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Total 199 results found since Jan 2013.

Research & Reviews in the Fastlane 108
This study had 25 Navy Corpsmen, 6.7% of whom had previously performed pneumothorax on a real patient, needle decompress cadavers at both the 2nd ICS mid-clavicular line and the 5th ICS anterior axillary line. The misplacement rate at the 5th ICS was 22.0% ves 82.0% at the 2nd ICS (p < 0.001). The participants placed the needles closer to the target spot in the 5th ICS and rated it easier. When will decompression at the 5th ICS anterior axillary line become the default spot? Recommended by Lauren Westafer Systems and Administration Jena AB, et al. Physician spending and subsequent risk of malpractice claims: observa...
Source: Life in the Fast Lane - November 11, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Administration Airway Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care EBM literature recommendations research and reviews Source Type: blogs

Research & Reviews in the Fastlane 107
This study suggests we’re even worse at it when the ED is busy. Researchers looked at 1116 hand hygiene opportunities presented to nurses, physicians and other healthcare professionals and used time to physician assessment as a marker of ED crowding. Mean hand hygiene compliance was only 29% but more worryingly longer mean time to physician assessment and higher nursing hours were associated with even lower compliance (24%). The bottom line? No matter how busy you are, WASH YOUR HANDS! Recommended by Lauren Westafer, Natalie May Emergency Medicine Tseng HJ et al. Imaging Foreign Bodies: Ingested, Aspirated, and...
Source: Life in the Fast Lane - November 4, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation clinical critical care EBM FOAM literature recommendations research and reviews Source Type: blogs

Research & Reviews in the Fastlane 106
This study investigated the use of apneic oxygenation in the ICU. The researchers found no difference in the lowest O2 sat. However, it’s unclear if this study is applicable to the ED setting and it likely does not reflect our standard management (33% had BPAP during apnea, 40% had BVM during apnea). For now, collective anecdotes of efficacy reign while we await research in the ED setting. The authors conclusion is that apneic oxygenation does not appear to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared to usual care. Although this is the first randomized...
Source: Life in the Fast Lane - October 28, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Clinical Research ECG Education Emergency Medicine Intensive Care Pediatrics Public Health R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 099
This study took a sample from healthy pregnant patients (n=760) at different stages of gestation. They found, unsurprisingly, that d-dimer increases with gestational age, congruent with limited prior literature. They propose a continuous increasing d-dimer in pregnancy. With PE experts such as Dr. Kline proposing gestation adjusted d-dimer, this is a research space to watch. Recommended by: Lauren Westafer Systems and administration Del Portal DA, et al. Impact of an Opioid Prescribing Guideline in the Acute Care Setting. J Emerg Med 2015. PMID: 26281819 As many EDs implement voluntary opioid prescribing guidelines, this...
Source: Life in the Fast Lane - September 9, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Immediate care in sport – time for a change
How confident would you be if you are taken out of your emergency room and transported to be pitchside caring for a critically injured athlete? Your only medical equipment is strapped to your waist in a small bag; you have a physio with you, there are no other Doctors, no nurses and no little red button to press for help. There are twenty thousand people watching you at the ground and you are live on the sports channel with a further million people watching on… Time critical limb injury The days of finding a local Doctor who happens to be nearby or a relative of the players to “cover a game” are over. Medical...
Source: Life in the Fast Lane - September 8, 2015 Category: Emergency Medicine Authors: Fraser Brims Tags: Sports Medicine ICIR ICIS Immediate care Pitchside sport medicine Trauma Source Type: blogs

Research and Reviews in the Fastlane 097
This article looks at the role medicolegal concerns play in the management of patients with chest pain. The authors found that up to 30% of patients would not have been admitted if physicians had an established “acceptable miss-rate” or worked in a zero medicolegal risk environment. Maybe it’s time that we make some real headway in these areas in order to cut down on unnecessary healthcare spending. Recommended by: Anand Swaminathan Read More: Expunging “Zero-Miss” from Chest Pain Evaluations (EM Lit of Note) The Best of the Rest Emergency Medicine, PulmonaryHutchinson BD et al. Overdiagno...
Source: Life in the Fast Lane - August 26, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Intensive Care Pediatrics Respiratory Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews urology Source Type: blogs

Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 19, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs

Research and Reviews in the Fastlane 091
Welcome to the 91st 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 7 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 t...
Source: Life in the Fast Lane - July 15, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine Haematology Intensive Care R&R in the FASTLANE Resuscitation critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 085
This study was a retrospective cohort study of 298 patients with confirmed PE. In this population, a 45% were HST negative while 55% were positive. From the HST-negative group, there were no death, CPR or need of thrombolysis compared with 6% of mortality and 9% of CPR or thrombolysis in the HST-positive group. It appears that HST is a good prognosis biomarker in patients with pulmonary embolism. Recommended by: Daniel Cabrera Emergency medicineLin BW. A Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries. J Emerg Med 2015. PMID: 25886984 Fingertip avulsion injuries are typically frustra...
Source: Life in the Fast Lane - May 27, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Clinical Research Education Emergency Medicine Intensive Care R&R in the FASTLANE Social Media critical care examination literature recommendations research and reviews Source Type: blogs

LITFL Review 183
Welcome to the 183rd LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week  The Emergency Medicine Educator’s Conference (EMEC) posted the first of its conference videos. Dan Boden shares Derby’s ideas and success on teaching the whole department. Plenty of food for thought….. [SL]   The Best of #FOAMed Emer...
Source: Life in the Fast Lane - May 24, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Funtabulously Frivolous Friday Five 107
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…introducing Funtabulously Frivolous Friday Five 107 Question 1 What is the connection between the image and the 2010 earthquakes in Christchurch, New Zealand? + Reveal the Funtabulous Answer expand(document.getElementById('ddet1634593902'));expand(document.getElementById('ddetlink1634593902')) Takotsubo The image is of a Japanese octopus pot or trap, known as a “tako tsubo”. The apical ballooning seen in stress cardiomyopathy resembles this, hence t...
Source: Life in the Fast Lane - May 22, 2015 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five Ackee fruit christchurch FFFF Winterbottom's sign Zoon's balanitis Source Type: blogs

Research and Reviews in the Fastlane 081
This article reviewed 17,583 adult ED intubations over 10 years at 13 different centers. The study found 95% of intubations were performed by ED physicians with good results: 99% of intubations were successful within 3 attempts.Orotracheal intubation with RSI was, of course, the most common technique, with 85% first pass success rate with this technique. And first pass success rates increased over time during the 10 year period, showing that we are continuing to get better!Interestingly, senior residents had 85% first pass rate, compared to just 72% for attendings.For drugs, etomidate was overwhelmingly the most commonly u...
Source: Life in the Fast Lane - April 30, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

The Broken Doctors Hotel
After a particularly bad winter, with trolley bound patients waiting hours for a bed and colleagues calling in sick as they became increasingly physically and mentally run down…I close my eyes and dream of a new life running a bar, restaurant and hotel…The Broken Doctors HotelConciergeGeneral Practitioner/Primary Care Physician: Responsible for taking the bookings for the hotel and restaurant. This is a high quality establishment and they are kept busy managing demand, maintaining flow, redirecting clients to other venues as appropriate, arranging a later sitting at the restaurant as required, directin...
Source: Life in the Fast Lane - April 29, 2015 Category: Emergency Medicine Authors: Tor Ercleve Tags: Arcanum Veritas Graham Johnson The Broken Doctors Source Type: blogs

Just another intoxicated head injury
At the start of another busy weekend nightshift in a rural ED you receive a handover from the day team.A 31 year old female was brought in by police after an assault. Agitated, with a previous history of traumatic brain injury and intravenous drug use, the young lady is restrained and procedural sedation is required to perform the head CT scan.The sedation was challenging, as a result of Withnail levels of tolerance to benzodiazepines. Following 30mg IV Midazolam and two doses of Droperidol 10mg IM, and 10mg IV, the patient is still fighting and needs further sedation with Ketamine.Following confirmation of no intracranial...
Source: Life in the Fast Lane - April 27, 2015 Category: Emergency Medicine Authors: James Gaston Tags: Cardiology Clinical Case Education Toxicology and Toxinology droperidol TDP Torsades VT Source Type: blogs

Research and Reviews in the Fastlane 080
This study calls into question the current guidelines and will hopefully lead to more evidence-based recommendations in the future.Recommended by: Zack RepanshekRead More: Antibiotics for community-acquired pneumonia: Is azithromycin out? (Pulm CCM)The Best of the RestOphthalmology, Ultrasound Vrablik ME et al. The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis. Ann Emerg Med 2015; 65(2):199-203. PMID: 24680547Nice meta-analysis of bedside US for retinal detachment in Annals of EM showing 97-100% sensitivity, 83-100% specificity, based...
Source: Life in the Fast Lane - April 23, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Ophthalmology Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and reviews Source Type: blogs