Emergency medicine journal : EMJ
-
Review Meta Analysis
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Venous blood gas in adult patients with diabetic ketoacidosis.
A short cut review was carried out to establish whether venous blood gas measurement accurately demonstrates the degree of acidosis in patients with diabetic ketoacidosis. A total of 27 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
-
Review Meta Analysis Comparative Study
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Oral methionine compared with intravenous n-acetyl cysteine for paracetamol overdose.
A short cut review was carried out to establish whether methionine was better than n-acetyl cysteine at reducing the severity of liver damage after paracetamol overdose. Thirty nine papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
-
Review Meta Analysis
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Clinical probability scoring and pulmonary embolism.
A short cut review was carried out to establish the diagnostic utility of clinical probability scoring in stratifying the risk of pulmonary embolus. A total of 938 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
-
Review
Salt of the earth or a drop in the ocean? A pathophysiological approach to fluid resuscitation.
The evolved endocrine response after injury leads to sodium, chloride, and water retention at a time when large volumes of sodium containing fluids are given to maintain the circulation and preserve tissue oxygenation. Sodium, chloride, and water are also retained because of increased systemic vascular permeability to plasma proteins, especially albumin, which sequesters fluid in the interstitial space and causes oedema. ⋯ This review attempts an overview of these processes and addresses the question, "Can manipulation of fluid resuscitation influence the inflammatory response to injury and organ function". Results of randomised controlled prospective clinical studies suggest that limiting the sodium and chloride input and optimal use of synthetic colloids, which are well retained in the vascular space, can reduce the inflammatory response to injury and improve organ function.