Emergency medicine journal : EMJ
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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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A short cut review was carried out to establish whether brain natriuretic peptide (BNP) can be used as a marker for acute coronary syndromes. 685 citations were found, of which eight 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. ⋯ NPV and PPV may be unacceptably low to enable use as a sole cardiac marker. Incorporation into a multimarker strategy and serial estimations may be necessary.
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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.
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A short cut review was carried out to establish whether ultrasound placement of three-in-one block is better than placement using a nerve stimulator. 137 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 ultrasound guidance is better than electrical nerve stimulation at obtaining a good quality three in one femoral block.