitor therapy. Cleve Clin J Med 2011 May;78(5):297-304. Pubmed PMID: 21536824

Visceral angioedema caused by ACE inhibitors in another obscure, easily missed toxicologic cause of cryptic abdominal pain and vomiting, to be considered along with narcotic bowel syndrome and cannabinoid hyperemesis.

Recommended by Leon Gussow
Learn more: The Poison Review — Puzzling abdominal pain and vomiting? Consider ACE inhibitor-induced visceral angioedema
Fulltext

• Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. Epub 2010 Jul 31. Review. PubMed PMID: 20674088

Levitan et al get into some great technical aspects of video and alternative devices for laryngoscopy. The point here is that while VL may make laryngoscopy easier, tube delivery and placement may paradoxically become more difficult, primarily because of the sharper angle between the blade and the trachea. Porn for airway enthusiasts.

Recommended by Seth Trueger

• Segal N, Yannopoulos D, Mahoney BD, Frascone RJ, Matsuura T, Cowles CG, McKnite SH, Chase DG. Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation. 2012 Mar 28. [Epub ahead of print] PubMed PMID: 22465807.

Supraglottic devices (SGDs) have been all the rage in emergency settings lately. For lots of good reasons. But this tiny study questions the use of SGDs in cardiac arrest. Without any blood pressure, SGDs compress the carotids and restrict cerebral blood flow. And the flow measurements are convincing. But – it’s on pigs. Still, this will be talked about.

Recommended by Thomas Dolven
Learn more: ScanCrit.com — Supraglottic airway devices in the critically ill

• Green RS Reflections from a Canadian visiting South Africa: Advancing sepsis care in Africa with the development of local sepsis guidelines. African Journal of Emergency Medicine (2012), http://dx.doi.org/10.1016/j.afjem.2012.03.004

Sepsis is a killer worldwide… but needs champions to pioneer it’s death. An excellent overview from Dr Green who is a world Guru on the topic.

Recommended by Sa’ad Lahri
Fulltext

• Homma S, et al; the WARCEF Investigators. Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm. N Engl J Med. 2012 May 2. [Epub ahead of print] PubMed PMID: 22551105.

WARCEF trial – For patients with severe heart failure (LVEF < 25%), Warfarin was no better than Aspirin for the combined outcome of any stroke or death. There was a significant reduction in the incidence of ischaemic stroke, but at the expense of major haemorrhage. Patients with pre-existing AF were excluded.

Recommended by Matthew Mac Partlin
Fulltext

• Matthaiou DK, Ntani G, Kontogiorgi M, Poulakou G, Armaganidis A, Dimopoulos G. An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med. 2012 Apr 27. [Epub ahead of print] PubMed PMID: 22538461.

Procalcitonin levels – not much good for diagnosing bacterial sepsis, but handy for shortening duration of therapy without increasing 28-day negative outcome rates.

Recommended by Matthew Mac Partlin
Fulltext

• Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, Desai SV, Shanholtz C, Brower RG, Pronovost PJ. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012 Apr 5;344:e2124. doi: 10.1136/bmj.e2124. PubMed PMID: 22491953; PubMed Central PMCID: PMC3320566.

Our ARDS-Net guided lung-protective ventilation strategy seems to work long term as well. ARDS-Net demonstrated a short term mortality benefit. This US 4 academic centre (13 ICUs – medical, surgical, trauma) prospective observational trial demonstrated an absolute 4% and 8% drop in 2 year mortality with adherence to one or both of the ARDS-Net lung-protective ventilation parameters respectively, compared to no adherence at all. No report on morbidity outcomes though.

Recommended by Matthew Mac Partlin
Fulltext

• Nomura, Jason T, Genes N, Bollinger HR, Bollinger M, and  Reed JF. “Twitter Use During Emergency Medicine Conferences.” The American Journal of Emergency Medicine (March 16, 2012). PMID 22424992

I’ve always been jealous watching my timeline on twitter fill with hashtags from folk at big conferences. @takeokun pulled the tweets from one conference to get an idea of what people were saying. I look forward to filling your timeline when I’m at ICEM2012!

Recommended by Andy Neill

• Ranchord AM, Argyle R, Beynon R, Perrin K, Sharma V, Weatherall M, Simmonds M, Heatlie G, Brooks N, Beasley R. High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: a pilot randomized controlled trial. Am Heart J. 2012 Feb;163(2):168-75.

No difference in this pilot study of titrated oxygen therapy for STEMIs – but wide confidence intervals… more studies needed.

Recommended by Andy Brainard

• Smith SW, Khalil A, Henry TD, Rosas M, Chang RJ, Heller K, Scharrer E, Ghorashi M, Pearce LA. Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction. Ann Emerg Med. 2012 Apr 18. [Epub ahead of print] PubMed PMID: 22520989.

This is Steve Smith’s (yes that guy) big idea about distinguishing BER from STEMI on ECG criteria. This type of thing is really important as the classic STEMI criteria just aren’t cutting the mustard. It’s a dense enough paper to follow and even if you don’t understand the calculation the concept is priceless.

Recommended by Andy Neill

• Chiang HK, Zhou Q, Mandell MS, Tsou MY, Lin SP, Shung KK, Ting CK. Eyes in the needle: novel epidural needle with embedded high-frequency ultrasound transducer–epidural access in porcine model. Anesthesiology. 2011 Jun;114(6):1320-4. PubMed PMID: 21519228; PubMed Central PMCID: PMC3104409.

Tech porn. One-crystal ultrasound transducer placed on the tip of a stylette that fits in the lumbar needle! Never miss an epidural again. And when they get smaller, they will fit in a spinal needle. Maybe.

Recommended by Thomas Dolven

• Walter S, Kostopoulos P, Haass A, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012 May;11(5):397-404. Epub 2012 Apr 11. PubMed PMID: 22497929

Taking the crazy on the road – mobile stroke response units with an MD and a scanner in order to save a few minutes for TPA administration. Not sure this is the best resource outlay….

Recommended by Ryan Radecki
Learn more: EM Literature of Note — Mobile Stroke units – Probably Not Helpful

• Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012 Mar;67(3):318-40. PMID: 22321104

The Difficult Airway Society has published these guidelines for tracheal extubation. The focus is on the peri-operative patient but it provides an overview and framework for a procedure rarely undertaken in the ED. It’s also healthy reminder that what goes in must come out.

Recommended by John Larkin, Cliff Reid
Learn more: Extubation guidelines
Fulltext

• Moyer VA. What we don’t know can hurt our patients: physician innumeracy and overuse of screening tests. Ann Intern Med. 2012 Mar 6;156(5):392-3. PubMed PMID: 22393136.

Clear evidence that physicians need education on what our tests are telling us.

Recommended by Mike Jasumback

• Reiter DA, Lakoff DJ, Trueger NS, Shah KH. Individual Interactive Instruction: An Innovative Enhancement to Resident Education. Ann Emerg Med. Elsevier Inc.; 2012 Apr. 18;:1–4. PMID 22520994

A useful discussion of how web2.0 and ‘asynchronous learning’ has an important role in educating trainees and getting it recognised as valid learning. This is really important I think but my one concern is that if we show how much we can learn in our own time via free resources then they’ll take away our protected training time.

Recommended by Andy Neill, Chris Nickson, Mike Cadogan

• Corrado D, Pelliccia A, Heidbüchel H, Sharma S, Link M, Basso C, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. European Heart Journal. 2010 Jan.;31(2):243–259. PMID: 19933514

Linked to by someone on twitter (as usual I can’t remember). This is by the Italian folk famous for ECG screening of ALL athletes. Seeing as 50% of athletes will have “abnormal” ECGs this is a great paper to pick out which “abnormal” bits matter and which are actually normal.

Recommended by Andy Neill

• Dumas F, Manzo-Silberman S, Fichet J, Mami Z, Zuber B, Vivien B, Chenevier-Gobeaux C, Varenne O, Empana JP, Pène F, Spaulding C, Cariou A. Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors? Crit Care Med. 2012 Apr 6. [Epub ahead of print] PubMed PMID: 22488008.

Some cardiac arrest patients will do better going to the cath lab – but your bedside troponin measurement doesn’t accurately predict who.

Recommended by Ryan Radecki
Learn more: Post-arrest troponin measurements predict little

• Le Cong M, Gynther B, Hunter E, Schuller P. Ketamine sedation for patients with acute agitation and psychiatric illness requiring aeromedical retrieval. Emergency Medicine Journal. 2011 May 12. PMID: 21565879

We all know Minh Le Cong is a retrieval legend but now we have publications to prove it. This describes a series of psychotic patients who got ketamine to get them on a plane (I suspect he stole the idea from the A-team) and transferred safely. I suspect ketamine would be useful to get control in the ED too.

Recommended by Andy Neill

• Brancati FL. The art of pimping. JAMA. 1989 Jul 7;262(1):89-90. PubMed PMID: 2733128.

The classic, original work on the art of pimping in medicine.

Recommended by Chris Nickson
Learn more: Pimping in perspective

• Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011 Oct;140(4):859-66. Epub 2011 May 5. Review. PubMed PMID: 21546439.

Ultrasound for pneumothorax is more frequently useful than FAST for free fluid. This should really be standard EM practice.

Recommended by Andrew Brainard

• Schulman S, Crowther MA. How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch. Blood. 2012 Mar 29;119(13):3016-23. Epub 2012 Feb 1. PubMed PMID: 22302737.

Great review of novel oral anticoagulants, from ‘what’ to ‘how to’ (All quoted trials are outpatients or non-ICU in-patients. Lots of pharmacokinetic extrapolation, not so much hard evidence). Warfarin still tops for AF and DVTs if stable therapeutic INR, poor compliance, GI (any) bleeding concerns, creatinine clearance <30ml/min, limited budget. 4-factor PCC seems to be the only potential reversal agent and add 6 hours of dialysis for dabigatran. (Just wonder if rivaroxaban would be a target for intralipid as an antidote!?)

Recommended by Matthew Mac Partlin
Fulltext

• Blom A, Taylor A, Whitehouse S, Orr B, Smith E. A new sign of inappropriate lower back pain. Ann R Coll Surg Engl. 2002 Sep;84(5):342-3. PubMed PMID: 12398129; PubMed Central PMCID: PMC2504150.

Does your patient’s low back pain pain have an organic cause? Probably not if they react to the heel-tap test: “The patient sits on the examination couch with his hips and knees flexed to 90°. After suggesting that the test may cause lower back pain, the examiner lightly taps the patient’s heel with the base of his hand. If the patient complains of sudden lower back pain, the test is considered to be positive.” The paper also describes Waddell’s signs, with which this simple test compares favourably.

Recommended by Chris Nickson
Fulltext

• EINSTEIN–PE Investigators. Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med. 2012 Mar 26. [Epub ahead of print] PubMed PMID: 22449293

This one is a game-changer. A single oral agent is non-inferior to a heparin / warfarin protocol in patients with symptomatic pulmonary embolism. Other –xabans are in the pipeline. Apixaban will probably be even better than rivaroxaban. Now if someone would only be brave enough to compare –xabans to nothing, we would have even more valuable information. (Disclaimer: this study was drug company funded)

Recommended by Joe Lex
Fulltext

• Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. PMID: 8208267.

This is an classic. Lumbar MRI scans 100 hospital employees with no back pain or history of it. Read by two radiologists with clear definitions of what to report. Kappa 0.59. Much more interestingly almost 70% of these asymptomatic people had abnormalities. Most were bulges but a quarter were “protrusions” and almost 10% had facet disease. MR great for cauda equina but maybe not for telling us what causes your patient’s back pain…

Recommended by Andy Neill
Fulltext

• Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005 Aug;60(8):1071-6. PubMed PMID: 16127115.

A great paper to show the surgical registrar who whinges about having to see another ‘constipated’ elderly patient: “Abdominal pain in older patients should be investigated thoroughly as, in this study, nearly 60% of patients were hospitalized, 20% underwent operative or invasive procedures, 10% had return ED visits, and 5% died within a 2-week follow-up period.

Recommended by Chris Nickson

• Colloca L, Miller FG. The Nocebo Effect and Its Relevance for Clinical Practice. Psychosom Med 2011 Sep;73:598-603. Pubmed PMID: 21862825

In contrast to the beneficial placebo effect, the term “nocebo effect” describes “adverse effects produced by expectations”. For example, a certain number of research subjects will develop described side effects attributed to a study drug, even if they end up in the placebo arm. This interesting paper discusses important clinical and ethical issues related to this phenomenon.

Recommended by Leon Gussow

• Parrish A, Lancaster R.Does the nose know? Amitraz poisoning and olfaction. S Afr Med J 2012 Mar 2;102(4):231-2. PMID: 22464501

Back to basics… using your senses.

Recommended by Sa’ad Lahri
Fulltext

• Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009 Apr;40(4):343-53. Epub 2009 Mar 17. Review. PubMed PMID: 19278678

A great discussion of the pros and cons of different methods for stemming hemorrhange from pelvic fractures. The authors ultimately advocate going to the OR for preperitoneal packing prior to angiography for hemodynamically unstable patients.

Recommended by Chris Nickson

• Bellomo R. The dangers of dogma in medicine. Med J Aust. 2011 Oct 3;195(7):372-3. PubMed PMID: 21978331.

Written by an intensivist who has few rivals in his quest to bring light where there is darkness in medicine. An excerpt: “Doctors would do well to maintain a degree of cautious skepticism for both bold new fashions and received wisdom, whether generated by the world or by the self. They would do even better to question what they do and see such questioning as an asset. It is everyone’s responsibility to find out how to ask questions systematically, find answers from searching the literature, critically appraise the literature and apply the results to practice.”

Recommended by Chris Nickson

• Berger E. Web 2.0 in Emergency Medicine: Specialty Embracing the Future of Medical Communication. Ann Emerg Med. 2012; 59(4) A21-A23

A sign that Web 2.0 is on the road to becoming mainstream for emergency phyisicians?

Recommended by Mike Cadogan
Fulltext

• Krumholz SD et al. Study of Neurontin: Titrate to Effect, Profile of Safety (STEPS) Trial. Arch Intern Med ;2011 Jun 27;171:1100-1107. Pubmed PMID: 21709111

So-called seeding trials are framed as phase 4 research, but are often designed and partially carried out by drug firms’ marketing departments to promote increased use of a specific drug. Disclosure of the true goal is made neither to the patients nor to participating clinicians. This must-read paper uses internal company memos obtained during product liability litigation to describe the whole sordid process.

Recommended by Leon Gussow

• Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2012 Mar 22;366(12):1099-107. Pubmed PMID: 22435369

There’s a new (old) TPA on the block – and 25 patients worth of data says it’s better than the old TPA. Good enough for the NEJM!

Recommended by Ryan Radecki
Learn more: Emergency Medicine Literature of Note — TPA is dead! Long live TPA!

• Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.  JAMA. 2012 Mar 21;307(11):1161-8. PubMed PMID: 22436956

This massive Japanese observational study, like the brilliant Jacobs et al study finds that adrenaline (aka epi) increases ROSC. But it is associated (no causation implied by an observational study, remember) with worse outcomes in the longer term (survival AND neurological outcomes). Do we need a really big RCT? Can it be done? Are you going to stop giving epi? (But what else is there to give… SNP?)

Recommended by Chris Nickson, Ryan Radecki
Learn more:
Emergency Medicine Literature of Note — More Nails In the Coffin For Epinephrine
EMCrit Wee — Abandon Epinephrine?

• Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation. 2011 Sep;82(9):1138-43. Epub 2011 Jul 2. PubMed PMID: 21745533.

By now everyone knows this paper, but it needs to be on R&R… and not just because its from Western Australia (all power to Jacobs and Jelinek!). Commentators like John Marx on Journal Watch interpreted this as evidence of benefit for adrenaline as although it was underpowered, it found an increase in ROSC with epi that was not statistically significant. That’s all well and good but even if it was statistically significant, would it be clinically significant? Or could it even make things worse down the track?

Recommended by Chris Nickson
Learn more:
EMRAP — PACA Study — Epinephrine (Mel Herbert talks to Ian Jacobs; subscription required)
EMCrit Wee — Abandon Epinephrine?

• Casey SJ, de Alwis WD. Review article: Emergency department assessment and management of stab wounds to the neck. Emerg Med Australas. 2010 Jun;22(3):201-10 PubMed PMID: 20497212.

Avoid a trauma tribulation when faced with penetrating neck injuries.This is an excellent overview of the assessment and management of stab wounds to the neck.

Recommended by John Larkin

• Crash-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. Pubmed PMID: 20554319

The paper that started the debate on TXA in trauma, sparked several subgroup analysis papers and is slowly finding it’s way into clinical practice.

Recommended by John Larkin
Learn more:
EMCrit Podcast 67 – Tranexamic Acid (TXA), Crash 2, & Pragmatism with Tim Coats
Emergency Medicine Ireland — Crash-2
Emergency Medicine Literature of Note — Critique of Crash-2
ICU Rounds Podcast — EARLY use of Tranexamic Acid may improve survival from bleeding in trauma
The Lancet — Crash-2: Tranexamic Acid and Trauma Patients (includes link to fulltext pdf)
The NNT — Tranexamic acid for Trauma

• Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Ann Emerg Med. 2012; 59(3): 165-175 [Epub 2011 Nov 1. PMID: 22050948.

Outstanding review of preoxygenation (and oxygenation) for airway management.  Editor's note: This paper entered the hall of fame in the very first edition of R&R, but is so good it deserves another recommendation now its in print. Plus it has been made free access - nice one Annals of Emergency Medicine!

Recommended by David Newman
Fulltext
Learn more: EMCrit — Preoxygenation, reoxygenation and deoxygenation;  Resus.ME — Preoxygenation and prevention of desaturation

• Peterson MC, Holbrook JH, Hales Von D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992 Feb.;156(2):163–165. Pubmed PMID: 1536065

Not the perfect study but confirms what we know by intuition that so much of our diagnosis is made by the history. They say about 80%. A good history of course will avoid premature closure and all those other cognitive biases that screw us up but history is the key.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — The mechanics of reasoning
Fulltext

• Beyer H, Cherkas D. Corneal foreign body removal using a bent needle tip. Am J Emerg Med. 2012 Mar;30(3):489-90. Epub 2011 Feb 26. PubMed PMID: 21354749.

A useful modification of the classic technique for FB removal in the cornea. A bend in the needle makes things much simpler.

Recommended by Scott Weingart

• Habboushe JP, Walker G. Novel use of a urine pregnancy test using whole blood. Am J Emerg Med. 2011 Sep;29(7):840.e3-4. Epub 2010 Aug 13. PubMed PMID: 20708881.

A nice little practical tip for finding out if your sick patient is pregnant.

Recommended by Chris Nickson

• Sandercock P, Lindley R, Wardlaw J, Dennis M, Innes K, Cohen G, et al. Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited. Trials. BioMed Central Ltd; 2011 Nov. 30;12(1):252. Pubmed PMID: 22129158

IST-3 is a 3000 pt RCT of lytics for stroke which enrolled people outside the current indications for tPA. It’s definitely not the repeat of NINDS that a lot of us has wanted but it’s stil a big important trial. So far they’ve only published the baseline data (eg 50% were >80 yrs) but it’s an interesting read as to things to come.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — Some updates on IST-3
Fulltext

• Stergiopoulos K, Brown DL. Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease: Meta-analysis of Randomized Controlled Trials. Arch Intern Med. 2012 Feb 27;172(4):312-9. PubMed PMID: 22371919.

PCI for patients not having a STEMI doesn’t save lives, prevent heart attacks, or reduce symptoms.

Recommended by David Newman

• Schutz et al. Clinical management of tuberculosis and HIV-1 co-infection. Eur Respir J. 2010 Dec;36(6):1460-81. Epub 2010 Oct 14 Pubmed PMID: 20947678

State of the Art clinical review. Highly relevant for some of us where up to 60 % of our Emergencies in the Emergency Centre are HIV/TB related.

Recommended by Sa’ad Lahri

• Lerner EB, Moscati RM. The golden hour: scientific fact or medical “urban legend”? Acad Emerg Med. 2001 Jul;8(7):758-60. Review. PubMed PMID: 11435197.

The story of trauma’s mythical ‘golden hour’ is a story worth knowing.

Recommended by Chris Nickson
Fulltext

• 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.

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.

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.

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.

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.

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

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.

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.

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

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.

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?

• Imazio M, Brucato A, Ferrazzi P, Rovere ME, Gandino A, Cemin R, Ferrua S, Belli R, Maestroni S, Simon C, Zingarelli E, Barosi A, Sansone F, Patrini D, Vitali E, Trinchero R, Spodick DH, Adler Y; COPPS Investigators. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011 Nov 22;124(21):2290-5. Epub 2011 Nov 16. PubMed PMID: 22090167.

Colchicine used for a month after cardiac surgery decreases the incidence of new onset AF and the recovery time. It did not affect mortality or reduce stroke. Food for thought but probably not good enough to recommend as routine care yet…

Recommended by Oliver Flower
Fulltext

• Flower O, Finfer S. Glucose control in critically ill patients. Intern Med J. 2012 Jan;42(1):4-6. doi: 10.1111/j.1445-5994.2011.02631.x. PubMed PMID: 22276558.

A short and sweet summary of where we are today in the glucose control in ICU saga.

Recommended by Chris Nickson
Fulltext

• Geelhoed GC, de Klerk NH. Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust. 2012 Feb 6;196:122-6. PMID:  22304606.

Introducing the 4 hour rule in WA in 2009 was associated with reduced ED overcrowding and, in the tertiary hospitals studied, reduced hospital mortality, in the subsequent year, despite rising presentation numbers. 1) Hawthorn effect? Overcrowding started to fall in the period immediately preceding the introduction of the 4 hour rule – the staff knew it was coming. 2) Implications for other ED populations? 3) No description of mechanisms to facilitate the 4 hour rule – Need stakeholder buy-in. Goes well with the accompanying MJA paper on implementing a 4-hour rule. 4) Implications for ED career longevity if it is reduced to a mere triage service.

Recommended by Matthew Mac Partlin
Fulltext

• Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K.  Morphine and Ketamine Is Superior to Morphine Alone for Out-of-Hospital Trauma Analgesia: A Randomized Controlled Trial. Ann Emerg Med. 2012 Jan 11. [Epub ahead of print] PubMed PMID: 22243959.

Ketamine plus morphine is better than morphine alone for trauma pain in the pre-hosp setting. More “adverse effects” in the ketamine group if you count increased heart rate as a SE. No reason why we can’t do the same thing in the ED if needed.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — Morphine and ketamine for prehospital analgesia

• Roback MG, Wathen JE, MacKenzie T, Bajaj L. A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency  department orthopedic procedures. Ann Emerg Med. 2006 Nov;48(5):605-12. Epub 2006 Aug 14. PubMed PMID: 17052563.

I’ve only ever used ketamine IV in kiddies and adults but a lot of guidelines suggest IM is great too. This is an unblinded RCT of IV v IM which seems to me to show that IV is better. There was a lot more vomiting than usual in this trial (18% in one group and 35% in the other) Was stopped early at “nursing request” when the nurses thought the IM was crap.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — Ketamine IV versus IM

• Teoh DL, Reynolds S. Diagnosis and management of pediatric conjunctivitis. Pediatr Emerg Care. 2003 Feb;19(1):48-55. Review. PubMed PMID: 12592117.

Great review of a common problem with highlights of some often overlooked issues. Sometimes it is good to review what we think is “simple.”

Recommended by Sean Fox
Learn more: Pediatric EM Morsels — Conjunctivitis and Conjunctivitis-Otitis Syndrome

• Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: analysis of the ideal breast. J Plast Reconstr Aesthet Surg. 2012 Jan;65(1):8-16. Epub 2011 Aug 24. Review. PMID: 21868295.

Hmmm… Perhaps useful for emergency presentations of the future. I can see the triage note now: “Patient presents with non-ideal breasts”. Also of note, the authors are from ‘The Cadogan Clinic”…

Recommended by Chris Nickson

• Urdang M, Mallek JT, Mallon WK. Tattoos and piercings: a review for the emergency physician. West J Emerg Med. 2011 Nov;12(4):393-8. PubMed PMID: 22224126; PubMed Central PMCID: PMC3236178.

Tattoos and piercings can give significant clues to a person’s lifestyle and risk factors, and also cause specific complications such as dental trauma (oral piercings) and failure of barrier contraception (genital piercings).

Recommended by Leon Gussow
Fulltext

• Fox JC, Richardson AG, Lopez S, Solley M, Lotfipour S. Implications and approach to incidental findings in live ultrasound models. West J Emerg Med. 2011 Nov;12(4):472-4. PubMed PMID: 22224140; PubMed Central PMCID: PMC3236140.

When teaching hand-on ultrasound, how should you deal with the possibility that incidental findings may show up when models are scanned? An important topic I had not seen discussed previously.

Recommended by Leon Gussow
Fulltext

• Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a  case series of 98 patients. Mayo Clin Proc. 2012 Feb;87(2):114-9. PubMed PMID: 22305024.

Somewhat vague in its definitions, but the largest case series of cannabinoid hyperemesis syndrome to date.

Recommended by Leon Gussow

• Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, Mannino D, Sciurba FC, Holguin F. Outcomes of Non-invasive Ventilation for Acute Exacerbations of COPD in the United States, 1998-2008. Am J Respir Crit Care Med. 2011 Oct 20. [Epub ahead of print] PMID: 22016446.

Increase in use of NIPPV in USA is associated with improving mortality rates between 1998 and 2008, including elderly >75yo. Cheaper too and can keep patients out of ICU if pro-active, motivated respiratory ward. Pulmonary rehab might be the key (associated editorial explores this). Mortality worse if NIPPV fails and converted to IMV, especially if late failure.

Recommended by Matthew Mac Partlin

• 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. PMID: 21983370.

This is something I’d not even thought of before now but it seems that bevel direction might play a role in IJ CVC placement. Bevel down seems the way to go. Though this is by no means a perfect study as they didn’t define what a haematoma was.

Recommended by Andy Neill
Learn more: Emergency Medicine Ireland — Bevel up or down for IJ central lines?

• Cha SI, Shin KM, Lee JW, Lee J, Lee SY, Kim CH, Park JY, Jung TH. Clinical characteristics of patients with peripheral pulmonary embolism. Respiration. 2010;80(6):500-8. Epub 2010 Jan 21. PMID: 20110642.

More stuff about whether small PEs are important or not. The sub-segmental ones probably aren’t a big deal… Unfortunately this isn’t the study to really clarify that. A slightly dodgy chart review and not that many with the small PEs that the study is actually interested in. Not sure who alerted me to the paper but please let me know!

Recommended by Andy Neill
Fulltext
Learn more: Emergency Medicine Ireland — Are small PEs benign? Probably, but this doesn’t help.

• Newnham HH, De Villiers Smit P, Keogh MJ, Stripp AM, Cameron P. Emergency and  acute medical admissions: insights from US and UK visits by a Melbourne tertiary health service. Med J Aust. 2012 Feb 6;196:101-3. PMID: 22304592.

Australian EM posse from the Alfred head West and find that the UK and the US are tackling ED access block by returning to the days of ED as a doctor-led triage / limited-treatment service and reintroducing the general physician to acute ward medicine. Plus ca change … Oh, and at the end there’s a quiet nod at the lack of outcome data. Faster inefficacy?

Recommended by Matthew Mac Partlin

• Pearson ML, Selby JV, Katz KA, Cantrell V, Braden CR, Parise ME, Paddock CD, Lewin-Smith MR, Kalasinsky VF, Goldstein FC, Hightower AW, Papier A, Lewis B, Motipara S, Eberhard ML; for the Unexplained Dermopathy Study Team. Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy. PLoS One. 2012;7(1):e29908. Epub 2012 Jan 25. PMID: 22295070; PMCID: PMC3266263.

I have been waiting for this publication since it was first announced that Morgellons was going to be studied. Can it really be true that thousands of people are breaking out in sores that then extrude thread-like fibers? Are we missing the boat and ignoring the coming storm of unexplained dermopathy? No, we are not. The CDC took on this hot topic and has laid to rest any infectious or environmental cause. The mysterious fibers that were being extruded by the open sores at an alarming rate? Mostly cellulose, as in cotton.

Recommended by Rob Orman
Fulltext

• Reicks M, Redden JP, Mann T, et al.  Photographs in lunch tray compartments and vegetable consumption among children in elementary school cafeterias.  JAMA 2012, Feb 8 307(6):539-628. PMID: 22302602

Children may be temporarily subliminally tricked into eating more vegetables.

Recommended by Ryan Radecki
Fulltext
Learn more: Emergency Medicine Literature of Note — Eat your vegetables!

• Holla M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J. 2012 Feb;29(2):104-7. PMID: 21335583

More evidence that the obsession with cervical collars is founded on dogma rather than science.

Recommended by Cliff Reid
Learn more: Resus.ME — Another reason to be skeptical about cervical collars.

• Wampler DA, Molina DK, McManus J, Laws P, Manifold CA. No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. Prehosp Emerg Care. 2011 Jul-Sep;15(3):320-4. PMID: 21612385.

OK. Your opiate OD patient wants to leave after the naloxone kicks in. Although there are limitations given the retrospective design and the prehospital setting, this study suggests that putting the safety of your staff and other patients first – and allowing the patient to leave – may be the best strategy. It’s follows on from a classic retrospective prehospital study by Vike et al (2003) [PMID: 12896894].

Recommended by Chris Nickson

• Irish CB, Carden LO. Emergency Ultrasound in patients with respiratory distress. EM Critical Care. 2012;(2)1

If you want to know how ultrasound can help you assess and manage critically ill patients with respiratory distress, this hot of the press review is where to turn.

Recommended by Chris Nickson

• Rhee CM, Bhan I, Alexander EK, Brunelli SM.  Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism.  Arch Intern Med. 2012 Jan 23;172(2):153-9. PMID: 22271121

As if you needed another reason to not order CTs, you’re probably damaging the thyroid gland with the iodinated contrast as well.

Recommended by Ryan Radecki
Learn more: Emergency Literature of Note — Further harms of IV contrast

• Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S, Wilmer A, Van den Berghe G. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. Epub 2011 Jun 29. PMID: 21714640.

EPaNIC trial (MC-PrRCT) -> If you parenterally feed a critically ill patient who is already being enterally fed; they get out of ICU alive a tiny bit earlier, endure 2 days less of ventilation and have fewer infections if you start the PN after 8 days rather than within 48hrs… Um…OK! But shouldn’t most of your patients be out of the ICU by then anyway? Especially if they are mostly cardiac surgery patients! (Survivor treatment bias!!!)

Recommended by Matthew Mac Partlin
Fulltext

• Young PJ, Saxena M, Beasley R, Bellomo R, Bailey M, Pilcher D, Finfer S, Harrison D, Myburgh J, Rowan K. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med. 2012 Jan 31. [Epub ahead of print] PMID: 22290072.

Hot of the press (pun intended). Early fever is associated with improved outcomes in critically ill patients with infection but with worsened outcomes in those without infection. These data provide the basis for the hypothesis that administration of paracetamol to critically ill patients with fever and infection worsens outcome. This hypothesis is being tested in the HEAT trial.

Recommended by Paul Young

• Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med. 2010 Oct;56(4):392-401.e1. PMID: 20868907.

The DORM study is an important step towards rehabilitating the reputation of droperidol in the sedation of agitated patients. Droperidol is an (almost) essential emergency drug that we should not be afraid to use when required.

Recommended by Chris Nickson

• Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, Patterson PD, Hostler D. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med. 2012 Jan;19(1):85-91. doi:10.1111/j.1553-2712.2011.01254.x. Epub 2012 Jan 5. PMID: 22221346.

While I have no doubt that being tired contributes to mistakes I suspect this study is testing the wrong thing and misses the fact that when we need to cope we probably do

Recommended by Andy Neill

• Solomon RC. Coffers brimming, ethically bankrupt. Ann Emerg Med. 2012 Feb;59(2):101-2. Epub 2011 Nov 10. PMID: 22078890.

A brilliantly written piece outlining our culpability as physicians and our responsibility to make a stand and pay the moral and financial cost of our involvement with big pharma.

Recommended by Andy Neill

• Allgaier R, Vallabh K, Lahri S. Scurvy: A difficult diagnosis with a simple cure. African Journal of Emergency Medicine (2012): Article in Press

“The life of a pirate wasn’t always full of adventure and partying” … A forgotten disease?

Recommended by Sa’ad Lahri and Chris Nickson
Fulltext

• Klotz L. How (not) to communicate new scientific information: a memoir of the famous Brindley lecture. BJU Int. 2005 Nov;96(7):956-7. PMID: 16225508.

At once unbelievable, horrifying and a lesson in how to give a talk that no one will ever forget. Left me speechless.

Recommended by Chris Nickson
Learn more: LITFL — How to give an unforgettable talk.
Fulltext

• Marks V. Murder by insulin: suspected, purported and proven — a review. Drug Test Anal 2009 Apr;1:162-76. PMID: 20355194

With the recent series of suspicious hypoglycemic deaths at Stepping Hill Hospital in Greater Manchester (U.K.), this paper takes on added interest. It summarizes 66 cases of known or suspected insulin poisoning, and makes some important points about the forensic issues involved.

Recommended by Leon Gussow

• James MF, Michell WL, Joubert IA, Nicol AJ, Navsaria PH, Gillespie RS. Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma). Br J Anaesth. 2011 Nov;107(5):693-702. Epub 2011 Aug 19. PMID: 21857015.

Cliff Reid saw this paper first but it’s worth reading yourself. Conclusions say colloids better for resus. Actual results say quite the opposite. Great paper to read on obfuscation of a key issue.

Recommended by Andy Neill
Learn more: Resus.ME — FIRST: Fluids in Resuscitation; Emergency Medicine Ireland — Colloids for Resus in Trauma

• Roquilly A, Mahe PJ, Seguin P, Guitton C, Floch H, Tellier AC, Merson L, Renard B, Malledant Y, Flet L, Sebille V, Volteau C, Masson D, Nguyen JM, Lejus C, Asehnoune K. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. JAMA. 2011 Mar 23;305(12):1201-9. PMID: 21427372.

MC-DB-PrRCT: Intubated polytrauma patients (ISS>15) given 7 day H’cort IVI regime have significant lesser incidence of HAP by 28 days. Also shorter ICU and ventilation and just statistically significant lower incidence of ARDS. Lesser surgical wound infection, but higher incidence of UTI, bacteraemia – all non-statistically significant.

Recommended by Matthew Mac Partlin

• Rosenberg H, Al-Rajhi K. ED ultrasound diagnosis of a type B aortic dissection using the suprasternal view. Am J Emerg Med. 2012 Jan 11. [Epub ahead of print] PMID: 22244228.

Great case report of type B aortic dissection diagnosed on bedside ED ultrasound. There are online video clips from this case: Descending aorta Suprasternal view with color doppler Suprasternal view no color Longitudinal aorta

Recommended by Leon Gussow