Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2010
Morbidity associated with heroin overdose presentations to an emergency department: a 10-year record linkage study.
To examine hospitalizations in a cohort of 224 patients who presented with non-fatal heroin overdose to an ED. ⋯ Non-fatal heroin overdose ED presentations are associated with a cluster of hospitalizations around that episode, likely to be related to heroin availability. Presentation to hospital by heroin users represents an opportunity to counsel less risky behaviour.
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Emerg Med Australas · Jun 2010
Addressing inadequacies in Victoria's trauma system: responses of the Consultative Committee on Road Traffic Fatalities and Victorian trauma services.
Victoria's new trauma care system has been followed by reductions in preventable and potentially preventable deaths and in deficiencies contributing to death. This improvement has followed triaging more patients to expanded major trauma services where mortality was already lower rather than to improved results within the major trauma services, metropolitan or rural trauma services or ambulance services, Victoria. The objective of the present study was to identify continuing inadequacies within the individual trauma services and in association with representatives of these services to develop appropriate countermeasures. ⋯ Interaction between the Consultative Committee on Road Traffic Fatalities and Victorian trauma services identified continuing deficiencies in the new trauma care system and developed consensus recommendations to target these problems. These require implementation through the State Trauma Committee.
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The effect of nightshift on ED staff performance is of clinical and risk-management significance. Previous studies have demonstrated deterioration in psychomotor skills but the present study specifically assessed the impact of nightshift on clinical performance. ⋯ Nightshift effect on clinical performance is anecdotally well known. The present study quantifies such effects, specifically for the ED setting, and paves the way for focused research. The implications for clinical governance strategies are significant, as the fraternity embraces the mandate to maintain quality emergency care 24 h per day.
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Emerg Med Australas · Jun 2010
Case ReportsAcute neck swelling: a diagnostic dilemma in a regional hospital.
This case study describes an incident of acute neck swelling in a patient presenting to the ED of a regional hospital after hours. Maintaining and securing her airway proved to be challenging, as did arriving at the correct cause of her airway obstruction and neck swelling.
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Emerg Med Australas · Jun 2010
Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.
Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. ⋯ A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.