Emergency medicine journal : EMJ
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A short-cut review was carried out to establish whether lignocaine, epinephrine, tetracaine gel is more effective than tetracaine, epinephrine, cocaine gel as a topical anaesthetic agent in minor skin lacerations that still need suturing. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that lignocaine, epinephrine, tetracaine gel is as effective and is without the inherent disadvantages associated with cocaine.
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A short-cut review was carried out to establish whether Bell's palsy is best treated with a combination of prednisolone and an antiviral agent or prednisolone alone. Four systematic reviews and two small studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is insufficient evidence to recommend an antiviral agent in addition to prednisolone in the treatment of Bell's palsy.
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A short-cut review was carried out to establish whether the traditional three-sided dressing is better than a one-way chest seal at preventing the respiratory complications from penetrating chest trauma. Only one animal study, two guidelines and two case reports provided published evidence relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is very little evidence, but that the one-way seals may have practical advantages, particularly in the out-of-hospital setting.
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Over 40% of patients admitted to emergency departments (ED) with chest pain receive a non-cardiac diagnosis. Patients with non-cardiac chest pain (NCCP) have a good prognosis in terms of cardiac adverse events and mortality; however, they tend to have poor outcomes in terms of psychological morbidity, quality of life (QoL), further chest pain and the use of health services. In recent years there has been an increase in the use of ED-based 'rapid rule-out' protocols and the provision of dedicated chest pain units. ⋯ Factors associated with poorer psychological outcomes included gender, age, previous psychiatric history and certain symptoms such as fear of dying and light headedness. However, the studies were heterogeneous, with a variety of outcome measures, designs and settings. In summary, the review identifies poor psychological outcomes in NCCP patients accessing ED-based care; however, there is a need for longitudinal studies using reliable and valid measures to define further the predictors of these poor outcomes.