J Emerg Med
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Review Meta Analysis
Intravenous Flecainide for Emergency Department Management of Acute Atrial Fibrillation.
Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these patients have recent-onset AF (<48 h). The poor prognosis associated with AF is being increasingly recognized, and there is some evidence for better outcomes in younger patients with recent-onset AF when sinus rhythm is restored. Flecainide is recommended in the latest international guidelines for cardioversion of recent-onset AF, but its safety and efficacy relative to other recommended agents are unclear. ⋯ Intravenous flecainide cardioversion could be a safe and effective option for emergency physicians to restore sinus rhythm in selected patients with acute AF.
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Review Meta Analysis
Diagnostic Accuracy of Clinical Decision Rules to Exclude Fractures in Acute Ankle Injuries: Systematic Review and Meta-analysis.
Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule. ⋯ The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.
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Review Meta Analysis
Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis.
Delayed intracranial hemorrhage is a potential complication of head trauma in anticoagulated patients. ⋯ The present study is the first published meta-analysis estimating the risk of delayed intracranial hemorrhage 24 h after head trauma in patients anticoagulated with vitamin K antagonist and normal initial CT scan. In most situations, a repeat CT scan in the emergency department 24 h later is not necessary if the first CT scan is normal. Special care may be required for patients with serious mechanism of injury, patients showing signs of neurologic deterioration, and patients presenting with excessive anticoagulation or receiving antiplatelet co-medication.
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Review Meta Analysis
Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis.
Topical anesthetics are used in the emergency department (ED) to relieve eye pain and allow eye examinations in patients with corneal abrasions. There is concern for delayed corneal healing, which is associated with the long-term use of topical anesthetics, so outpatient use is not recommended. ⋯ There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion. Data on safety are sparse, and the use of this treatment is currently not supported by evidence.
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Review Meta Analysis
A Meta-Analysis of the Reliability of the History in Suspected Poisoning.
Management of acute poisoning depends on the reliability of history of the poisoning event. ⋯ A history of paracetamol ingestion is moderately reliable, and further evaluation is required to make a clinical diagnosis of acute poisoning with street drugs.