Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2013
Randomized Controlled TrialVaginal examination does not improve diagnostic accuracy in early pregnancy bleeding.
The study aims to determine if a vaginal examination improves diagnostic accuracy when assessing women who present to the ED with vaginal bleeding in the first trimester of pregnancy. ⋯ In a stable patient presenting to the ED with first trimester bleeding, clinical diagnosis is highly inaccurate and is not improved by vaginal examination. Routine vaginal examination is not necessary as part of the initial patient assessment.
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Emerg Med Australas · Jun 2013
Effects of obesity on patient experience in the emergency department.
The study aims to determine if obesity (body mass index ≥30.0 kg/m(2) ) adversely affects the patients' ED experience in terms of flow variables and rates of assistance, investigation and procedure. ⋯ In this single-centre study, obesity did not appear to adversely affect ED treatment. The observed differences in some investigation rates might relate to suspected morbidities and difficulties in physical examination.
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Emerg Med Australas · Jun 2013
Agreement between arterial and venous pH and pCO2 in patients undergoing non-invasive ventilation in the emergency department.
Blood gas analysis is an important part of the assessment of ventilatory function in patients with respiratory distress. Traditionally, analysis of arterial blood has been used, but recently, there has been a move towards venous blood gas analysis for selected conditions. Arteriovenous agreement for pH and pCO2 in adult patients undergoing non-invasive ventilation (NIV) has not been explored to date. The aim of this study was to address this question. ⋯ Eighty-nine sample pairs in 53 patients were studied. Median age was 74, and 64% of patients were male. The principal diagnoses were chronic obstructive pulmonary disease (43%) and acute pulmonary oedema (40%). Mean difference for pH (a-v) was 0.04 pH units (95% limits of agreement -0.02, 0.11). Mean difference for pCO2 (a-v) was -8.02 mmHg (95% limits of agreement -22.63, 6.58) CONCLUSION: For adult patients undergoing NIV in an ED, arteriovenous agreement for pH was close with narrow limits of agreement making venous pH clinically interchangeable with arterial pH. Agreement for pCO2 was poor with unacceptably wide limits of agreement.
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Emerg Med Australas · Jun 2013
Blood pressure cuffs as a vector for transmission of multi-resistant organisms: colonisation rates and effects of disinfection.
Blood pressure (BP) cuffs are potential vectors for transmission of multi-resistant organisms (MROs). The present study aims to determine MRO colonisation rates in BP cuffs from areas of high patient flow as an assessment of the quality of disinfection and infection control practices. ⋯ Although MRSA and VRE were infrequently isolated, current disinfection and infection control protocols need to be improved given the greater recovery of organisms from the inner compared with outer surfaces of BP cuffs.
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Emerg Med Australas · Jun 2013
Procedural sedation and analgesia for reduction of distal forearm fractures in the paediatric emergency department: a clinical survey.
Distal forearm fractures frequently require reduction in children. We set out to survey how such fractures are currently reduced at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. ⋯ Paediatric distal forearm fractures are commonly reduced in the surveyed EDs, most commonly under ketamine or nitrous oxide. Areas of improvement include better defined cut-offs for fracture reduction and for referral to theatre, improved differential efficacy of PSA agents, standardised guidelines for PSA and introduction of image intensifiers into more EDs.