Emergency medicine journal : EMJ
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To quantify the health gains and costs associated with improving ambulance and thrombolysis response times for acute myocardial infarction. ⋯ Improving ambulance response times appears to be cost effective. Reducing door-to-needle time will have a smaller effect at an uncertain cost. Further benefits may be gained from reducing the time from onset of symptoms to starting thrombolysis.
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A short cut review was carried out to establish whether smectite was a useful therapy in acute diarrhoea. A total of 21 papers were found of which five 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. The clinical bottom line is that oral smectite appears to be effective at shortening the duration of the diarrhoea in children with acute diarrhoea rehydrated with oral rehydration solution.
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Airway management is a core aspect of emergency medicine. The technique of rapid sequence intubation (RSI) creates continuing debate between anaesthetists and emergency physicians in the UK, although similar complication rates for emergency department (ED) RSI have been shown for both specialties. This study examined prospectively collected data on every ED RSI performed in a university hospital in Glasgow over 5 years. ⋯ Emergency physician performed ED RSI is increasingly common but is not associated with overall higher numbers of RSIs being performed in the ED. Effective pre-oxygenation should be emphasised during training.
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Case Reports
Vertebral artery dissection and cerebellar infarction following chiropractic manipulation.
Vertebral artery dissection (VAD) associated with chiropractic cervical manipulation is a rare but potentially disabling condition. In this report, we present a young patient manifesting with repeated vertigo. ⋯ A number of cases of VAD associated with chiropractic cervical manipulation have been reported, but rarely in the emergency medicine literature. We present a case of this rare occurrence, and discuss the diagnostic pitfalls.