This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, JustiWelcome to the 173rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social median Morgenstern 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
Shandro J et al. Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Annals of emergency medicine. 68(4):501-508.e1. 2016. PMID: 27130802
- Human trafficking is a tragic problem. We play a vital role in ending slavery as emergency care providers. I recommend reading this article so you can learn how to spot the signs of trafficking. For a brief synopsis, you can read the post at the link below.
- Recommended by: Clay Smith
The Best of the Rest
Barnett et al. Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. N Engl J Med. 2017;376(7):663-673. PMID: 28199807
- It is reasonable to posit that Emergency Physicians who prescribe opiates with a more permissive threshold give rise to additional downstream long-term use, but this paper’s methodology hangs by several flimsy threads.
- Recommended by: Ryan Radecki
- Further reading: The emergency narcotic dispensary (EM lit of note); The case of the aimless company (EM Nerd)
Hodgson C, Cuthbertson BH. Improving outcomes after critical illness: harder than we thought! Intensive care medicine. 42(11):1772-1774. 2016. 27836316
- Hodgson and Cuthbertson’s commentary on the recent RAPIT trial is an excellent, yet concise, analysis of the difficulties in determining whether complex interventions improve patient-centered outcomes in the critically ill. These studies keep turning up negative – much to our disappointment – and there are many possible reasons why.
- Recommended by: Chris Nickson
Emergency MedicineNumé AK et al. Syncope and Motor Vehicle Crash Risk: A Danish Nationwide Study. JAMA internal medicine. 176(4):503-10. 2016. PMID: 26927689
- Lots of potential problems any time you try to make conclusions from databases, but one number really stood out to me in this paper: 4.4%. For patients presenting with first time syncope, they had a 4.4% chance of being in a significant MVC (requiring emergency department care) in the next 2 years. Hard to know how this applies to different populations, but discussing driving with our patients is essential.
- Recommended by: Justin Morgenstern
Rhodes A et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock. Crit Care Med 2017 [epub ahead of print] PMID: 28101605
- The 2016 Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock just published. Going through the ABC’s of resuscitation (Identification, Fluid Resuscitation, and Antibiotics) the recommendations made are:
1. Screening for sepsis is recommended, however not much is said about the use of SIRS vs qSOFA.
2. Recommend at least 30cc/kg of IV crystalloid be given within the first 3 hours. Hopefully everyone agrees this is not the case (i.e ESRD, CHF).
3. Target a MAP of 65mmHg and norepinephrine is the recommended as the first-choice vasopressor, but second line pressors have been updated to vasopressin (up to 0.03 U/min) or epinephrine
4. Early, appropriate broad empiric antibiotics are now recommended within one hour of sepsis identification. As a side note double coverage of pseudomonas is not recommended.
- Recommended by: Salim R. Rezaie
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…
That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors 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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