Emergency medicine journal : EMJ
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Rising intracranial pressure (ICP) is a poor prognostic indicator in traumatic brain injury (TBI). Both mannitol and hypertonic sodium solutions are used to treat raised ICP in patients with TBI. ⋯ The evidence shows that both agents effectively lower ICP. There is a trend favouring the use of hypertonic sodium solutions in patients with TBI.
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Randomized Controlled Trial Multicenter Study
STOP!: a randomised, double-blind, placebo-controlled study of the efficacy and safety of methoxyflurane for the treatment of acute pain.
To evaluate the short-term efficacy and safety of methoxyflurane for the treatment of acute pain in patients presenting to an emergency department (ED) with minor trauma. ⋯ The results of this study suggest that methoxyflurane administered via the Penthrox inhaler is an efficacious, safe, and rapidly acting analgesic.
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Comparative Study
Clinical scaphoid score (CSS) to identify scaphoid fracture with MRI in patients with normal x-ray after a wrist trauma.
The aim of this study was to compare a combination of three commonly used tests to identify scaphoid fractures with MRI in patients with normal x-ray after a wrist trauma. ⋯ If a patient with wrist pain after injury and normal x-ray has a CSS≥4 (pain in the anatomical snuffbox in addition to pain at scaphoid tubercle or longitudinal compression or both) we recommend MRI. A CSS <4 has a negative predictive value of 96%, which makes scaphoid fracture unlikely.
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A short-cut review was carried out to establish whether bedside ultrasound was accurate at diagnosing necrotising fasciitis in patients with limb infections. A total of 187 papers were found using the reported searches, of which one 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 this paper is tabulated. It is concluded that there is limited evidence supporting the use of bedside ultrasound as an adjunct diagnostic tool in differentiating cellulitis from necrotising fasciitis in patients with a limb infection.
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Observational Study
The relationship between hyperlactatemia and microcirculation in the thenar eminence as measured using near-infrared spectroscopy in patients with sepsis.
Near-infrared spectroscopy (NIRS)-derived variables during a vascular occlusion test (VOT) have recently been used to evaluate peripheral circulatory insufficiency in patients with sepsis. We investigated the relationship between NIRS-derived variables and the lactate concentration during sepsis. ⋯ We revealed a significant correlation between NIRS-derived variables and the lactate concentration during sepsis.