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Research and Reviews in the Fastlane 049
This study found that women with higher BMI (> 25) were at an increased risk for medication failure (OR 3.60). The authors recommend that women with higher BMIs should be offered copper IUDs (not realistic in most EDs). Alternatively, some agents are more effective and may be viable options. Recommended by: Anand Swaminathan 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...
Source: Life in the Fast Lane - September 22, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Alternative Medicine Cardiology Education Emergency Medicine Infectious Disease Obstetrics / Gynecology Pre-hospital / Retrieval Resuscitation critical care Intensive Care literature R&R in the FASTLANE recommendations Research a Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs

Research and Reviews in the Fastlane 048
This study looked at one institution’s discrepancy rate between EP and radiologist plain film reads over 10 years. They found overall an ~3% discrepancy rate on all plain films. This of course does not mean the radiologist was correct in every discrepancy. But it does show we agree most of the time. Most interestingly, the rate of discrepancies requiring emergent change in management was a mere 0.056%! Recommended by: Zack Repanshek Prehospital/Retrieval Braude D et al. Air Transport of Patients with Pneumothorax: Is Tube Thoracostomy Required Before Flight? Air Med J. 2014 Jul-Aug;33(4):152-6. PMID: 25049185 C...
Source: Life in the Fast Lane - September 15, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Education Emergency Medicine Pediatrics Pre-hospital / Retrieval Public Health Respiratory Resuscitation Toxicology and Toxinology critical care Intensive Care literature R&R in the FASTLANE recommendati Source Type: blogs

Research and Reviews in the Fastlane 047
In this study, the research team collected pooled urine (read many people used the urinal they collected from) from a popular nightclub area in London and analyzed the specimens for the presence of illicit drug compounds. The goal was to determine whether this method could be used to track patterns and monitor trends in recreational drug use.  Recommended by: Anand Swaminathan Emergency Medicine, Critical Care, Anaesthetics Hindman BJ et al. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation with Macintosh and Airtraq Laryngoscopes. Anesthesiology. 2014; 121(2):260-71. PMID...
Source: Life in the Fast Lane - September 9, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE critical care Intensive Care literature recommendations Research and Review Source Type: blogs

Research and Reviews in the Fastlane 046
This study looked at initiating cooling prehospital after out of hospital cardiac arrest with resuscitation. No surprise, these patients cooled faster, reaching 34 degrees > 1 hour faster! Unfortunately, this early cooling did not show a benefit in survival or neurologic outcome. This was true for both VF and non-VF arrest. Prehospital cooling reduced core temperature by hospital arrival and reduced the time to reach a temperature of 34°C, but did not improve survival or neurological status among patients resuscitated from prehospital VF or those without VF Recommended by: Salim Rezaie, Zach Repanshek The R&R i...
Source: Life in the Fast Lane - September 1, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Emergency Medicine R&R in the FASTLANE critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs

Research and Reviews in the Fastlane 045
Welcome to the 45th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is 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. 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 f...
Source: Life in the Fast Lane - August 25, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Emergency Medicine Intensive Care R&R in the FASTLANE critical care Education literature recommendations Research and Review Source Type: blogs

Research and Reviews in the Fastlane 044
This study looks at the agreement between radiologists in reading CTPAs for pulmonary embolism. They found that more than 10% of studies initially read as positive were later read as either negative or indeterminate. Many of the change in read occurred in subsegmental embolisms. This study throws further doubt on starting patients on long term anticoagulation based on the presence of a subsegmental pulmonary embolism. Recommended by: Anand Swaminathan Education Raemer DB. Ignaz semmelweis redux? Simul Healthc. 2014 Jun;9(3):153-5. PMID: 24401925 As a rabid in situ simulationist it is good to be tempered now an then by a...
Source: Life in the Fast Lane - August 18, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Emergency Medicine Haematology Infectious Disease Intensive Care R&R in the FASTLANE Resuscitation critical care literature recommendations Research and Review Source Type: blogs

ECG waves and hyperkalaemia
BSCC Physiology 015 Question: Draw a normal ECG tracing showing the durations of the major intervals Examinee response + Show: Drawing and explanation in real-time video/audio expand(document.getElementById('ddet196739019'));expand(document.getElementById('ddetlink196739019')) Question: How does the ECG tracing change in hyperkalaemia Examinee response + Show: Drawing and explanation in real-time video/audio expand(document.getElementById('ddet1920711794'));expand(document.getElementById('ddetlink1920711794')) + Show Transcript expand(document.getElementById('ddet1683865941'));expand(document.getElementById('ddetlink16...
Source: Life in the Fast Lane - August 16, 2014 Category: Emergency Medicine Authors: Deanne Chiu Tags: Basic Science Cardiology Physiology ECG ECG intervals ECG tracing ECG waves EKG hyperkalaemia Source Type: blogs

Research and Reviews in the Fastlane 042
This article challenges the notion that lacerations need to be closed within a specific “golden period” lest they become infected. The authors find that diabetes, wound contamination, length greater than 5 cm and location on the lower extremity are important risk factors for wound infection. Time from injury to wound closure is not as important as previously thought. Recommended by: Anand Swaminathan Read More: Goldfinger (More Dogma of Wound Care) (SGEM) Emergency Medicine, Procedural Sedation Green SM, Andolfatto G. Managing Propofol-Induced Hypoventilation. Ann Emerg Med. 2014 Jul 11. pii: S0196-0644...
Source: Life in the Fast Lane - August 4, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

Funtabulously Frivolous Friday Five 101
It is 393 days since the last instalment of Funtabulously Frivolous Friday Five (FFFF episode 100) and since the last posting we have been inundated with a steady trickle of email protestation. The arbitrary threshold for re-instatement was forcibly fixed for Fifty, and thus the 50th email became the straw that broke the authors back and we return once again to the arcane world of the Who, What, Where, Why and When of medical trivia. Bring back Funtabulously Frivolous Friday!! I, and my colleagues miss it!! …from a cardiology nurse, who enjoys more than cardiology! – madeupquote.com Question 1 What was the...
Source: Life in the Fast Lane - August 1, 2014 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five FFFF medial quiz Medical Trivia Mrs. Winslow's Soothing Syrup Source Type: blogs

Research and Reviews in the Fastlane 041
This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values? Recommended by: Jerremy Fried Read More: Age Adjusted D-Dimer Testing (RE...
Source: Life in the Fast Lane - July 29, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was ma...
Source: Life in the Fast Lane - July 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE Source Type: blogs

Research and Reviews in the Fastlane 039
Welcome to the 39th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is 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 13 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 f...
Source: Life in the Fast Lane - July 14, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Cardiology Emergency Medicine Emergency Medicine Update Featured Infectious Disease Intensive Care Pre-hospital / Retrieval Resuscitation critical care literature R&R in the FASTLANE recommendations research and revi Source Type: blogs

Research and Reviews in the Fastlane 038
This study, however, has major flaws and biases that question the validity of their conclusions. Only 19% of centers that were contacted agreed to contribute data to the Consortium. Additionally, the researchers do not assess the quality of the studies included in their meta-analysis. Regardless, observational data should not be used to trump the RCT data included in the recent, Cochrane review. Finally, Roche pharmaceuticals was a major sponsor of this research team. The accompanying editorial is a must-read. Recommended by: Anand Swaminathan Infection Control, Hand hygiene D’Egidio G et al. A study of the ...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs

On Call
Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER doc, I need [insert name of specialty here].” And like magic, ten minutes later, I’m talking to the local expert in whatever the patient has.Fun fact: in the last month, I have consulted both physiatry and rheumatology from the ER.So I was a little surprised recently when I had a patient with a nine-m...
Source: Movin' Meat - July 7, 2014 Category: Emergency Medicine Source Type: blogs