Emergency medicine Australasia : EMA
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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
Paracetamol toxicity: What would be the implications of a change in Australian treatment guidelines?
The present study aims to study the implications for resource utilisation if Australia adopted recent revised UK treatment guidelines for paracetamol poisoning. ⋯ Alignment of current Australian paracetamol treatment guidelines with those in the UK would result in an increase in ED attendances as directed by Poisons Information Centres and hospital admissions for antidotal treatment. This would be associated with increased health expenditure and inpatient bed utilisation. The present study does not support the clinical need for adoption of UK paracetamol treatment guidelines in Australia.
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Following findings of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial, tranexamic acid (TxA) use post trauma is becoming widespread. However, issues of generalisability, applicability and predictability beyond the context of study sites remain unresolved. ⋯ The study population chosen has high mortality and morbidity and is potentially most likely to benefit from TxA's known mechanisms of action. This and further trials involving appropriate sample populations are required before evidence based guidelines on TxA use during trauma resuscitation can be developed.
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Emerg Med Australas · Apr 2014
Acute coronary syndrome diagnosis at hospital discharge: How often do we get it right in the emergency department?
Acute coronary syndrome (ACS) encompasses unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST segment myocardial infarction (STEMI). In 2007-2008 in Australia, there were 95 000 hospitalisations for ACS. There is limited data about the level of agreement between the ED and hospital discharge diagnosis. The objective of the present study is to describe the proportion of ED patients with a concordant ACS hospital discharge diagnosis and determine factors associated with this. ⋯ Almost one-third of patients who are admitted to the hospital with ACS have a different hospital discharge diagnosis. English as a primary language and presenting with chest pain are associated with a more concordant diagnosis. More research needs to be performed to better understand these findings.