One-Liners in Emergency Medicine

A shortcut systematic review was carried out to establish whether in patients with suspected acute coronary syndromes presenting to the emergency department, measurement of electrocardiographic ST elevation at the J point or 60 ms after the J point will lead to more accurate identification of patients with acute coronary occlusion who may benefit from immediate coronary revascularisation. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated...

In patients with new-onset atrial fibrillation and symptom onset within 48 hours, rhythm control is preferred over rate control if the patient is younger than 65 years. For patients with congestive heart failure, valvular heart disease, hypertension, or permanent atrial fibrillation, rate control remains the favored strategy.

There is insufficient evidence to show clinically meaningful differences between antibiotics for group A beta hemolytic streptococci tonsillopharyngitis. Penicillin or amoxicillin is recommended as first choice, given the absence of resistance and low cost.

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A short cut review was carried out to establish whether restrictive fluid administration in penetrating thoracic trauma impacted on patients' mortality. 143 papers were found using the reported searches, 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 are tabulated. It is concluded that there is paucity of relevant research and there is limited scientific evidence to inform fluid administration in these patients...

CLINICAL QUESTION: In emergency department patients with symptoms suggestive of acute myocardial infarction, is the absolute or relative change of cardiac troponin assays (either high sensitivity or ultrasenstive) more accurate in diagnosing acute myocardial infarction at 1 to 2 hours postpresentation? ARTICLE CHOSEN: Rechlin T, Ifran A, Twerenbold R, et al. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction...

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A short cut review was carried out to establish the diagnostic utility of Emergency Physician performed ultrasound in confirming or refuting the diagnosis of deep vein thrombosis compared with a radiology scan. A systematic review incorporating 16 studies and two studies published subsequently were found to be relevant to the question. The clinical bottom line was that some studies demonstrated high sensitivity and specificity compared with the reference standard but this finding was not universal.

A short cut review was carried out to establish whether a negative D-dimer could be used to rule out pulmonary embolism in the presence of clinical suspicion in a pregnant patient. Five studies were considered directly relevant to the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes and study weaknesses were tabulated. The clinical bottom line was that a negative D-dimer result was considered sensitive enough to rule out pulmonary embolism in patients who were in the first two trimesters of pregnancy but that the false positive rate was so high as to render the test useless in patients in the third trimester if standard cut-off values were used...

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A short-cut review was carried out to establish whether prophylactic antiemetic agents reduce the incidence of vomiting in immobilised patients who have suffered trauma. A total of 137 papers were found using the reported searches, 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 papers are tabulated. It is concluded that prophylactic use of antiemetic agents in trauma patients may reduce the likelihood of vomiting some 5-12-fold...

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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CLINICAL QUESTION: Are antiepileptic drugs associated with reduced pain intensity in patients with neuropathic pain or fibromyalgia? BOTTOM LINE: In treating diabetic neuropathy and postherpetic neuralgia compared with placebo, gabapentin and pregabalin are associated with a modest increase in the number of patients experiencing meaningful pain reduction. In treating fibromyalgia, compared with placebo, pregabalin alone is associated with a small increase in the number of patients experiencing meaningful pain reduction...