Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2009
Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome.
To determine the proportion of adverse events in patients discharged after ED assessment for possible acute coronary syndrome. ⋯ In a large Australian ED, less than 1% of patients presenting with symptoms suggestive of coronary syndrome were discharged and subsequently had a 30 day adverse event. Reducing this proportion by admitting patients with traditional risk factors would markedly increase hospital workload. Opportunities exist to improve both the safety and efficiency of chest pain assessment in the ED.
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Emerg Med Australas · Dec 2009
Clinical TrialThe 10 mL syringe is useful in generating the recommended standard of 40 mmHg intrathoracic pressure for the Valsalva manoeuvre.
The Valsalva manoeuvre (VM) continues to be first-line management for haemodynamically stable supraventricular tachycardia in the acute setting. 40 mmHg of intrathoracic pressure is seen as an essential component of the VM. Anecdotally, blowing into a 10 mL syringe to move the plunger is one method of pressure generation; however, to date its effectiveness has not been tested. The objective of the present study was to assess if blowing into a syringe sufficient to move the plunger could produce the required 40 mmHg of pressure. ⋯ The present study has demonstrated that blowing into a 10 mL Terumo syringe, to move the plunger, generated 40 mmHg intrathoracic pressure, thereby meeting the recommended intrathoracic pressure for optimum VM performance.
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Access block is the inability of ED patients requiring admission to access appropriate inpatient beds in a timely fashion, defined in Australasia as more than 8 h in the ED. The present study describes changes in prevalence of access block in Australia over a 4 year period. ⋯ Around one-third of all patients receiving care in these ED surveys were experiencing access block. There is evidence that flow through New South Wales ED has improved. The data suggest that most hospitals have passed the point of efficiency.
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Emerg Med Australas · Dec 2009
ReviewReview article: the use of pelvic examination within the emergency department in the assessment of early pregnancy bleeding.
Early pregnancy bleeding is a common presentation in the emergency setting. Traditionally, its assessment relied on clinical findings, including pelvic examination. However in recent years, ultrasonography and quantitative beta human chorionic gonadotropin assays have gained prominence and are now first-line in diagnosing early pregnancy bleeding. ⋯ However, when ultrasonography and beta human chorionic gonadotropin testing are unavailable or the results inconclusive, pelvic examination should be considered. Assessment in these instances must focus on identifying possible life-threatening conditions, such as ectopic pregnancy, as well as determining the safety of discharge pending definitive assessment. Speculum examination is indicated in those presenting with severe bleeding or hypotension as removal of obstructing endocervical products can be a crucial resuscitative measure.