Emergency medicine Australasia : EMA
-
Emerg Med Australas · Jun 2014
ReviewReview article: Shock Index for prediction of critical bleeding post-trauma: A systematic review.
Early diagnosis of haemorrhagic shock (HS) might be difficult because of compensatory mechanisms. Clinical scoring systems aimed at predicting transfusion needs might assist in early identification of patients with HS. The Shock Index (SI) - defined as heart rate divided by systolic BP - has been proposed as a simple tool to identify patients with HS. ⋯ An association between higher SI and bleeding was demonstrated in all studies. The SI is a readily available tool and may be useful in predicting CB on arrival to hospital. The evaluation of improved utility of the SI by performing and recording at earlier time-points, including the pre-hospital phase, is indicated.
-
Emerg Med Australas · Jun 2014
Characteristics of patients who leave the emergency department without being seen: The first report in China.
The incidence of patients who leave without being seen (LWBS) by a doctor in the ED in China has not been reported. The purpose of this study is to identify the prevalence and characteristics of the LWBS patient population as well as predictors of LWBS in the ED of a tertiary hospital of China. ⋯ Independent LWBS predictors include paediatric patients arriving on foot in the evening with lower acuity problems. Potential risk management strategies should be implemented to decrease or eliminate the LWBS population by improving communication and providing increased comfort measures.
-
Human psychology, neuroscience and behavioural economics study the human mind, brain and behaviour. Scientific research has discovered a great deal about the factors that influence human perception, judgment and activity in the real world. ⋯ I propose that meta-cognition, or thinking-about-thinking, has the potential to inform how we practice emergency medicine. By accommodating human traits rather than trying to defy them, we can ultimately benefit our patients.
-
Emerg Med Australas · Jun 2014
Understanding emergency department staff needs and perceptions in the provision of palliative care.
The primary aim of the present study was to investigate Australian ED staff perspectives and needs regarding palliative care provision. Secondary aims were to assess staff views about death and dying, and their awareness of common causes of death in Australia, particularly those where a palliative care approach is appropriate. ⋯ Our study suggests that although ED staff expressed confidence regarding symptom management in palliative care, they lacked understanding of the patients in whom a palliative approach could be applied and sought further education in areas, such as end-of-life communication and ethical issues. ED specific training and clinical interventions in palliative care provision would seem to be needed and justified.
-
Emerg Med Australas · Jun 2014
Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patients.
There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. ⋯ IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56% of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.