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Total 199 results found since Jan 2013.

Research and Reviews in the Fastlane 182
This study was called LOV-ED. Initiation of a mechanical ventilation protocol in the ED using a low tidal volume strategy, PEEP protocols, rapid FiO2 weaning, and head-of-bed elevation resulted in dramatic clinical improvement in the composite primary outcome: ARDS or ventilator-associated conditions; NNT = 14. And a secondary outcome, mortality, was also improved, NNT = 7. There is no way to account for all the confounders or other process improvements that may have also led to better outcomes, but the use of propensity analysis makes this association very believable. REBEL EM has a great deep-dive on this article. Starti...
Source: Life in the Fast Lane - May 18, 2017 Category: Emergency Medicine Authors: Jeremy Fried Tags: Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 176
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 176th 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 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid,  Justin Morgenstern and, of cour...
Source: Life in the Fast Lane - March 16, 2017 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Cardiology Clinical Research Emergency Medicine Intensive Care R&R in the FASTLANE EBM literature recommendations research and reviews Source Type: blogs

Like a bridge over troubled waters
aka Cardiovascular Curveball 014 A 38yo man presented to ED with a 2 hour history of central crushing chest pain. His past medical history included haemochromatosis and a negative stress echo done one year ago following an episode of chest pain which the patient describes as different to the pain that bought him to the emergency department today. An ECG is done: Q1. Describe this ECG. + Reveal Answer expand(document.getElementById('ddet317893350'));expand(document.getElementById('ddetlink317893350')) The ECG demonstrates underlying sinus rhythm with a rate of 75 bpm and normal axis. antero-lateral ST elevation. au...
Source: Life in the Fast Lane - February 20, 2017 Category: Emergency Medicine Authors: Tom Cassidy Tags: Cardiology ECG Investigation Acute MI BER bridge bridging cardiovascular curveball myocardial bridge STEMI Source Type: blogs

Research and Reviews in the Fastlane 167
This article summarizes several retrospective reviews, concluding that patients with heroin overdose typically do well after EMS treat-and-release naloxone administration, and that they can be safely discharged from the ED after a period of one-hour observation. Considerable limitations in the retrospective nature of such reviews and significant impact of new adulterants such as fentanyl and U-47700 on current “heroin” overdoses seriously limit interpretation and applicability of these studies to today’s clinical practice. Strong caution should be taken in making practice changes based on retrospective and potentiall...
Source: Life in the Fast Lane - January 5, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Toxicology and Toxinology recommendations research and reviews Resuscitation Source Type: blogs

Research and Reviews in the Fastlane 151
This study takes data from a trauma registry and shows a survival rate for resuscitative thoracotomy (RT) of 9.7% vs. 37.5% for REBOA. There are a number of issues with this study due to the retrospective design. Additionally, the RT group was more likely to be dead on presentation in comparison to the REBOA group (71% vs. 38% without vital signs). While this data supports REBOA use, a prospective study should be undertaken to gauge the benefit of this modality. Recommended by: Anand Swaminathan Retrieval, Pre-hospital and Disaster Sadek S, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the ...
Source: Life in the Fast Lane - September 14, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Disaster Education Emergency Medicine Intensive Care Pre-hospital / Retrieval Trauma critical care examination literature R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

Research and Reviews in the Fastlane 150
This study demonstrated the decrease of both BNP and pro-BNP in obese patients presenting to the ED with CHF exacerbations. 10-20% were below the clinical cutoff points for the test. A much more useful test for these patients…ultrasound! Recommended by: Jeremy Fried Emergency medicine       Davidson BL. The association of direct thrombin inhibitor anticoagulants with cardiac thromboses. Chest. 2015. PMID: 25254608 This paper is a commentary, so the level of evidence is not great but is fairly well substantiated and is pretty important to discuss the points it makes. NOACs have been associated with a lower ri...
Source: Life in the Fast Lane - September 8, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE critical care literature recommendations research and reviews Resuscitation Source Type: blogs

Extinguishing Medical Errors with Oil and Gas
Unfortunately for patients and healthcare workers alike, medical errors happen. No matter how well-trained and experienced the practitioner, underneath the scrubs there still resides a human and errors will follow. However, systems can be put in place to minimise them and medicine could do well to learn lessons from other industries. In 2012, there were 107 serious medical errors in Australian hospitals. These ranged from surgery performed on the wrong patient or body part, to surgery where instruments were left inside the patient, to medication errors and in-hospital suicides 1. When considered in the context of the 53 mi...
Source: Life in the Fast Lane - August 3, 2016 Category: Emergency Medicine Authors: Tane Eunson Tags: Administration Medical Errors atul gawande O&G oil and gas industry Source Type: blogs

Research and Reviews in the Fastlane 144
Welcome to the 144th 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, 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 ...
Source: Life in the Fast Lane - July 28, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Intensive Care Neurology R&R in the FASTLANE EBM Emergency Medicine literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better. 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? Might change your clinical practice R&R Eureka! Revolut...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs

Beta-Blockers for Cocaine and other Stimulant Toxicity
Dogma: “a belief or set of beliefs that is accepted by the members of a group without being questioned or doubted; a point of view or tenet put forth as authoritative without adequate grounds.” Years ago I treated a university student who presented to the emergency department (ED) after drinking several cans of a popular caffeinated energy drink to “pull an all-nighter” during final exam week. He was tremulous, agitated, and pale, with sinus tachycardia ranging from 140 to 160 bpm and normal blood pressure (BP). The house officer (registrar) working with me that night proposed treating him with a benzodiazepine, bu...
Source: Life in the Fast Lane - July 4, 2016 Category: Emergency Medicine Authors: John Richards Tags: Toxicology and Toxinology alpha stimulation amphetamines Beta Blockers cocaine dogma John Richards Stimulant Toxicity Stimulants Source Type: blogs

JellyBean 035 with Charles Bruen
You might be a brain surgeon but it’s not rocket science is it? A jellybean with Charles Bruen; Doctor, FOAMed enthusiast and genuine aerospace engineer. Yeah but! It’s not Rocket Science is it? So one super long training period is enough for most of us. Most. Not Charles. Charles studied aerospace engineering at MIT. (Yes that MIT.) Having literally engineered rockets Charles retrained as an physician. (Critical Care Medicine and Emergency Cardiology no less!) (Nutter.) Engineers make things happen. That’s almost the job description. Matt MacPartlin gets a chat going about the engineering mind set and how it fi...
Source: Life in the Fast Lane - June 1, 2016 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Charles Bruen Source Type: blogs

Funtabulously Frivolous Friday Five 142
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 142 Question 1 We’ve all heard of Occam’s Razor but what is Hickam’s Dictum or the Anti-razor? + Reveal the Funtabulous Answer expand(document.getElementById('ddet172338752'));expand(document.getElementById('ddetlink172338752')) A patient can have as many diseases as they damn well please. Occam’s razor can be paraphrased ‘when investigating a patient with multiple symptoms, a single uni...
Source: Life in the Fast Lane - April 22, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five abarognosis anti-razor Crabtree's bludgeon hickam's dictum life expectancy occam's razor Rene Laennec Stethoscope Source Type: blogs

Research and Reviews in the Fastlane 131
This study only shows an association and not causality and will need further prospective studies to elucidate the truth. However, in the absence of better evidence, either agent appears reasonable as the first line but rocuronium has a number of advantages (absence of contraindications, longer paralysis). Recommended by: Anand Swaminathan Read More: Does Succinylcholine Increase Mortality in Severe TBI Patients? (UMEM Education Pearls), Rocuronium vs. Succinycholine (Core EM) 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 th...
Source: Life in the Fast Lane - April 20, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care LITFL Neurology Pre-hospital / Retrieval Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 129
This study looks at CMAC DL vs CMAC VL and found that 1st pass success rate was not statistically significantly different. The most important insights in this trial are in the discussion where the authors note a high number of protocol violations: “This may demonstrate that emergency intubation is a dynamic process, and that plans may change second-to-second based on new information gained immediately before or during tracheal intubation.” Airway management is a complex process and it’s unlikely that we’ll ever have a study looking at one particular facet that has a profound effect on success rates....
Source: Life in the Fast Lane - April 6, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Cardiology Education Emergency Medicine Pediatrics Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs