This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors
This Edition’s R&R Hall of Famer
Vincent JL et al. Ten big mistakes in intensive care medicine. Intensive Care Med. 2014. PMID 25502093
- From one of the absolute masters of critical care Dr. Vincent, here’s ten important challenges in the care of critically ill that we should all reflect on and strive to overcome.
- Recommenced by: Chris Nickson
- Learn more – John Greenwood’s summary linked below for a quick preview. http://marylandccproject.org/general/must-read-paper-vincent-10-big-mistakes-icm/
The Best of the Rest
Adelgais KM et al. Intra-Abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries. J Pediatr. 2014; 165(6):1230-1235. PMID 25266346
- The leading cause of mortality in children is accidental injuries. Fortunately, the majority of kids that you see after injuries will not have severe trauma, but sorting out those who are at risk of serious abdominal trauma can be difficult. This is a reminder that you can rely on your exam… when the child has a normal GCS. As the GCS declines, the reliability of your exam declines as well.
- Recommended by Sean Fox
Research and Critical Appraisal
BMJ. 2014 Oct 31;349:g6557. PMID 25361576
- This is really just to highlight the excellent series that Phillip Sedgwick [@statistics_man] writes for the BMJ. Sadly not #FOAMed but a great resource for those looking to learn for the UK FCEM exam. Here’s a link to every single one below.
- Recommended by: Andy Neil
Sheren PB et al. Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill. Scand J Trauma Resusc Emerg Med. 2014; 22(1): 41. PMID 25209044
- An excellent, evidence based review of the critical components of RSI. The authors use this evidence to build a standard operating procedure with an airway checklist and kit dump that can aid in building team dynamics and decrease the incidence of adverse events.
- Recommended by Anand Swaminathan
Loubani OM, Green RS. A Systematic Review of Extravasation and Local Tissue Injury from Administration of Vasopressors through Peripheral Intravenous Catheters and Central Venous Catheters. J Crit Care 2015. PMID 25669592
- We’re taught to administer vasopressors through central lines and this may delay these medications. These authors searched the literature to find extravasation and local tissue complications of vasopressors and came up with case reports (n=305 from 270 patients). They found that local tissue injury attributable to peripheral administration tends to occur in distal IV sites following long durations of infusions (average infusion duration before extravasation: 35.2 h). If a patient needs a pressor, they can get it peripherally temporarily while you’re obtaining central access.
- Recommended by Lauren Westafer
Mutschler M et al. The ATLS(®) classification of hypovolaemic shock: A well established teaching tool on the edge?.Injury 2014; 45 Suppl 3:S35-8. PMID 25284231
- The ATLS shock classification has been taking a beating lately. The classification in it self has very little scientific back up – studies have shown that more than 90% of all trauma patients could not be classified according to system. Irrespective of mechanism of injury the classification it may overestimate the degree of tachycardia associated with hypotension and underestimate mental disability in the presence of hypovolaemic shock. Does the ATLS faculty believe it? – Doesn’t seem so. In a survey among 383 European ATLS course instructors and directors the actual appreciation and confidence in this tool during daily clinical trauma care was assessed. Less than half (48%) of all respondents declared that they use the system in their own practice. Overall it seems that the ATLS shock classification today serves only on purpose – namely to test the students attending the course. Hopefully future ATLS manuals will revise the current classification.
- Recommended by Søren Rudolph
The R&R iconoclastic sneak peek icon key
|The list of contributors||The R&R ARCHIVE|
|R&R Hall of famer You simply MUST READ this!||R&R Hot stuff! Everyone’s going to be talking about this|
|R&R Landmark paper A paper that made a difference||R&R Game Changer? Might change your clinical practice|
|R&R Eureka! Revolutionary idea or concept||R&R Mona Lisa Brilliant writing or explanation|
|R&R Boffintastic High quality research||R&R Trash Must read, because it is so wrong!|
|R&R WTF! Weird, transcendent or funtabulous!|
That’s it for this week…