Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2009
ReviewReview article: Efficacy and safety of methoxyflurane analgesia in the emergency department and prehospital setting.
This article reviews the evidence for the analgesic efficacy of methoxyflurane in both prehospital and ED settings, as well as the adverse event profile associated with methoxyflurane use. Although there are no published controlled trials of methoxyflurane in sub-anaesthetic doses, available data indicate that it is an efficacious analgesic. There is inadequate evidence regarding its use as an agent for procedural pain. Despite the potential for renal impairment evident when it was used in anaesthetic doses, no significant adverse effects have been reported in the literature, neither in patients nor occupationally, when the dose used is limited to that currently recommended.
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Emerg Med Australas · Feb 2009
Comparative StudyDoes emergency department workload adversely influence timely analgesia?
The impact of ED overcrowding on delay to analgesia has not been well studied. Our objective was to determine if ED workload influenced time to analgesia (TTA). ⋯ No relationship between workload and TTA was observed; however, there were delays to analgesia associated with age, non-English-speaking background and delay to pain assessment.
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Emerg Med Australas · Feb 2009
Comparative StudyImproving adherence to asthma clinical guidelines and discharge documentation from emergency departments: implementation of a dynamic and integrated electronic decision support system.
The authors previously developed a dynamic and integrated electronic decision support system called ACAFE (Asthma Clinical Assessment Form and Electronic decision support). The objective of this present study was to evaluate the effectiveness of this system on asthma management and documentation in an ED. ⋯ The use of this decision support system in patients presenting to emergency with asthma was associated with improvements in clinical documentation and discharge management plans. Electronic decision support systems developed collaboratively with clinicians should play an important part of system-wide efforts to improve guideline adherence and compliance in ED.
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Many EDs have difficulty transferring admitted patients to inpatient beds in a timely manner because of access block. We assessed ED patient preferences for waiting location. ⋯ Patients would prefer to wait in ward corridors for their ward bed if there was no ED cubicle available. Waiting in the ED corridor is their least preferred option. Patients usually expect to get to their ward bed within 3 h. However, with high levels of access block, patient expectations for waiting times for a bed are usually not met. These findings could be used to drive system changes that are more patient-focussed.
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Emerg Med Australas · Feb 2009
Comparative StudyProcedural sedation in children in the emergency department: a PREDICT study.
To investigate current procedural sedation practice and compare clinical practice guidelines (CPG) for procedural sedation at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. This will determine areas for improvement and provide baseline data for future multicentre studies. ⋯ Procedural sedation in this research network commonly uses N(2)O, ketamine and midazolam for a wide range of procedures. Areas of improvement are the lack of guidelines for certain agents, documentation, staff competency training and auditing processes. Multicentre research could close gaps in terms of age cut-offs, fasting times and optimal indications for various agents.