Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2010
ReviewReview article: Can venous blood gas analysis replace arterial in emergency medical care.
The objectives of the present review are to describe the agreement between variables on arterial and venous blood gas analysis (in particular pH, pCO(2) , bicarbonate and base excess) and to identify unanswered questions. MEDLINE search of papers published from 1966 to January 2010 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO(2) , bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size with 95% limits of agreement. ⋯ There is insufficient data to determine if these relationships persist in shocked patients or those with mixed acid-base disorders. For patients who are not in shock, venous pH, bicarbonate and base excess have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO(2) is too poor and unpredictable to be clinically useful as a one-off test but venous pCO(2) might be useful to screen for arterial hypercarbia or to monitor trends in pCO(2) for selected patients.
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Emerg Med Australas · Dec 2010
Case ReportsSuccessful drainage of a traumatic haemopericardium with pericardiocentesis through an intercostal approach.
A case of traumatic haemopericardium, sustained after blunt thoracic trauma, is described in a paediatric patient that was successfully drained by needle pericardiocentesis under 2D-echocardiographic guidance, via an intercostal approach, in the Children's Intensive Care Unit. The patient was haemodynamically unstable with obvious signs of cardiac tamponade. ⋯ There were no complications as a result of the pericardiocentesis. No further surgical intervention was required.
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Emerg Med Australas · Dec 2010
Comparative StudyManagement guideline in haemodynamically unstable patients with pelvic fractures: Outcomes and challenges.
Clinical practice guidelines for haemodynamically unstable patients with pelvic fractures were initiated in February 2005 at our level 1 trauma centre. The purpose of the present study was to evaluate guideline adherence and outcome of guideline performance. In a retrospective clinical study all patients admitted with a pelvic fracture from August 2003 to March 2007 were identified from a prospective trauma registry database. ⋯ The introduction of guidelines has influenced the approach to haemodynamically unstable patients with pelvic fractures. Multiple factors can potentially influence the strict adherence to the guideline. Care provided can still be improved by addressing the challenges in guideline performance.
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Emerg Med Australas · Dec 2010
Retrospective case note review of patients brought to Ipswich emergency department under mental health emergency examination orders: does intoxication alter outcome?
To alter staff perceptions, and to examine alternative management processes for intoxicated patients brought to Ipswich ED under mental health emergency examination orders by comparing disposition outcomes with non-intoxicated patients. ⋯ This audit showed similar outcomes for both patient groups contrary to the perceptions expressed by ED staff in informal surveys. The admission and referral rate for both groups indicate they are an at-risk population. The admission rate of 16% has led to this department negotiating alternative accommodation for patients while they sober up.