Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2016
ReviewReview article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review.
Risk stratification tools for patients presenting to rural EDs with undifferentiated chest pain enable early definitive treatment in high-risk patients. This systematic review compares the most commonly used risk stratification tools used to predict the risk of major adverse cardiac event (MACE) for patients presenting to rural EDs with chest pain. A comprehensive search of MEDLINE and Embase for studies published between January 2011 and January 2015 was undertaken. ⋯ The HFA/CSANZ guidelines achieved zero cases of MACE but discharged only 1.3% of patients. EDACS-ADP can potentially increase diagnostic efficiency of patients presenting at ED with chest pain. Further assessment of tool in a rural context is recommended.
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Emerg Med Australas · Oct 2016
Review Meta AnalysisReview article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the management of presumed acute ischaemic stroke? A systematic review and meta-analysis.
The objective of the present study is to independently and systematically assess the harms and benefits of intravenous thrombolysis for patients with presumed acute schaemic stroke. ⋯ There is clear evidence of increased early mortality, increased rates of symptomatic intracranial haemorrhage and also of improved functional outcomes for patients with presumed acute ischaemic stroke treated with thrombolysis. The available data are unlikely to resolve the controversy regarding the use of intravenous thrombolysis in this population, and further randomised controlled trials are urgently required.
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Emerg Med Australas · Oct 2016
ReviewPotential role for psychological skills training in emergency medicine: Part 1 - Introduction and background.
Psychological skills training (PST) is the systematic acquisition and practice of different psychological techniques to improve cognitive and technical performance. This training consists of three phases: education, skills acquisition and practice. Some of the psychological skills developed in this training include relaxation techniques, focusing and concentration skills, positive 'self-suggestion' and visualisation exercises. ⋯ Despite the benefits realised in other professions, medicine has only recently begun to explore certain elements of PST. The present paper reviews the history and evidence behind the concept of PST. In addition, it presents some aspects of PST that have already been incorporated into medical training as well as implications for developing more comprehensive programmes to improve delivery of emergency medical care.
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Emerg Med Australas · Oct 2016
Observational StudyFluid bolus therapy in emergency department patients: Indications and physiological changes.
The aim of the present paper is to study the indications for fluid bolus therapy (FBT) and its associated physiological changes in ED patients. ⋯ In ED, FBT is used mostly in patients without shock. However, after an immediate haemodynamic effect, FBT is associated with absent or limited physiological changes at 1 or 2 h. Even in shocked patients, the changes in MAP at 1 or 2 h after FBT are small.