Emergency medicine journal : EMJ
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A short-cut review was performed to evaluate whether inflammatory markers such as C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC) and procalcitonin (PCT) are able to discriminate between streptococcal and viral tonsillitis, enabling a reduction in the overuse of antibiotics. Eight studies with a total of 1031 participants were found. ⋯ The clinical bottom line is that WCC, CRP and PCT levels are higher in patients with streptococcal tonsillitis compared to patients with tonsillitis or pharyngitis without group A streptococcus isolated from a throat swab. Which of these markers has the best test performance characteristics requires further study.
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To evaluate the role of ambulance response times in improving survival for out-of-hospital cardiac arrest (OHCA). ⋯ The arrival of a crew prior to OHCA means that the chance of surviving the arrest increases sevenfold. Overall it is possible that rapid response to patients in immediate risk of arrest may be at least as beneficial as rapid response to those who have arrested. Concentrating resources on reducing response times across the board to improve survival for those patients already in arrest is unlikely to be a cost-effective option to the U.K. National Health Service.
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To assess if ultrasound measurement of the optic nerve sheath diameter (ONSD) can accurately predict the presence of raised intracranial pressure (ICP) and acute pathology in patients in the emergency department. ⋯ This study shows that ultrasound measurement of ONSD is sensitive and specific for raised ICP in the emergency department. Further observational studies are needed but this emerging technique could be used to focus treatment in unstable patients.