Emergency medicine journal : EMJ
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Cannulation of children is often required for administration of intravenous fluids and medications, but can cause pain and anxiety. Amethocaine and a eutectic mixture of local anaesthetics (EMLA) cream are two of the most commonly used local anaesthetic creams. ⋯ Based on the evidence reviewed here and considering analgesic properties and cost-savings associated with both creams, a weak recommendation can be issued in favour of Amethocaine cream for cannulation in children based on high-quality evidence but where the treatment choice will depend on other factors including cost and provider preference.
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Review Case Reports
BET 2: The use of age-related D-dimers to rule out deep vein thrombosis.
A short cut review was carried out to establish whether the use of age-adjusted D-dimer cut-offs is better than the standard, unadjusted diagnostic cut-off for excluding the diagnosis of deep vein thrombosis (DVT) in the Emergency Department. 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 the use of an age-adjusted D-dimer cut-off in patients aged over 50 years increases the ability to safely exclude DVT in patients with low clinical probability without the need for ultrasound scanning.
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High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation. ⋯ The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.
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Review Case Reports
BET 1: Do patients with a clinically suspected subsegmental pulmonary embolism need anticoagulation therapy?
A short cut review was carried out to establish whether the incidence of recurrent venous thromboembolism and mortality is lower among patients with isolated subsegmental pulmonary embolism who are treated with anticoagulant therapy compared with those who are not treated with anticoagulant therapy. We identified six studies that were directly relevant to the question. All of these studies were observational in nature and included only a small number of patients with isolated subsegmental pulmonary embolism who were not treated with anticoagulants. ⋯ The clinical bottom line is that the limited available evidence suggests that the incident of recurrent venous thromboembolism is very low in patients with isolated subsegmental pulmonary embolism. However, this is based on limited data from small observational studies. Further evidence from larger trials is necessary before a recommendation can be made to withhold anticoagulation in this situation.