• This week I learnt – 6

    That we may not have to use sterile gloves for suturing¬† Magnesium can help to rate control Atrial fibrillation (but interestingly not cardioversion). There is concern that high dose naloxone will lead to rebound agitation; however this did not seem the case in this observational study. The continued utility of TXA is demonstrated in this paper looking specifically at the low acuity injuries and still demonstrates a survival benefit (if given early).        

  • Can we use non-sterile gloves for suturing?

    A review of some of the latest low-resourcs emergency medicine evidence Use of non-sterile gloves for suturing Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial Juliette J M Zwaans ,Wouter Raven , Arthur V Rosendaal, Esther M M Van Lieshout, Geesje Van Woerden ,Peter Patka ,Juanita A Haagsma , Pleunie P M Rood Aim To assess if the use of non-sterile gloves gives equally as few wound infections for traumatic wounds as sterile gloves. Rationale Previous systematic reviews and one observational study in the emergency department have shown no difference in infection rates.…

  • This week I learnt- 5

    Controlling fever doesn’t seem to have any effect on serious outcomes or death. Controlling fever could be harmful but of course can be provided for comfort. It is probably safe to skip thrombolysis and go straight to thrombectomy. Beware winter’s morphology as STEMI mimic In kids with buckle fracture unlikely matters much what type of immobilisation is offered. That saying “quiet” in an emergency department does not make it busier (but leads to perception it is!)    

  • TWIL-4

    That the biggest decrease in a patient’s angina symptoms come form telling them the lesion they have isn’t going to cause a problem. Explored more; apparently about a third had symptoms completely improved. Clinical prediction tools are much better validated to “rule out” than “rule in” the need for intervention. The “weekend effect” is more likely due to lack of community services than inadequate hospital services. In low-resources environments (in this case South Africa) a (Free) emergency department visit could cost them about a third of their monthly income.    

  • TWIL-3

    This week I learnt The SNOOP mnemonic is useful to rule out serious cause of acute headache Pain scores at triage are not associated with admission or mortality In rotator cuff shoulder pain a one of session of physio is equally effective than a long course (but no placebo control). Ebola has made (another) resurgence in the democratic republic of Congo. Unfortunately; there is no good evidence for unconditional cash transfers to treat poverty. NSTEMI treated later rather than in first few hours do very similarly to those who get to the cath lab a couple of days later.