Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2008
Re-presentation and suicide rates in emergency department patients who self-harm.
To investigate adult presentations to North Shore Hospital, Auckland, New Zealand, following deliberate self-harm, determine re-presentation and suicide rates and investigate the characteristics of those patients who re-present. ⋯ Re-presentation and suicide rates in our study were similar to previously published rates. Further research is needed to identify strategies to reduce re-presentations and excess mortality in all people who deliberately self-harm.
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Emerg Med Australas · Aug 2008
ReviewReview article: leaving the emergency department without being seen.
Patients who leave the ED without being seen (LWBS) are unlikely to be satisfied with the quality of the service provided and might be at risk from conditions that have not been assessed or treated. We therefore examined the available research literature to inform the following questions: (i) In patients who attend for ED care, what factors are associated with the decision to LWBS? (ii) In patients who attend for ED care, are there adverse health outcomes associated with the decision to LWBS? (iii) Which interventions have been used to try to reduce the number of patients who attend for ED care and LWBS? From the available literature, there was insufficient evidence to draw firm conclusions; however, the literature does suggest that patients who LWBS have conditions of lower urgency and lower acuity, are more likely to be male and younger, and are likely to identify prolonged waiting times as a central concern. LWBS patients generally have very low rates of subsequent admission, and reports of serious adverse events are rare. ⋯ Further research is recommended to include comprehensive cohort or well-designed case-control studies. These studies should assess a wide range of related factors, including patient, hospital and other relevant factors. They should compare outcomes for groups of LWBS patients with those who wait and should include cross-sectoral data mapping to truly detect re-attendance and admission rates.
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Over the past 20 years, emergency medicine (EM) in China has been through a period of rapid development. This included the formal establishment of professional association of EM in 1986 and the establishment of ED in all county-level hospitals across the country in the late 1990s. In line with the rapid economic development of China, ED have been equipped with appropriate 'hardware' equipment, but the 'software' part of the ED system remains underdeveloped. ⋯ EM in China remains underdeveloped, at least partly, for two main reasons: the current financial status of the health-care system and lack of sufficient numbers of qualified EM specialists. Chinese education and training systems are now beginning to produce high-quality emergency specialists, although there is not yet consistency across all courses. In Australia, the specialty of EM is well developed and, as such, this country is well placed to contribute to the development of ED in China.
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Emerg Med Australas · Aug 2008
Paediatric and adolescent horse-related injuries: does the mechanism of injury justify a trauma response?
To identify the frequency, variety and disposition of horse-related injury presentations to the ED and to use this information to evaluate the existing institutional trauma team activation criteria following horse-related injuries. ⋯ Although horse-related injury presentations are uncommon, severe injuries do occur. Patients presenting with severe horse-related injuries do not always activate a full trauma team response based on current trauma team activation criteria. These severe injury presentations are supported by a limited trauma team response, which activates on the mechanism of injury. The effectiveness of this as a contingency system needs to be evaluated.
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Emerg Med Australas · Aug 2008
ReviewReview article: hypertonic saline use in the emergency department.
Hypertonic saline (HS) is being increasingly used for the management of a variety of conditions, most notably raised intracranial pressure. This article reviews the available evidence on HS solutions as they relate to emergency medicine, and develops a set of recommendations for its use. ⋯ HS is also recommended for treating severe and symptomatic hyponatremia, and is worth considering for both recalcitrant tricyclic antidepressant toxicity and for cerebral oedema complicating paediatric diabetic ketoacidosis. HS is not recommended for hypovolaemic resuscitation.