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Emerg Med J. 2007 September; 24(9): 684.
PMCID: PMC2464641

Emq Answers

Answer 1

Theme: Resuscitation room interventions

  1. False. The NNT is likely to be a little better than 40, the widely quoted NNT for thrombolysis.1
  2. False. NNT is 100.2
  3. False. NNT is 47.3
  4. True. NNT is 5.4

Answer 2

Theme: Angioedema

  1. True.
  2. False. The patient may have been on the ACE inhibitor for years.5
  3. True.
  4. True. Treatment essentially consists of stopping the ACE inhibitor. Intravenous steroids and antihistamines are prescribed in practice but not proven.

Answer 3

Theme: Major trauma

  1. True. In a study in a children's hospital in New Zealand, 444 children with trauma were triaged to the resuscitation room, 347 of whom had a pelvic x ray. Only one fracture was found, and this was clinically apparent. The authors suggest requesting a pelvic x ray only when the clinical examination reveals abnormal findings or is uninterpretable, or in the presence of haematuria.6,7
  2. False.8
  3. False. The CRASH trial was stopped prematurely when it became apparent that there was more harm than benefit.9
  4. False. In one UK study, there was a single survivor from 486 patients intubated without drugs (56% by doctors). This patient had a penetrating chest injury requiring on‐scene thoracotomy.10

References

1. FTT Collaborative Group Indications for fibrinolytic therapy in suspected myocardial infarction. Lancet 1994. 343311–322.322 [PubMed]
2. The Gusto Investigators Global utilization of streptokinase and tissue‐plasminogen activator for occluded coronary arteries. N Engl J Med 1993. 329673–682.682 [PubMed]
3. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST‐segment elevation. N Engl J Med 2001. 345494 [PubMed]
4. Nolan J P, Morley P T, Hoek T L, et al; Advancement Life support Task Force of the International Liaison committee on Resuscitation Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the international liaison committee on resuscitation. Resuscitation 2003. 57231–235.235 [PubMed]
5. Chiu A G, Newkirk K A, Davidson B J. et al Angiotensin‐converting enzyme inhibitor‐induced angiodema: a multicentre review and an algorithm for airway management. Ann Otol Rhinol Laryngol 2001. 110834 [PubMed]
6. Rees M J, Aickin R, Kolbe A. et al Screening pelvic radiograph in paediatric trauma. Paediatr Radiol 2001. 31497–500.500 [PubMed]
7. BestBETs Pelvic radiology is not always indicated in severe blunt trauma if the patient has no pelvic symptoms and is GCS 15. Available at http://www.bestbets.org/cgi‐bin/bets.pl?record = 00035 (accessed 18 July 2007)
8. Cooper D Y, Myles P S, McDermott F T. et al Pre‐hospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury. JAMA 2004. 291135 [PubMed]
9. CRASH trial collaborators Final results of MRC CRASH, a randomised placebo‐controlled trial of intravenous corticosteroid in adults with head injury: outcomes at 6 months. Lancet 2005. 3651957–1959.1959 [PubMed]
10. Lockey D, Davies G, Coats T. Survival of patients who had pre‐hospital intubation without anaesthesia or muscle relaxants, observational study. BMJ 2001. 323141 [PMC free article] [PubMed]

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