Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether patients with deep vein thrombosis (DVT) are at risk of embolism during ultrasound compression testing. No papers were found that directly answered the clinical question. The clinical bottom line is that currently there is no evidence to suggest that compressing vessels in order to identify a DVT could cause an embolic event. Therefore we can consider ultrasound assessment a safe reliable investigation for the diagnosis of DVT with no evidence of causing harm.
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A short cut review was carried out to establish whether ultrasonography can assist in the performing of a lumbar puncture. Fifty-one citations were reviewed of which three answered the three part question. The clinical bottom line is that ultrasound shows early promise as a tool to assist in achieving a successful lumbar puncture.
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Review Case Reports
Dolasetron overdose resulting in prolonged QTc interval and severe hypotension: a case report and literature review.
Dolasetron (Anzemet) overdose is uncommon, and, to our knowledge, this is the only case report of an intentional overdose. Dolasetron (dolasetron mesylate) is a selective 5-hydroxytryptamine 3 antagonist derived from pseudopelletierine, and is used in the prevention and treatment of nausea and vomiting. Transient and asymptomatic ECG changes, including QRS widening and PR and QTc prolongation, have been reported in therapeutic doses. ⋯ Sodium bicarbonate was used in an attempt to reduce cardiac sodium channel block, although we observed no apparent benefit. As dolasetron becomes more commonly used in the outpatient setting, both doctors and patients need to be aware of the dangers of dolasetron in toxic doses. The pharmacology and toxicology of dolasetron are discussed.
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Diabetic muscle infarction (DMI) is a rare complication of longstanding, poorly controlled diabetes. Only a few cases have been reported in the literature. The case of a 34-year-old man with a 7-year history of type 2 diabetes mellitus, with sudden onset of left thigh pain, is described here. ⋯ Short-term prognosis is very good; however, the recurrence rate is high. Long-term prognosis is poor, with most patients dying from cardiovascular complications of diabetes within 5 years of diagnosis. This case supports the need for a high index of suspicion, when a poorly controlled patient with diabetes presents with non-traumatic limb pain.
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A short cut review was carried out to establish whether routine chest x rays are required following bronchoscopy guided percutaneous dilational tracheostomy (PDT). A total of 393 citations were reviewed of which six answered the three part question. The clinical bottom line is that at present there is no clinical evidence to support routine postprocedure chest x ray following bronchoscopy guided percutaneous dilatianal tracheostomy.