Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether antibiotics are indicated for human bites. Eighty nine papers were found using the reported search, of which two represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. Prophylactic antibiotics should be given to all patients with human bites to the hands, feet, and skin overlying joints or cartilaginous structures, and to all patients with bites that penetrate deeper than the epidermal layer.
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The use of resuscitation formulae for burns is advocated for A&E departments. Much care is taken to calculate the percentage of the burn, but this is then multiplied by an approximate weight. How accurate is this figure and should it be more carefully measured? Forty two sets of case notes of patients with resuscitation sized burns were reviewed. ⋯ The majority have only stand on scales. Three departments have sit on scales; however, if they were assessing the weight of a patient who is unable to sit they would need to ask the patient, relatives, or simply guess. Investment in weighing equipment should be encouraged if resuscitation formulae are to have any place in the A&E management of burn patients.
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Baclofen has become increasingly popular in the treatment of spasticity disorders. Its availability for misuse has also increased. ⋯ He was treated successfully with full supportive management, and was discharged from the hospital on the 12th day following admission. If a past medication history is not immediately available, baclofen overdose should be included in the differential diagnosis of an acutely confused patient complicated with rhabdomyolysis, as routine toxicology screening does not include baclofen.
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A short cut review was carried out to establish whether the addition of nebulised furosemide to beta-agonist therapy improves outcomes in acute asthma. Altogether 87 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. ⋯ The author, date and country of origin, patient group studied, study type, relevant outcome, results, and study weaknesses of the best papers are tabulated. There is currently insufficient evidence to support the routine addition of nebulised furosemide to standard beta agonist therapy in acute asthma in adults.