Emergency medicine journal : EMJ
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Review Meta Analysis
Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta-analysis.
To estimate the effect of intravenous and nebulised magnesium sulphate upon hospital admissions and pulmonary function in adults and children with acute asthma. ⋯ Intravenous magnesium sulphate appears to be an effective treatment in children. Further trials are needed of intravenous and nebulised magnesium sulphate in adults and nebulised magnesium sulphate in children.
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This paper aims to identify and review new and unproven emergency department (ED) methods for improved evaluation in cases of suspected acute coronary syndrome (ACS). Systematic news coverage through PubMed from 2000 to 2006 identified papers on new methods for ED assessment of patients with suspected ACS. ⋯ None of these new methods is likely to be the perfect solution, and the best strategy today is therefore a combination of modern methods, where the optimal protocol depends on local resources and expertise. With a suitable combination of new methods, it is likely that more patients can be managed as outpatients, that length of stay can be shortened for those admitted, and that some patients with ACS can get earlier treatment.
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A short cut review was carried out to establish whether a raised D-dimer could be used to identify patients with an acute thoracic aortic dissection. Seven papers were found addressing the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are presented in table 1. The clinical bottom line is that a D-dimer value <500 ng/ml makes the diagnosis unlikely but there is still the possibility of a thrombosed false lumen.
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A short cut review was carried out to establish whether an epidural infusion provided any advantage over intravenous analgesia in the management of blunt thoracic trauma. Only four papers presented 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 this paper are presented in table 2. The clinical bottom line is that epidural analgesia may provide better pain relief, but may not alter clinical outcomes.