Emergency medicine journal : EMJ
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A short-cut review was performed to evaluate whether inflammatory markers such as C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC) and procalcitonin (PCT) are able to discriminate between streptococcal and viral tonsillitis, enabling a reduction in the overuse of antibiotics. Eight studies with a total of 1031 participants were found. ⋯ The clinical bottom line is that WCC, CRP and PCT levels are higher in patients with streptococcal tonsillitis compared to patients with tonsillitis or pharyngitis without group A streptococcus isolated from a throat swab. Which of these markers has the best test performance characteristics requires further study.
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A short-cut review was carried out to establish whether patients requiring lower limb immobilisation should have thromboprophylaxis. A total of 148 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. ⋯ The clinical bottom line is that ambulatory patients with temporary lower leg immobilisation who are over 50, in a rigid cast, non-weight bearing or with a severe injury should be considered as an at risk group for venous thromboembolism (VTE). If there are any other current proven VTE risk factors, patients should be considered as high risk.
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A short-cut review was carried out to establish whether icatibant is effective in the treatment of hereditary angioedema. A total of 168 papers were found using the reported search, of which one represented 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 this best paper are tabulated. The clinical bottom line is there is promising evidence for the use of the bradykinin receptor antagonist icatibant for the treatment of acute attacks of hereditary angioedema.
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A short cut review was carried out to establish which intraosseous device is best for use in the prehospital environment. A total of 2100 papers were found using the reported search, of which 2 represented 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 tabulated. The clinical bottom line is that traditional manual intraosseous infusion devices have better success rates and faster insertion times compared with semi-automatic intraosseous infusion devices in the prehospital setting.
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Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. ⋯ Once diagnosed, the responsibility of advising and further counselling of patients with ACL injuries is best left to the orthopaedic knee specialist. Family practitioners and emergency room doctors should not feel pressured to offer advice on specialist areas such as return to sports without reconstruction or indeed the need for reconstruction. Indeed, decisions to return to sports with ACL-deficient knees have all too often led to disastrous reinjury events to the articular cartilage and/or the menisci.