Best evidence topic report. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary.

A short cut review was carried out to establish whether nimodipine is better than placebo at reducing mortality and neurological sequelae in patients with subarachnoid haemorrhage. Altogether 465 papers were found using the reported search, of which one 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 this best paper are tabulated. A clinical bottom line is stated. Clinical scenario A 24 year old man presents to the emergency department after a sudden headache and collapse. He presents with a GCS of 13 and a weakness of the left side. Computed tomography confirms a subarachnoid bleed. You refer him to the neurosurgeons who suggest giving him nimodipine to reduce cerebral vasospasm. You are too embarrassed to ask why. Three part question In [patients with proven subarachnoid haemorrhage] is [nimodipine better than placebo] at [resolving mortality and neurological sequelae]? Search strategy Medline 1966-01/04 using the Ovid interface. [subarachnoid. mp OR exp subarachnoid hemorrhage] AND [nimodipine.mp OR exp nimodipine] Limit to human, English AND abstracts. Search outcome Altogether 465 papers found. One recent Cochrane systematic review identified. No relevant papers published after the date of the systematic review. The review was critically appraised (see table 1). Comment(s) SAH is a devastating illness. Treatment with calcium antagonsits seems to offer a decrease in secondary ischaemic events in these patients. This is shown by the reduction in mortality and clinical findings. Although not specifically investigated in the BET, oral nimodipine appears to be the first choice of drug. c CLINICAL BOTTOM LINE Oral nimodipine is an important adjuvant treatment for SAH. Rinkel GJE, Feigin VL, Algra A, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Library. Issue 4. Oxford: Update Software, 2002. Aspiration of breast abscesses Report by S Thirumalaikumar, Clinical Fellow Checked by S Kommu, Senior House Officer Abstract A short cut review was carried out to establish whether needle aspiration was an alternative to incision and drainage in the management of breast abscess. Altogether 63 papers 333 www.emjonline.com group.bmj.com on June 25, 2017 Published by http://emj.bmj.com/ Downloaded from