Lane's Top Ten

I can't claim credit for this, but Lane Blankenship recently gave his Senior Grand Rounds, and it was excellent!  Here are his top ten articles:

1. Schrager J, et al.  Favorable bed utilization and readmission rates for emergency department observation unit heart failure patients.  AcadEmerg Med. 2013 Jun;20(6):554-61.  Takeaway: Maybe the ED can provide more efficient care.
2. Than M, et al.  2-Houraccelerated diagnostic protocol to assess patients with chest pain symptomsusing contemporary troponins as the only biomarker: the ADAPT trial.  J Am Coll Cardiol. 2012 Jun 5;59(23):2091-8.  Takeaway: We can decrease bed utilization and feel reassured that we are not sending home low risk patients to die.
3. Rivers M, et al.  Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001 Nov 8;345(19):1368-77.  Takeaway: EGDT saves lives.  Aggressive care in people who are sick.  The first 6 hours are critical.
4. Debacker D, et al.  Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*.  Crit Care Med. 2012 Mar;40(3):725-30.  Takeaway: NE in, DA out!
5. Middleton P, et al.  Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate.  Emerg Med J. 2006 Aug;23(8):622-4.  Takeaway: VBG = ABG.
6. Michaleff ZA.  Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review.  CMAJ. 2012 Nov 6;184(16):E867-76.  Takeaway: Canadian is more accurate.  Both are acceptable if you don't plan on imaging every c-spine.  Clinical decision rules can reduce the amount of testing that we do.
7. Kline JA, et al.  Prospective multicenter evaluation of the pulmonary embolism rule-out criteria.  J Thromb Haemost. 2008 May;6(5):772-80.  Takeaway: The combination of gestalt estimate of low suspicion for PE and PERC(-) reduces the probability of VTE to around 1% in about 20% of outpatients with suspected PE.
8. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network.  N Engl J Med. 2000 May 4;342(18):1301-8.  Takeaway: In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use.
9. Saccilotto RT, et al.  San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review.  CMAJ. 2011 Oct 18;183(15):E1116-26.  Takeaway: The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department.
10. Idris AH.  The sweet spot: Chest compressions between 100-120/minute optimize successful resuscitation from cardiac rest.  JEMS. 2012 Sep;37(9):4-9.  Takeaway: The likelihood of ROSC after out-of-hospital cardiac arrest was greatest with use of chest compression rates between 100–120 compressions/minute and ROSC declined when compression exceeded 125 compressions/minute.