Bruce Martin

Antibiotics in orbital floor fractures.

A short cut review was carried out to establish whether prophylactic antibiotics are indicated in patients with undisplaced maxillary or orbital floor fractures. Altogether 214 papers were found using the reported search, but none presented any evidence to answer the clinical question. More research is needed in this area and, in the mean time, local advice should be followed.

Regional nerve block in fractured neck of femur

A short cut review was carried out to establish whether regional nerve block is better than intravenous analgesia in reducing pain in hip fractures. Altogether 21 papers were found using the reported search, of which four 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.

Journal clubs in clinical medicine

Journal clubs in clinical medicine have long been recognised as a useful tool for keeping up to date with new developments.1 More recently they have been used as a tool for the teaching of critical appraisal,2 which for emergency medicine trainees in the UK is an important part of …

Negative urine analysis to exclude urinary tract infection

Report by Bruce Martin, Specialist Registrar in Emergency Medicine Checked by Angaj Ghosh, Senior Clinical Fellow A very anxious mother brings her 4 year old daughter to the emergency department concerned about her persistent fever. Examination reveals that she does indeed have a temperature of 37.6°C. She has no obvious signs of localised infection, so you decide that you need to test her urine to see …

Two thumb compared with two finger cardiopulmonary resuscitation in infants

A short cut review was carried out to establish whether the two thumb technique was superior to the two finger technique in delivering effective chest compressions in infants with cardiac arrest. Altogether 175 papers were found using the reported search, of which four 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.

Radiology in paediatric cervical spine injury.

A 55 year old right handed man presented with a three month history of left arm pain and precordial chest discomfort. His symptoms had started three months previously after a heavy game of squash. Three years before the acute episode, he was involved in a motorcycle accident and had sustained a left mid-clavicular fracture. On clinical examination he was …

Detection of pneumoperitioneum on erect chest radiograph

A short cut review was carried out to establish whether a normal erect chest radiograph excludes the diagnosis of perforated abdominal viscus. Altogether 37 papers were found using the reported search, 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 best papers are shown in table 1. A clinical bottom line is stated.

Midazolam and emergence phenomena in children undergoing ketamine sedation

Report by Simon Carley, Specialist Registrar Search checked by Bruce Martin, Specialist Registrar A 4 year old boy presents to the emergency department with a 4 cm laceration to the thigh. This requires cleaning and layered suture closure. You decide to sedate him using ketamine intramuscularly. You are successful and close the wound. …

Erythrocyte sedimentation rate and septic arthritis in children

Report by Russell Boyd, Consultant Search checked by Bruce Martin, Specialist Registrar A 3 year old child presents to the emergency department with a short history of limp, temperature and difficulty in weight bearing on the left leg. The pain is principally located at the hip joint and you fear this …

Closure of pretibial lacerations

Report by Muhammad Ahmad, Specialist Registrar Search checked by Bruce Martin, Specialist Registrar A 70 year old woman presents to the emergency department with a pretibial flap laceration. The wound will need cleaning and then closing. You …