Emergency medicine journal : EMJ
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Review Meta Analysis
Can the Ottawa knee rule be applied to children? A systematic review and meta-analysis of observational studies.
The Ottawa knee rule (OKR), a clinical decision aid is used to reduce unnecessary radiography. It is not clear whether this rule can be applied to children. ⋯ The OKR has high sensitivity and adequate specificity for children over the age of 5 years. There are not enough good data to advocate application of the OKR in children less than 5 years.
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To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis. ⋯ These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.
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Comparative Study
Evaluation of a method for converting venous values of acid-base and oxygenation status to arterial values.
This paper evaluates a method in which arterial values of pH, carbon dioxide tension (Pco(2)) and oxygen tension (Po(2)) calculated from venous values and pulse oximetry are compared with simultaneously measured arterial values. ⋯ Arterial pH and Pco(2) can be calculated precisely from peripheral venous blood in a broad patient population. The method has potential for use as a screening tool in emergency medical departments and in medical and surgical wards to assess a patient's acid-base and oxygenation status prior to sampling arterial blood or to help in the decision to refer the patient to the ICU. In departments where arterial blood gas values are used to monitor patients (eg, pulmonary medicine), the method might reduce the number of arterial samples taken by replacing them with peripheral venous blood samples, thus reducing the need for painful arterial punctures.
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To assess the utility of bedside ultrasound performed by an emergency physician in adults undergoing diagnostic lumbar puncture. ⋯ The ultrasonographically measured depth of the dura mater correlates strongly with the final needle depth.
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Ricin is a member of a group of protein toxins whose cytosolic target is the 28S rRNA of the 60S ribosomal subunit. It was recently introduced as a weapon of terrorism in some countries. There is little evidence about the mechanism, diagnosis and treatment of ricin poisoning. The case history is reported of a patient with ricin poisoning who presented with nausea and vomiting following ingestion of Korean castor bean.