Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2007
Management of haemodynamically stable patients with abdominal stab wounds.
Australasian trauma centres receive relatively low numbers of penetrating injuries from stabbings. There is limited agreement regarding protocols to guide the management of haemodynamically stable patients with penetrating injuries. This has resulted in a wide variation in practice with anecdotally high negative laparotomy rates. The aim of the present study was to review the ED procedures, investigations and disposition of this group of patients. ⋯ The number of penetrating abdominal injuries remains low. Imaging alone cannot reliably exclude intraperitoneal injury. A greater utilization of ED wound exploration and laparoscopy based on agreed guidelines could improve management. An algorithm for the management of these patients is suggested.
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Emerg Med Australas · Jun 2007
Cricoid pressure: assessment of performance and effect of training in emergency department staff.
(i) To evaluate the theoretical knowledge and practical skills of ED staff regarding the technique of cricoid pressure; (ii) to assess the efficacy of two methods of cricoid pressure training. ⋯ Theoretical knowledge and technique regarding cricoid pressure was poor among our ED staff. Both methods of training appeared to improve performance. The biofeedback group was more likely to apply correct pressure immediately after training. The effects of training diminished rapidly with time.
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Emerg Med Australas · Jun 2007
Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic.
Patients presenting to the ED with obstructive nephropathies benefit from early detection of hydronephrosis. Out of hours radiological imaging is expensive and disruptive to arrange. Emergency physician ultrasound (EPU) could allow rapid diagnosis and disposition. If accurate it might avert the need for formal radiological imaging, exclude an obstruction and improve patient flow through the ED. ⋯ Although the accuracy of detection of hydronephrosis after focused training in EPU is encouraging, further experience and training might improve the accuracy of EPU and allow its use as a screening tool.
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Emerg Med Australas · Jun 2007
Clinical outcomes of magnetic resonance imaging in blunt cervical trauma.
To determine whether MRI of the cervical spine resulted in a change in management of patients with blunt trauma and normal plain X-ray (XR)/CT of the cervical spine. ⋯ An abnormal MRI after normal plain XR and CT cervical spine studies resulted in a change in non-operative management at discharge. Early MRI resulted in one patient receiving surgery before discharge. No unstable injuries were detected by MRI that were not evident on plain XR or CT cervical spine.
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Emerg Med Australas · Jun 2007
Emerging epidemic in Australia: abdominal stab wounds. Twenty-four months at a major trauma centre.
The incidence of abdominal stab wounds treated at the Royal Melbourne Hospital, Parkville, Vic., Australia has noticeably increased over the 12 month period to March 2006, mirroring an increase in penetrating abdominal trauma throughout many Australian trauma centres. Management protocols for abdominal stab wounds are still contentious. The current study quantifies the increase in stab wounds at the Royal Melbourne Hospital over a 24 month period and analyses the management modalities used. ⋯ Abdominal stab wounds treated at Royal Melbourne Hospital have substantially increased over the past 12 months. Although management is still contentious, a management protocol for anterior abdominal stab wounds is proposed, outlining the role of CT scanning, conservative management, laparoscopy and laparotomy.