Emergency medicine journal : EMJ
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Review Meta Analysis
Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis.
To review the prognosis of patients with bilateral fixed and dilated pupils secondary to traumatic extradural (epidural) or subdural haematoma who undergo surgery. ⋯ Despite the poor overall prognosis of patients with closed head injury and bilateral fixed and dilated pupils, our findings suggest that a good recovery is possible if an aggressive surgical approach is taken in selected cases, particularly those with extradural haematoma.
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Randomized Controlled Trial Multicenter Study
Benztropine for the relief of acute non-traumatic neck pain (wry neck): a randomised trial.
The aim of this study was to determine the effect of intra-muscular benztropine on pain and range of motion in patients presenting to the emergency department with acute, non-traumatic neck pain (wry neck). ⋯ Benztropine was ineffective for reducing pain or improving range of motion of the cervical spine in patients suffering from acute, non-traumatic neck pain, but frequently caused anticholinergic side effects. However, as the CI for the primary outcome included the minimum difference considered clinically significant, an important effect of benztropine cannot be ruled out.
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A shortcut review was carried out to establish if CXR had sufficient sensitivity to rule out significant thoracic injury in haemodynamically stable, paediatric patients with a significant mechanism of trauma. No studies were found that directly answered the three-part question, but 13 studies were found which were considered relevant. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that important thoracic injuries may not be clinically apparent and that CT scans have a significantly higher sensitivity than CXR in detecting such injuries.
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Head Injury Transportation Straight to Neurosurgery was a cluster randomised trial studying suspected severe head injury treatment pathways conducted in the North East Ambulance Service NHS Foundation Trust and North West Ambulance Service NHS Trust between January 2012 and March 2013. This was the world's first large scale trial of any trauma bypass and was conducted as a feasibility study. This short report will describe some of the lessons learnt during this ground breaking and complex trial.