Emergency medicine journal : EMJ
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Case Reports
BET 1: Everything in graduation: arterial/end-tidal CO2 gradient and the diagnosis of pulmonary embolism.
A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2 Three papers were selected to answer the clinical question. ⋯ It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a 'rule in' test.
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Randomized Controlled Trial
EarLy Exercise in blunt Chest wall Trauma: a feasibility trial (ELECT Trial).
The aim was to complete a feasibility study that would test the methods of the main trial, that will investigate whether early thoracic and shoulder girdle exercises reduce chronic pain in patients with blunt chest wall trauma, when compared with normal care. ⋯ We have demonstrated that a fully powered randomised clinical trial of the EarLy Exercise in blunt Chest wall Trauma Trial is feasible.
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Randomized Controlled Trial
Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial.
It is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle tip positioning technique. Therefore, we assessed the success rates of two groups with or without wrist dorsiflexion by 5 cm wrist elevation in adult patients. ⋯ Wrist dorsiflexion may not be a necessity for ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients.
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To conduct a systematic review of the clinical literature to determine whether ultrasound can be used to improve the reduction of distal radius fractures in adults in the ED. ⋯ There is a lack of evidence that using ultrasound in the closed reduction of distal radius fractures benefits patients. Properly conducted randomised controlled trials with patient-orientated outcomes are crucial to investigate this technology.
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Recent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures. ⋯ In patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.