In my own experience of GPs and stories from others, the widest variation in practice I have seen is of one particular type of patient. Middle aged/elderly, maybe a few cardiac risk factors, often with a history of reflux disease - presenting to GP with mild/moderate cardiac-sounding chest pain of days duration, which they are not generally concerned about. +/- equivocal histories of SOB, nausea, or sweating if pressed. My question is - is it sensible to send these people in via 999 blue lights? How will it help them? They are often taking aspirin already, and presumably after days of ischaemia the myocardium is well and truly dead if it was MI and so they wouldn't be candidates for PCI or thrombolysis. It would seem to me that the cardiac problem to rule out in these patients is unstable angina, not MI. Is there anything to be done for this presentation cardiac-wise other than aspirin and referral to chest pain clinic, if not happy to send home with reassurance re: oesophageal spasm?
over 8 years ago
This video shows a shoulder reduction being attempted, using non-sedating methods. However, it is unsuccessful, and eventually a touch of sedation is used to...
about 6 years ago
Corticosteroids including ACTH (adrenocorticotrophin hormone) for childhood epilepsy other than epileptic spasms | Cochrane
We wanted to assess whether corticosteroids including ACTH are an effective treatment for children with epilepsy. Corticosteroids are sometimes used as an additional therapy to antiepileptic drugs in children with uncontrolled epilepsy. The role of corticosteroids in children with epilepsy is yet to be established.
almost 6 years ago
Acute renal colic is the pain caused by the blockage of urine flow secondary to urinary stones. The prevalence of kidney stone is thought to be between 2% to 3%, and the incidence has been increasing in recent years due to changes in diet and lifestyle. The renal colic pain is usually a sudden intense pain located in the flank or abdominal areas. This usually happens when a urinary stone blocks the ureter (the tube connecting the kidneys to the bladder). Different types of pain killers are used to ease the discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) and antispasmodics (treatment that suppresses muscle spasms) are used commonly to relieve pain and discomfort. This review aimed to assess the effectiveness of commonly used non-opioid pain killers in adult patients with acute renal colic pain. Fifty studies enrolling 5734 participants were included in this review. Treatments varied greatly and combining of studies was difficult. We found that overall NSAIDs were more effective than other non-opioid pain killers including antispasmodics for pain reduction and need for additional medication. We also found that the combining NSAIDs with antispasmodics did not increase the efficacy. No serious adverse effects were reported by any of the included studies.
almost 6 years ago
This video is part of a playlist of short videos which are intended to combine multiple choice questions' answering experience with an improved understanding...
about 5 years ago