Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2014
ReviewReview article: Elevated troponin: Diagnostic gold or fool's gold?
Troponin is a highly sensitive biomarker of myocardial injury and has been used extensively in everyday clinical practice in the community as well as in hospitals for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of patients with acute coronary symptoms. Dynamic elevations in biomarkers (troponin) are considered fundamental to the diagnosis of AMI. ⋯ An incorrect diagnosis of myocardial infarction can also lead to the oversight of serious life-threatening alternative causes of troponin elevation (e.g. pulmonary embolism). This article discusses the role of troponin in our everyday clinical practice in the ED.
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Emerg Med Australas · Apr 2014
Multicenter StudySmall rural emergency services still manage acutely unwell patients: A cross-sectional study.
Examine the range of clinical situations encountered at small rural emergency care services. We hypothesised that over a 12 month period, small rural emergency services would encounter almost the entire range of clinical situations described at designated EDs. ⋯ The five small rural emergency facilities encountered most of the clinical problems seen in full EDs. They saw almost all categories of emergency presentation, saw almost all diagnostic categories, treated critically ill and injured patients, and performed most procedures.
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Emerg Med Australas · Apr 2014
ReviewReview article: Ventricular assist devices in the emergency department.
Ventricular assist devices (VADs) have become an indispensable tool in the management of end-stage cardiac failure, both as a means of bridging to cardiac transplantation and as destination therapy for long-term quality of life improvement. Although the technology continues to advance and these devices continue to be refined, they are still associated with significant complications. This article reviews the basics of VAD function and physiology, as well as the myriad to complications that follow their implantation. This review aims to provide a systematic approach to the troubleshooting, diagnosis and management of both VAD-associated complications and the resuscitation of the decompensated VAD patient presenting to the ED.
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Emerg Med Australas · Apr 2014
A stream for complex, ambulant patients reduces crowding in an emergency department.
The study aims to evaluate the effect of adding a stream for complex, ambulatory patients in an ED. ⋯ The use of an appropriately resourced stream directed towards seeing a complex group of patients who do not require ongoing nursing care and who are capable of sitting in a chair improved departmental flow.
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Emerg Med Australas · Apr 2014
Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features.
National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated. ⋯ Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.