Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part F Summarizing the Evidence
Chapter 19. Summarizing the Evidence
Gordon Guyatt, Roman Jaeschke, Kameshwar Prasad, Deborah J. Cook
Clinical Scenario
Topics Discussed:
asthma, magnesium, review literature, status asthmaticus, summarizing the evidence
Excerpt:
"On call for general internal medicine, you receive a referral
of a 26-year-old woman with asthma exacerbation. She was in the
emergency department 2 weeks earlier and was discharged after treatment
with brochodilators and prescription for a short course of oral
steroids. Despite advice to do so, she has not been able to give
up her new cat. Her forced expired volume in 1 second (FEV1),
78% predicted when she departed the emergency department
2 weeks ago, is now 41% of predicted, and her peak expiratory
flow rate (PEFR) is 13% of predicted. Arterial blood gases
show pH 7.37, PaO2 69 mm Hg, and PaCO2 44 mm Hg.
You start treatment with bronchodilators and corticosteroids and
are considering whether the patient would be best treated in an
intermediate care unit when one of your junior colleagues suggests
treatment with intravenous magnesium sulfate. You are altogether
uncertain about this suggestion and so offer nothing more than a
polite acknowledgement, but she returns 15 minutes later with a
printout of Cochrane Library review dealing with the topic.1..."
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