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Total 199 results found since Jan 2013.

Research and Reviews in the Fastlane 128
This study looks at the accuracy of Emergency Physicians (EPs) in using POCUS to diagnose RV dysfunction. The small group of highly trained EPs were able to reliably identify RV issues with a (+) LR = 90 and a (-) LR of 0. While this looks great, it’s important to note the high level of training and the small number of patients (26) with RV dysfunction. More work needs to be done on how this applies to the typical EP. Recommended by: Anand Swaminathan Airway Mosier JM et al. The Physiologically Difficult Airway. W J Emerg Med 2016. PMID: 26759664 This article reviews patient features portending a physiologicall...
Source: Life in the Fast Lane - March 29, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Education Emergency Medicine R&R in the FASTLANE Respiratory critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 126
This article is a well done, RDCT comparing non-dissociative dose intravenous ketamine (0.3 mg/kg) to intravenous morphine (0.1 mg/kg). The authors found no statistically significant difference between the two at 30 minutes. This data gives further credence to the use of ketamine for acute pain relief in the ED though it does not demonstrate superiority. Recommended by Anand Swaminathan Cardiology Kim S, et al. Searching for answers to clinical questions using google versus evidence-based summary resources: a randomized controlled crossover study. Academic medicine : journal of the Association of American Medical Coll...
Source: Life in the Fast Lane - March 16, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 125
Welcome to the 125th 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, 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 ou...
Source: Life in the Fast Lane - March 10, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology ECG Emergency Medicine Gastroenterology Intensive Care R&R in the FASTLANE critical care EBM Education literature recommendations research and reviews Source Type: blogs

TechTool Thursday 067 MedShr
TechTool review – MedShr by MedShr Ltd on Android and iOS…and website MedShr is a private social network for doctors. It aims to allow the sharing of interesting patients including photos/videos. Members can discuss their cases and ask for suggestions from others. It aims to help improve clinical practice and facilitate learning and the sharing of patient data in a secure environment. The website gives no information about who runs MedShr (a bug bear of mine) but I know from speaking to them that it was created initially by a Cardiologist in the UK. I think they have brought in other UK clinicians to help edit...
Source: Life in the Fast Lane - February 4, 2016 Category: Emergency Medicine Authors: Tessa Davis Tags: Review Social Media Tech Tool Web Culture android App iphone MedShr social network social network for doctors techtool Source Type: blogs

Research and Reviews in the Fastlane 119
This study examines the dose-relationship of oxygen therapy and infarct size assess by biomarkers. Excluding hypoxic patients and those with cardiogenic shocks 441 patients with STEMI were randomized to oxygen or room air. Every 100 L increase in oxygen exposure in the first 12 h was associated with significantly increased cTnI and CK of 1,4% and 1,2% respectively. As the median supplemental oxygen exposure was 1746 L this would result in a 21% increase in infarct size. Recommended by: Soren Rudolph Quirky, weird and wonderful Wood CD et al. Evaluation of sixteen anti-motion sickness drugs under controlled laborato...
Source: Life in the Fast Lane - January 27, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Intensive Care Neurology Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Toxicology Toxicology and Toxinology critical care r Source Type: blogs

Research and Reviews in the Fastlane 118
This study provides validation of that approach. Although the study was retrospective and only included 45 patients with acute coronary occlusion, it provides valuable information on the utility of ST elevation/S wave ratio for diagnosis of acute MI in this subset of patients. Recommended by: Anand Swaminathan Pediatrics Study of Maternal and Child Kissing (SMACK) Working Group. Maternal kisses are not effective in alleviating minor childhood injuries (boo-boos): a randomized, controlled and blinded study. J Eval Clin Pract 2015. PMID: 26711672 This is kind of interesting in many ways, it appears that the paper was...
Source: Life in the Fast Lane - January 21, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Intensive Care Pediatrics R&R in the FASTLANE Respiratory critical care EBM recommendations research and reviews Resuscitation Source Type: blogs

LITFL R&R – Best of 2015
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - January 9, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs

Research and Reviews in the Fastlane 116
This article raises the question of how important MIC is and whether we should be developing and testing alternate ways to assess antibiotic efficacy. Recommended by: Anand Swaminathan Emergency Medicine Piazza G et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv 2015; 24;8(10):1382-92. PMID: 26315743 This is simple prospective data on a highly selected group of patients with massive or sub massive PEs. There were almost as many authors as patients here...
Source: Life in the Fast Lane - January 6, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Infectious Disease Intensive Care Pediatrics Radiology Respiratory critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

Research and Reviews in the Fastlane 113
Welcome to the 113th 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, 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 ou...
Source: Life in the Fast Lane - December 16, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Neurology Orthopedics Pediatrics Pre-hospital / Retrieval Resuscitation Cardiology Emergency Medicine Gastroenterology Infectious Disease Intensive Care critical care Education literature recommendations R&R in the FASTLANE R Source Type: blogs

Research and Reviews in the Fastlane 112
Welcome to the 112th 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, 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 ou...
Source: Life in the Fast Lane - December 9, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Emergency Medicine Infectious Disease Orthopedics Pediatrics Pre-hospital / Retrieval critical care Education Intensive Care literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs

Research and Reviews in the Fastlane 111
This study from Canada looked at the ED diagnosis of concussion in a convenience sample of 495 kids within 2 weeks of head injury and found that compared to the Zurich criteria, ED physicians underdiagnosed concussion. ED physicians diagnosed concussion in 40.4% of the patients, while the Zurich criteria for concussion were fulfilled by 89.5%. Concussion was more likely to be diagnosed in kids >10 years old, those playing collision sports, those with an injury >1 day prior, or 3+ symptoms. This criteria, in this case defined by SCAT3 (not validated in all head trauma/cumbersome in ED), may represent another area of o...
Source: Life in the Fast Lane - December 3, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Cardiology Emergency Medicine Infectious Disease Intensive Care Pediatrics Resuscitation Toxicology and Toxinology Trauma Urology critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 110
Welcome to the 110th 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, 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 ou...
Source: Life in the Fast Lane - November 25, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Emergency Medicine Haematology Infectious Disease Intensive Care LITFL review Pediatrics Resuscitation Toxicology and Toxinology critical care Education literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs

Research & Reviews in the Fastlane 109
This article synthesizes data from 58 publications to help guide clinicians in evaluating patients with chest pain for ACS. Overall, individual pieces of the history and physical don’t have the best test characteristics. Prior abnormal stress test (LR 3.1), peripheral arterial disease (LR 2.7) and pain radiating to both arms (LR 2.6) have the best, albeit weak, test characteristics. EKG findings were marginally better after exclusion of the obvious STEMI (ST segment depression LR 5.3, any ischemia LR 3.6). On the other hand, the HEART score performed quite well. For high-risk range HEART score (7-10) the + LR = 13 an...
Source: Life in the Fast Lane - November 19, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Education Emergency Medicine Intensive Care R&R in the FASTLANE Resuscitation Trauma critical care EBM literature recommendations research and reviews Source Type: blogs

Patients in the Himalayas Grateful for Care
BY RACHEL EDWARDS, MD   I traveled to India in August 2014 with Himalayan Health Exchange (HHE), which organizes groups of attending physicians, residents, medical students, and nurses from around the world to travel to one of the most remote parts of the world, deep in the Himalayan Mountains. Our route took us to the Pangi Valley of Northern India, where the road we traveled has only existed for a decade and is impassable during the winter months when the road is covered in snow. The people who live there are resilient and hardened by their environment of mountainous terrain and harsh climate.     Our group, escorted...
Source: Going Global - November 18, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs