Incidence and outcome of subarachnoid haemorrhage in the general and emergency department populations in Queensland from 2010 to 2014
ConclusionsThe incidence of SAH was similar to that previously reported for Australia. One in 50 ED patients with headache had SAH. Ten in 50 000 ED attendances had a SAH. These estimates can assist in the risk assessment for SAH. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Kevin H Chu, Ibrahim Mahmoud, Xiang ‐Yu Hou, Craig D Winter, Rosalind L Jeffree, Nathan J Brown, Anthony FT Brown Tags: Original Research Source Type: research
Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different ‐sized departments
Conclusion
These findings are the first multi‐site and multidisciplinary examinations of Australian ED staff perceptions, improving our understanding of staff stressors and coping strategies and highlighting similarities across different EDs. These data support the development and implementation of strategies to improve ED working environments to help ensure professional longevity of ED staff. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Louisa J Abraham, Ogilvie Thom, Jaimi H Greenslade, Marianne Wallis, Amy NB Johnston, Eric Carlstr öm, Donna Mills, Julia Crilly Tags: Original Research Source Type: research
Effect of the Prevent Alcohol and Risk ‐Related Trauma in Youth (P.A.R.T.Y.) Program among senior school students
ConclusionsThe P.A.R.T.Y. Program at The Alfred engaged substantial numbers of youths and achieved significant improvements among key outcome measures. Objectives were sustained at 3–5 months post‐programme, but demonstrated decay, highlighting the importance of continual reinforcement. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Anna Gunn, Janet McLeod, Rebecca Chapman, Hayley Ball, Mark Fitzgerald, Teresa Howard, Peter Cameron, Biswadev Mitra Tags: Original Research Source Type: research
Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data
ConclusionThe rate of repeat and frequent PAGP‐type presentations by older people decreased in 2012 compared with 2008, suggesting that initiatives implemented to reduce avoidable presentations may have had an effect. However, an increase in the rate of frequent non‐PAGP‐type presentations, predominately for acute exacerbation of cardiovascular and respiratory conditions, has important implications for planning future healthcare delivery; hence, the importance of initiatives such as the Health Care Home. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Judy Lowthian, Lyle Turner, Angela Joe, Christopher Pearce, Bianca Brijnath, Colette Browning, Marianne Shearer, Danielle Mazza Tags: Original Research Source Type: research
Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series)
Abstract
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. Databases were searched in 2017, incl...
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin ‐Khan, Trevor Russell Tags: Review Article Source Type: research
Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring
Abstract
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. Routine laboratory investigations such as cre...
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: 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 Tags: Review Article Source Type: research
Don't just do something, stand there! The value and art of deliberate clinical inertia
Abstract
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 a...
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Gerben Keijzers, Louise Cullen, Diana Egerton ‐Warburton, Daniel M Fatovich Tags: Perspective Source Type: research
See one, do one, teach one: Is it enough? No
(Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Chris Speirs, Victoria Brazil Tags: Trainee Focus Source Type: research
Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin ‐Fab
ConclusionDigoxin‐Fab was more commonly administered when heart rate was <51/min. It had a small effect on increasing heart rate; however, individual response to digoxin‐Fab was variable as patients were using other negative chronotropic medications. In symptomatic bradycardic patients on multiple heart failure medications, positive chronotropic and potassium‐lowering therapies should be considered in concert with digoxin‐Fab. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Hooman Arbabian, Hwee Min Lee, Andis Graudins Tags: Toxicology Source Type: research
Rapid and safe discharge from the emergency department: A single troponin to exclude acute myocardial infarction
ConclusionsThis supports the utilisation of a rapid rule out strategy to exclude AMI for patients that have an initial HsTnI measurement <5 ng/L in conjunction with a robust risk assessment. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Lisa Brichko, Hans G Schneider, William Chan, Jarrel Seah, De Villiers Smit, Anthony Dart, Jeremy P Stevens, Biswadev Mitra Tags: Original Research Source Type: research
Cervical spine traumatic epidural haematomas: Incidence and characteristics
ConclusionThis study shows a high incidence of CSTEH among trauma patients. CSTEH is associated with significant morbidity and mortality. High clinical vigilance is required to allow the request and acquisition of urgent magnetic resonance imaging to diagnose CSTEH as the entity is often not evident on initial cervical spine computed tomography investigations. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Lisa Brichko, Birinder Giddey, Jin Tee, Louise Niggemeyer, Mark Fitzgerald Tags: Original Research Source Type: research
Predicting re ‐presentation following discharge from the emergency department with non‐specific chest pain
ConclusionDespite a slightly increased rate of re‐presentation in patients with NSCP sent home from the ED, we conclude that there is minimal advantage in admitting many patients who lack a diagnosis for their chest pain. For a selected patient population, discharge from the ED may become a safe and cost‐effective approach. A prospective randomised study is required. (Source: Emergency Medicine Australasia)
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Tessa M Potezny, Christopher M Horwood, Paul Hakendorf, Cynthia Papendick, Campbell H Thompson Tags: Original Research Source Type: research
Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)
Abstract
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. Primary studies, systematic reviews and...
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin ‐Khan, Trevor Russell Tags: Review Article Source Type: research
Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)
Abstract
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. Primary studies, systematic revi...
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin ‐Khan, Trevor Russell Tags: Review Article Source Type: research
Review article: NEXUS criteria to rule out cervical spine injury among older patients: A systematic review
Abstract
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. A systematic review of the literature published prior to 1 January 2017 that reported on the performa...
Source: Emergency Medicine Australasia - December 1, 2017 Category: Emergency Medicine Authors: Gabriel Paykin, Gerard O'Reilly, Helen Ackland, Biswadev Mitra Tags: Review Article Source Type: research
