Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2015
Observational StudyInterrater agreement between expert and novice in measuring inferior vena cava diameter and collapsibility index.
In critical care medicine, US views of the inferior vena cava (IVC) and its change with respiration are used to estimate the intravascular volume status of unwell patients and, in particular, to answer the question: 'Is this patient likely to be fluid responsive?' Most commonly in the literature, the subxiphisternal (SX) window in the longitudinal plane is utilised. To date, no study has specifically assessed interrater agreement in estimating IVC diameter between emergency medicine specialists (experts) and trainees (learners). ⋯ The wide 95% limits of agreement demonstrate a poor interrater agreement between the IVC US measurements obtained by expert and learner users in the assessment of fluid status. These ranges are greater than clinically acceptable.
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Standard ampoules and prefilled syringes of adrenaline are widely available in Australasian EDs for use in cardiac arrest. We hypothesise that prefilled syringes can be administered more rapidly and accurately when compared with the two available standard ampoules. ⋯ The speed of administration of adrenaline utilising a Minijet (CSL Limited, Parkville, Victoria, Australia) is faster than using adrenaline in glass ampoules presented in their plastic packaging. Removing the plastic packaging from the 1 mL (1 mg) ampoule might result in more rapid administration similar to the Minijet. Resuscitation personnel requiring rapid access to adrenaline should consider storing it as either Minijets or ampoules devoid of packaging. These results might be extrapolatable to other clinical scenarios, including pre-hospital and anaesthesia, where other drugs are required for rapid use.
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Emerg Med Australas · Aug 2015
Triage-based resource allocation and clinical treatment protocol on outcome and length of stay in the emergency department.
The present study aimed to determine the relationship between the triage-based resource allocation and clinical treatment (TRACT) protocol and mortality and length of stay (LOS) in ED. ⋯ The TRACT protocol decreased the ED mortality in ESI 1 group and reduced the ED LOS in ESI levels 2 and 3 groups.