RESUMO
Two cases of violent, drug-intoxicated patients who presented considerable problems in management, and were resistant to standard sedative agents, are described. Effective and safe sedation, without the need for full anaesthesia and endotracheal intubation, was achieved using titrated doses of thiopentone. The merits of selecting this agent in these circumstances are discussed.
RESUMO
INTRODUCTION: The present article reviews the clinical and imaging clearance of the thoracic and lumbar spines of blunt trauma victims and the evolution of these strategies with the use of new imaging technologies. METHODS: A comprehensive literature search was performed, and articles identified were critically appraised RESULTS: Twenty papers were identified, 12 directly comparing computed tomography screening with plain X-rays. Evidence-based protocols are presented. The evolution of imaging strategies in response to new technology is described. CONCLUSIONS: Thoracolumbar spine screening is best done using reformatted images acquired when scanning the chest and abdomen of high-risk multi-trauma patients. If computed tomography is not clinically indicated for investigation of other injuries then plain films are the first line investigation.
Assuntos
Vértebras Lombares/lesões , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/lesões , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Tomografia Computadorizada por Raios X/métodosRESUMO
A short cut review was carried out to establish whether the addition of nebulised magnesium sulphate to beta agonist therapy improves outcome in acute asthma. Altogether 69 papers were found using the reported search, of which five 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 best papers are tabulated. A clinical bottom line is stated.
Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Sulfato de Magnésio/uso terapêutico , Doença Aguda , Agonistas Adrenérgicos beta/uso terapêutico , Quimioterapia Combinada , Emergências , Medicina Baseada em Evidências , Humanos , Nebulizadores e VaporizadoresRESUMO
A short cut review was carried out to establish whether antibiotic prophylaxis is indicated after trephining of a subungual haematoma. Two papers were found using the reported search, of which neither presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.
