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Emergency Department Education Group Evidence Update
5th September 2016
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NICE National Institute for Health and Care Excellence
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New and Updated Cochrane Systematic Reviews
Topiramate for acute affective episodes in bipolar disorder in adults
Authors' conclusions: It is not possible to draw any firm conclusions about the use of topiramate in clinical practice from this evidence. The only high-quality evidence found was that lithium is more efficacious than topiramate when used as monotherapy in the treatment of acute affective episodes in bipolar disorder, and we note that this evidence came from only two studies. Moderate-quality evidence showed that topiramate was no more or less efficacious than placebo as monotherapy when a 3-week endpoint was used, but the quality of the evidence for this outcome at a 12-week endpoint dropped to low. As we graded the quality of the evidence for the other findings as low and very low, it was not possible to draw any conclusions from the results.
Intravenous heparin during ruptured abdominal aortic aneurysmal repair.
Authors' conclusions: We identified no RCTs or CCTs of intravenous heparin in rAAA repairs (including parallel designs). Therefore, we were unable to assess the effect of intravenous heparin on all-cause mortality and incidence of general arterial disease, for example, cardiovascular, cerebral, pulmonary and renal pathologies in rAAA management in people undergoing an emergency repair. It is clear that an RCT is needed to address this question in rAAA management as there is no high quality evidence.
D-dimer test for excluding the diagnosis of pulmonary embolism.
Authors' conclusions: A negative D-dimer test is valuable in ruling out PE in patients who present to the A&E setting with a low PTP. Evidence from one study suggests that this test may have less utility in older populations, but no empirical evidence was available to support an increase in the diagnostic threshold of interpretation of D-dimer results for those over the age of 65 years.
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New England Journal of Medicine
Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors
S.J. Connolly and Others
N Engl J Med, August 30, 2016
Fire-Related Inhalation Injury
R.L. Sheridan
N Engl J Med 375:464, August 4, 2016
CME
Urticaria Multiforme
S. Kotlyar
N Engl J Med 375:470, August 4, 2016
Jennifer L. Wiler, MD, MBA, FACEP Reviewing Wnorowski AM and Halpern EJ., AJR Am J Roentgenol 2016 Aug 207:295
Effect of Medicaid Expansion on ED Utilization
Jennifer L. Wiler, MD, MBA, FACEP Reviewing Pines JM et al., Health Aff (Millwood) 2016 Aug 35:1480
Ultrasound-Guided IV Catheter Placement Increases Risk for CT Contrast Extravasation
Ali S. Raja, MD, MBA, MPH, FACEP Reviewing Rupp JD et al., Acad Emerg Med 2016 Aug 23:918
Fentanyl-Based Analgosedation Strategy for Intubated ICU Patients
Calvin A. Brown III, MD, FAAEM Reviewing Faust AC et al., Anesth Analg 2016 Aug 2;
External Validation of a Chest Pain Rule-Out Score
Jennifer L. Wiler, MD, MBA, FACEP Reviewing Flaws D et al., Emerg Med J 2016 Sep 33:618
Early ECMO Improves Survival in Trauma Patients with Acute Respiratory Distress Syndrome
Calvin A. Brown III, MD, FAAEM Reviewing Bosarge PL et al., J Trauma Acute Care Surg 2016 Aug 81:236
Pulmonary Embolism in Acute Exacerbations of COPD
Daniel M. Lindberg, MD Reviewing Aleva FE et al., Chest 2016 Aug 12;
The Importance of Early Treatment for UTI in Children
Louis M. Bell, MD Reviewing Marquez L and Palazzi DL., JAMA Pediatr 2016 Jul 25;
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Other Sources
The UK Chief Medical Officers have published UK Chief Medical Officers’ low risk drinking guidelines. The guidelines provide the most up to date scientific information to help people make informed decisions about their own drinking. The intention is to help people understand the risks alcohol may pose to their health and to make decisions about their consumption in the light of those risks, but not to prevent those who want to drink alcohol from doing so.
The Royal College of Emergency Medicine and the Royal College of Nursing have published The medicine needed for the emergency care service. This report is a result of a summit which set out to develop key recommendations for meeting increased demand for emergency medicine. The three emerging recommendations cover education and training, the A&E hub, and a new culture of collaboration between healthcare professionals.
Statistics
Provisional Accident and Emergency Quality Indicators for England - May 2016, by provider·
Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatient and Accident and Emergency data - April 2016 - June 2016
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