Emergency medicine journal : EMJ
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Review Meta Analysis
Effects of prophylactic anticholinergic medications to decrease extrapyramidal side effects in patients taking acute antiemetic drugs: a systematic review and meta-analysis.
To determine the effectiveness of prophylactic anticholinergic medications in reducing extrapyramidal symptoms in patients taking acute antiemetics with a dopamine D2 receptor antagonist effect. ⋯ Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus antiemetic therapy with a dopamine D2 antagonist effect, but not when it is given as an infusion. Because of significantly greater sedation with diphenhydramine, the most effective strategy is to administer the D2 antagonist antiemetic as a 15 min infusion without prophylaxis.
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A short-cut review was carried out to establish the diagnostic accuracy of blood biomarkers as an alternative to imaging for the diagnosis of ischaemic stroke. Nine 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 that blood biomarkers are currently not suitable for the diagnosis of acute ischaemic stroke.
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A short-cut review was carried out to establish the diagnostic accuracy of ultrasound for Salter-Harris type 1 fractures. Three studies were directly relevant to the question. ⋯ The clinical bottom line is that ultrasound may allow visualisation of Salter-Harris type 1 fractures. However, little is known as to its sensitivity and specificity, and therefore it cannot be used to eliminate the diagnosis.