Back Pocket Papers

Heres a list of papers I like to keep handy for when I’m discussing management of a patient with an attending or consultant. If you have any more you think would be good to add to the list, fill out the slot below and I’ll add it.

Airway Management

Preoxygenation and Prevention of Desaturation During Emergency Airway Management

Annals 2011. Weingart/Levitan. Discusses 10 questions on preoxygenation prior to intubation. Discusses concept and literature behind apneic oxygenation.

Cardiology

The Value of symptoms and signs in the emergent diagnosis of acute coronary syndrome

Resuscitation 2010. Looked at 800 patients presenting with concern for ACS, 19% of which were diagnosed with MI. Positive odds ratios: Pain radiating to right arm (2.23), Pain radiating to both arms (2.69), Vomiting (3.5), Central chest pain (3.29), and Diaphoresis (5.18).

The Chest Pain Choice Decision Aid

Circulation 2012. 204 patients with chest pain randomized to usual care vs decision aid diagram where patient decided on observation admission vs discharge with outpatient followup in 1-3 days. Patient’s felt more informed. 58% admission rate for decision aid vs 77% for usual care. Chest pain decision aid diagram link.

ICU Critical Care

Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis

NEJM 2012. Severe septic patients, put on either colloids vs crystalloids in management. Observed for 90 days. Colloids increased 8% (For every 13 patients, 1 increase in death) in mortality compared to crystalloids.

Neurology

Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid hemorrhage: prospective cohort study.

BMJ 2011. Prospective cohort, less than 1 hour in maximum onset, 11 centers, > 3000 pts, age > 15yo. No neuro deficits, GCS 15, no recurrent headaches. Used 3rd generation CT scan read by neuroradiologist. 49% received LP which was 1931 with no LP, 1506 were able to be contacted afterward with no signs of SAH. Others were lost to followup, though no signs of death or return to hospital in Canadian database. Overall noncontrast CT scan was sensitivity 92%; with CT scan < 6 hours having 100% sensitivity.

Trauma

Validity of a Set of Clinical Criteria to Rule Out injury to the Cervical Spine in Patients with Blunt Trauma

NEJM 2000. The Nexus study. 34000 patients. Used clinical criteria to have 100% sensitivity of picking up c-spine injuries. Mneumonic criteria: NSAID = Neuro deficit, spine tenderness, Altered mental status, Intoxication, Distracting Injury.

Factors associated with cervical spine injury in children with blunt trauma

Annals of EM 2011. PECARN study. Looked at risk factors for diagnosing c-spine injuries in patients < 16yo. 8 Factors that is >=1, sensitivity of 98%, specificity 26%. 8 Factors: AMS, focal neuro finding, neck pain complaint, torticollis, severe injury to torso, diving injury, high risk MVC (rollover, head-on, death, ejection, speed >55), or predisposing condition (Downs, Marfans, Ehler-Danlo).