Emergency medicine journal : EMJ
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Review Comparative Study
Ultrasound to detect haemothorax after chest injury.
A short cut review was carried out to establish whether ultrasonography is as sensitive and specific as chest x ray or computed tomography (CT) scan in detecting haemothorax after chest trauma. Thirty-nine papers were found using the reported searches, of which six 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 shown in table 3. It is concluded that ultrasonography is more sensitive and as specific as chest x ray at detecting haemothorax in patients with chest trauma.
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A short cut review was carried out to establish whether octreotide can prevent rebound hypoglycaemia after sulfonylurea overdose. Fourteen papers were found using the reported searches, 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 summarised in table 2. It is concluded that octreotide may be safe and effective in this situation.
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A short cut review was carried out to establish whether aminophylline improved return of spontaneous circulation rates and eventual outcome in bradyasystolic cardiac arrest. A total of 1154 papers were found using the reported searches, of which four 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 four papers are summarised in table 4. It is concluded that aminophylline offers no benefit in this situation.
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Case Reports
Ischaemic infarction masking aortic dissection: a pitfall to be avoided before thrombolysis.
Acute aortic dissection complicated by stroke is not uncommon but may be difficult to evaluate, especially in patients with impaired mental status. We report a patient who had evidence of an ischaemic stroke but was fortuitously not given thrombolytic treatment. ⋯ The decision of whether to give thrombolytic treatment is understandably an urgent one, but careful attention should be paid to subtle signs and symptoms such as atypical chest pain and carotid bruits that might suggest aortic dissection, especially involving the carotid arteries. There should be a high index of suspicion for acute aortic dissection in such cases and a low threshold for performing carotid ultrasound.
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Comparative Study
Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre.
To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity. ⋯ Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated.