Emergency medicine journal : EMJ
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A shortcut review was carried out to establish whether intravenous glucagon is a safe and effective treatment for patients with suspected lower oesophageal food bolus impaction. Seven studies were directly relevant to the question. ⋯ Its use may be associated with adverse effects such as vomiting, with the potential risk of oesophageal perforation. Intravenous glucagon should therefore be avoided.
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Pulmonary embolism (PE) is a leading cause of death in pregnancy and postpartum. Clinicians face a difficult choice when deciding whether to use diagnostic imaging to investigate for suspected PE in these patients, between risking potentially catastrophic consequences of missed diagnosis if imaging is withheld and risking unnecessary iatrogenic harm to both mother and fetus if imaging is overused. This paper explores the options for imaging and evidence for the use of clinical features, clinical predictions scores or biomarkers to select pregnant and postpartum women for imaging. It also considers where future research could be most appropriately directed.
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Physicians are called upon to teach students, residents, patients and their families in the clinical environment every day as part of clinical care. A fast-paced emergency department offers a unique set of challenges that require the physician to be an effective communicator. We present a top 10 list of ideas selected from the literature for the busy clinician to use on that next shift to improve bedside teaching.
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A shortcut systematic review was carried out to establish whether in patients with suspected acute coronary syndromes presenting to the emergency department, measurement of electrocardiographic ST elevation at the J point or 60 ms after the J point will lead to more accurate identification of patients with acute coronary occlusion who may benefit from immediate coronary revascularisation. Three studies were directly relevant to the question. ⋯ The clinical bottom line is that the current evidence does not justify a shift away from measurement of ST elevation at the J point, as advocated in international guidance. Due to the limited available evidence, however, further research in this area is necessary.