Emergency medicine journal : EMJ
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Randomized Controlled Trial Comparative Study
Comparison of nebulised magnesium sulphate and salbutamol combined with salbutamol alone in the treatment of acute bronchial asthma: a randomised study.
To test the hypothesis that combined administration of multiple doses of nebulised salbutamol and magnesium sulphate provides additional benefit compared with salbutamol alone in adult patients with acute asthma. ⋯ This study suggests that there is no therapeutic benefit of adding magnesium sulphate to salbutamol nebulisation in the treatment of patients with acute severe or life threatening asthma.
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Randomized Controlled Trial
Announcing the emergent patient in the emergency department: a randomised trial.
To determine which of three commonly used methods for notifying medical staff of the arrival of an emergent case to the triage area of an emergency department (ED) is optimal. ⋯ A microphone announcement heard by overhead speakers should be incorporated with other strategies to improve the timeliness of medical assessment of emergent cases.
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A short cut review was carried out to establish whether beta blockers should be used in the treatment of chest pain associated with cocaine use. 12 papers were found, of which two presented 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. The clinical bottom line is that Beta Blockers should not be used in the treatment of cocaine induced myocardial ischaemia.
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Comparative Study
Prediction of mortality among emergency medical admissions.
The Rapid Acute Physiology Score (RAPS) and Rapid Emergency Medicine Score (REMS) are risk adjustment methods for emergency medical admissions developed for use in audit, research, and clinical practice. Each predicts in hospital mortality using four (RAPS) or six (REMS) variables that can be easily recorded at presentation. We aimed to evaluate the predictive value of REMS, RAPS, and their constituent variables. ⋯ REMS is a better predictor of mortality in emergency medical admissions than RAPS. Age, GCS, and oxygen saturation appear to be the most useful predictor variables. Inclusion of other variables in risk adjustment scores, particularly blood pressure, may reduce their value.
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Review
Best evidence topic report. The use of intravenous terlipressin in non-variceal upper GI bleeds.
A short cut review was carried out to establish whether terlipressin should be used in upper GI bleeding when variceal bleeding is not suspected as the cause. 556 papers were found, of which none answered the three part question. The clinical bottom line is that there is no evidence for the use of intravenous terlipressin in patients presenting with acute, severe upper GI bleeds unless they have endoscopic evidence of varices or a high clinical index of suspicion is met.