Emergency medicine Australasia : EMA
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Debate around medical futility has produced a vast literature that continues to grow. Largely absent from the broader literature is the role of emergency medicine in either starting measures that prove to be futile, withholding treatment or starting the end of life communication process with patients and families. ⋯ We conclude that emergency physicians have the clinical ability and the legal and moral standing to resist providing futile treatment. In these situations they can take a different path that focuses on comfort care thereby initiating the process of the much sought after 'good death'.
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Emerg Med Australas · Oct 2011
Point prevalence of access block and overcrowding in New Zealand emergency departments in 2010 and their relationship to the 'Shorter Stays in ED' target.
To document the extent of access block and ED overcrowding in New Zealand in 2010 and to determine whether these were linked to the hospital's ability to meet the Shorter Stays in ED target. ⋯ Hospital access block was seen more often in larger hospitals and significantly associated with failure to meet the 'Shorter Stays in ED' health target, whereas ED overcrowding was seen in both small and large hospitals, but not associated with failure to meet the target.
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To describe in-hospital resuscitation outcomes and factors associated with survival at Auckland City Hospital, New Zealand. ⋯ Survival from cardiac arrest in our hospital compared well to similar centres and good neurological outcome was higher than reported previously. Reduced survival during the 'After-Hours' period is cause for concern, and further research into the factors underlying this is required.
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Emerg Med Australas · Oct 2011
Case ReportsShifting Gas Artefact Sign: Early sonographic detection of pneumoperitoneum.
This case report describes the use of ultrasound to diagnose pneumoperitoneum in an unstable patient with abdominal pain. Gas in peritoneum produces a specific sonographic appearance. The use of dynamic manoeuvres improves confidence in the ultrasound diagnosis of free gas. ⋯ The literature on sonographic detection of pneumoperitoneum is reviewed. The detection of pneumoperitoneum is a significant finding in non-traumatic abdominal pain and also in blunt abdominal trauma. In both settings more research is required to validate the utility of the test in the acute setting.
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Emerg Med Australas · Oct 2011
Case ReportsA case of phlegmesia cerulea dolens after dialysis catheter insertion.
Phlegmesia cerulea dolens (PCD) is a rare complication of deep vein thrombosis characterized by massive venous thrombosis leading to arterial compromise and tissue ischaemia. PCD carries high morbidity and mortality and is an often times overlooked cause of acute limb ischaemia that must be recognized and treated promptly. Early referral for percutaneous catheter directed thrombectomy offers an alternative to thrombolysis in patients who present with venous gangrene or fail anticoagulation therapy. A case of PCD is presented in a 71-year-old woman with end-stage renal disease 3 days after right femoral dialysis catheter placement.