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Emergency Medicine Australasia: EMA

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https://www.readbyqxmd.com/read/29346836/emergency-demand-repeat-and-frequent-presentations-by-older-patients-in-metropolitan-melbourne-a-retrospective-cohort-study-using-routinely-collected-hospital-data
#1
Judy Lowthian, Lyle Turner, Angela Joe, Christopher Pearce, Bianca Brijnath, Colette Browning, Marianne Shearer, Danielle Mazza
OBJECTIVE: To describe patterns for potentially avoidable general practice (PAGP)-type and non-PAGP-type ED presentations by older patients during 2008 and 2012. METHODS: Retrospective analysis of ED presentations by patients ≥70 years for 2008 and 2012. Metropolitan Melbourne public hospital data were obtained from the Victorian Emergency Minimum Dataset. Outcomes were characteristics of PAGP-type and non-PAGP-type presentations as defined by the Australian Institute of Health and Welfare; numbers and rates per 1000 population ≥70 years of repeat (×2-3/year) and frequent (≥ ×4/year) PAGP-type and non-PAGP-type presentations...
January 18, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29345427/review-article-best-practice-management-of-common-shoulder-injuries-and-conditions-in-the-emergency-department-part-4-of-the-musculoskeletal-injuries-rapid-review-series
#2
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Shoulder injuries are a commonly presenting complaint to the ED. In the absence of an obvious deformity, they can be difficult to assess and definitively diagnose because of the multiple structures that cause shoulder pain, the acuity and severity of pain and the lack of range of motion in the ED setting. The quality of ED care provided to patients with musculoskeletal shoulder pain is crucial to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common shoulder injuries and conditions in the ED...
January 18, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29341498/review-article-sepsis-in-the-emergency-department-part-2-investigations-and-monitoring
#3
REVIEW
Amith Shetty, Stephen Pj Macdonald, Gerben Keijzers, Julian M Williams, Benjamin Tang, Bas de Groot, Kelly Thompson, John F Fraser, Simon Finfer, Rinaldo Bellomo, Jonathan Iredell
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials...
January 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29341458/procedural-competency-in-emergency-medicine-training
#4
Viet Tran, Joanne Cobbett, Lisa Brichko
No abstract text is available yet for this article.
January 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29327445/don-t-just-do-something-stand-there-the-value-and-art-of-deliberate-clinical-inertia
#5
Gerben Keijzers, Louise Cullen, Diana Egerton-Warburton, Daniel M Fatovich
It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted...
January 12, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29327417/konjac-flour-noodles-associated-with-gastric-outlet-obstruction
#6
Christine Jackman, Ryan Waddell, Leon Fisher, Michael Ben-Meir, Gabriel Blecher, Gerard S Goh, Katie Walker
No abstract text is available yet for this article.
January 12, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29327415/mandatory-misrepresentation
#7
Julie Bunney
The ethical use of college membership in the statement of political opinion.
January 12, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29327414/e-prep-a-competency-based-emergency-department-procedural-training-programme
#8
Nicholas Taylor
No abstract text is available yet for this article.
January 12, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29322693/see-one-do-one-teach-one-is-it-enough-no
#9
Chris Speirs, Victoria Brazil
No abstract text is available yet for this article.
January 11, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29322679/maximising-direct-observation-of-procedural-skills-for-learning-in-the-emergency-department
#10
Victor Lee
No abstract text is available yet for this article.
January 11, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29316329/rapid-and-safe-discharge-from-the-emergency-department-a-single-troponin-to-exclude-acute-myocardial-infarction
#11
Lisa Brichko, Hans G Schneider, William Chan, Jarrel Seah, De Villiers Smit, Anthony Dart, Jeremy P Stevens, Biswadev Mitra
OBJECTIVE: To determine variables that could facilitate safe discharge from the ED following a single high-sensitivity troponin I (HsTnI) result to exclude acute myocardial infarction (AMI). METHODS: A retrospective cohort study was performed at a tertiary hospital of all patients that had serial HsTnI performed within 12 h of arrival to the ED over a 3 year period. The primary exposure variable of interest was a very low troponin initial result (HsTnI <5 ng/L)...
January 8, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29316267/elderly-patients-with-suspected-chronic-digoxin-toxicity-a-comparison-of-clinical-characteristics-of-patients-receiving-and-not-receiving-digoxin-fab
#12
Hooman Arbabian, Hwee Min Lee, Andis Graudins
OBJECTIVE: The aim of the present study was to compare clinical features of patients with elevated serum digoxin concentrations who were treated with digoxin-Fab with those where the immunotherapy was not given by a tertiary hospital toxicology service. METHODS: This was a retrospective series of patients with supratherapeutic serum digoxin concentrations referred to the toxicology service from August 2013 to October 2015. Data collected included demographics, presenting complaint, digoxin dose, other medications taken, serum digoxin, potassium and creatinine concentration on presentation and initial and post-digoxin-Fab heart rate...
January 8, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29268305/cervical-spine-traumatic-epidural-haematomas-incidence-and-characteristics
#13
Lisa Brichko, Birinder Giddey, Jin Tee, Louise Niggemeyer, Mark Fitzgerald
OBJECTIVE: Cervical spine traumatic epidural haematomas (CSTEH) can cause potentially devastating neurological deficits if not promptly identified. Study aims were to determine the incidence, characteristics and outcomes for patients with CSTEH. METHODS: A retrospective study was performed at a tertiary hospital with an adult Level 1 Trauma Centre on all consecutive patients diagnosed with CSTEH over a 4 year period. Medical record review was undertaken for all patients with the diagnoses of CSTEH to identify patient characteristics including age, mechanism of injury and co-morbid conditions...
December 21, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29266739/predicting-re-presentation-following-discharge-from-the-emergency-department-with-non-specific-chest-pain
#14
Tessa M Potezny, Christopher M Horwood, Paul Hakendorf, Cynthia Papendick, Campbell H Thompson
OBJECTIVE: To determine the 30 day major adverse cardiac events (MACE) and re-presentation rates of non-specific chest pain (NSCP) patients following four different disposition pathways and to contrast re-presentation rates of patients with NSCP with those for all other patients presenting to the ED. METHODS: Cases were derived from the ED database for two large teaching hospitals where patients aged 18 or over were triaged between 2009 and 2016, and their diagnosis on leaving the ED was NSCP...
December 20, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29243880/review-article-best-practice-management-of-common-knee-injuries-in-the-emergency-department-part-3-of-the-musculoskeletal-injuries-rapid-review-series
#15
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites...
December 15, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29235235/review-article-best-practice-management-of-common-ankle-and-foot-injuries-in-the-emergency-department-part-2-of-the-musculoskeletal-injuries-rapid-review-series
#16
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017...
December 13, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29232770/review-article-nexus-criteria-to-rule-out-cervical-spine-injury-among-older-patients-a-systematic-review
#17
REVIEW
Gabriel Paykin, Gerard O'Reilly, Helen Ackland, Biswadev Mitra
The National Emergency X-Radiography Utilization Study (NEXUS) criteria were derived from a heterogeneous group of adult blunt trauma patients, with the outcome measure assessed most commonly using plain X-ray radiographs. Recent observations have suggested inadequacy of these criteria for excluding injury in population subgroups such as the elderly. The aim of this systematic review was to determine the sensitivity of the NEXUS criteria in excluding cervical spine injury among older patients aged ≥65 years...
December 12, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29232768/modification-of-the-thrombolysis-in-myocardial-infarction-risk-score-for-patients-presenting-with-chest-pain-to-the-emergency-department
#18
Jaimi H Greenslade, Kimberly Chung, William A Parsonage, Tracey Hawkins, Martin Than, John W Pickering, Louise Cullen
OBJECTIVE: To develop a modified Thrombolysis in Myocardial Infarction (TIMI) score to effectively risk stratify patients presenting to the ED with chest pain. METHODS: A prospective observational study was conducted at two metropolitan EDs. Data were obtained during patient interview. The primary outcome was major adverse cardiovascular events (MACE) within 30 days of presentation. Two separate modifications of the TIMI score were developed. These scores were compared to the original TIMI in terms of the area under the receiver operating characteristic curve and diagnostic accuracy statistics (sensitivity, specificity, positive and negative predictive values)...
December 12, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29232762/review-article-best-practice-management-of-low-back-pain-in-the-emergency-department-part-1-of-the-musculoskeletal-injuries-rapid-review-series
#19
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Low back pain (LBP) is a common presentation to the ED, and a frequent cause of disability globally. The ED management is often associated with high rates of imaging, misuse and overuse of pharmacology and subsequent financial implications. Given this, improved quality of care for patients with LBP in ED is essential. This rapid review investigated best practice for the assessment and management of LBP in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015...
December 12, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29224237/major-haemorrhage-fatalities-in-the-australian-national-coronial-database
#20
Jacob S Gipson, Erica M Wood, Merrole F Cole-Sinclair, Zoe McQuilten, Neil Waters, Noel W Woodford
OBJECTIVE: The aim of the study is to describe the epidemiology of major bleeding fatalities. METHODS: A case series analysis of Australia's National Coronial Information System was conducted. Keywords were used to search for closed cases of major haemorrhage in the state of Victoria for the period 1 January 2009 to 31 December 2011. Coroners' findings, autopsy reports and police reports of cases were reviewed. Demographic data were extracted, and cases were assigned to a clinical bleeding context...
December 10, 2017: Emergency Medicine Australasia: EMA
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