Emergency medicine Australasia : EMA
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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.
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Emerg Med Australas · Dec 2009
Short-term risk of adverse outcome is significantly higher in patients returning an abnormal troponin result when tested in the emergency department.
Describe short-term mortality and hospitalization outcomes in patients undergoing troponin testing in Western Australia tertiary public hospital ED. ⋯ An abnormal ED troponin result appears to be associated with increased risk of subsequent hospitalization and death within 28 days of discharge.
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Emerg Med Australas · Dec 2009
Randomized Controlled Trial Comparative StudyParacetamol versus ibuprofen: a randomized controlled trial of outpatient analgesia efficacy for paediatric acute limb fractures.
Paediatric limb fracture is a common injury that presents frequently to the ED. The primary objective of the present study was to determine whether ibuprofen provides better analgesia than paracetamol for paediatric patients discharged with acute limb fractures. A prospective, randomized controlled study was conducted in a children's ED. ⋯ There were no significant differences in side-effects detected between the two groups. The present study shows that in the outpatient paediatric population, ibuprofen does not provide better analgesia than paracetamol. Pain from an acute fracture can be managed by regular simple oral analgesia and immobilization.
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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.