Emergency medicine journal : EMJ
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Review Meta Analysis
Oxygen therapy for acute myocardial infarction: a systematic review and meta-analysis.
Oxygen (O(2)) is widely recommended in international guidelines for treatment of acute myocardial infarction (AMI), but there is uncertainty about its safety and benefits. A systematic review and meta-analysis were performed to determine whether inhaled O(2) in AMI improves pain or the risk of death. Cochrane CENTRAL Register of Controlled Trials, MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, LILACS and PASCAL were searched from start date to February 2010. ⋯ Evidence for O(2) in AMI is sparse, of poor quality and pre-dates advances in reperfusion and trial methods. Evidence is suggestive of harm but lacks power and excess deaths in the O(2) group could be due to chance. More research is required.
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The use of therapeutic hypothermia is recommended for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital ventricular fibrillation cardiac arrest. There is evidence that the time taken to achieve target temperature impacts survival. ⋯ Among OHCA patients who met recognised inclusion criteria, therapeutic hypothermia was implemented successfully by the ED staff. The temperature should be measured continuously from the same site in both the ED and the ICU. This will provide consistent and continuous temperature monitoring between the ED and the ICU and will enable prompt intervention to prevent temperature increases.
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To determine which measures, other than a reduction in waiting time, could prevent the departure of the left-without-being-seen (LWBS) patients in an emergency department. Secondary objectives were description of the characteristics of LWBS patients, analysis of their reasons for leaving and assessment of their medical outcome. ⋯ The 'quality' of the waiting time appears to be important in the decision to leave. If this aspect was taken into account, a reduction in the number of LWBS patients and improved quality of care could be achieved in emergency departments.