Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2017
Renal effects of an emergency department chloride-restrictive intravenous fluid strategy in patients admitted to hospital for more than 48 hours.
Patients commonly receive i.v. fluids in the ED. It is still unclear whether the choice of i.v. fluids in this setting influences renal or patient outcomes. We aimed to assess the effects of restricting i.v. chloride administration in the ED on the incidence of acute kidney injury (AKI). ⋯ In a before-and-after trial, a chloride-restrictive strategy in an ED was associated with a significant decrease in the incidence of stage 3 of KDIGO-defined AKI.
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Emerg Med Australas · Dec 2017
Do antiemetic drugs benefit adult emergency department patients with nausea? The literature says no, but is it right?
Nausea is a common problem in ED patients. Antiemetic drugs have been used in the ED for decades, but a recent Cochrane review found no convincing evidence for the benefit of antiemetic drugs over placebo. This was largely based on three placebo-controlled trials, which found mean Visual Analog Scale (VAS) changes for various drugs and placebo, to be similar. ⋯ Use of a VAS cut-off level indicative of clinically significant symptom improvement would allow comparison of numbers of patients with improved nausea ratings. This is proposed as the best option currently available. Preliminary testing of this outcome measure suggests that the conclusions of past studies may be misleading, and that the question of antiemetic efficacy for ED patients is not yet answered.
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Emerg Med Australas · Dec 2017
Uniting emergency and inpatient clinicians across the ED-inpatient interface: The last frontier?
Unwell patients in the ED requiring inpatient admission must negotiate the interface between the ED and inpatient wards. Despite its importance and scale, this ED-inpatient interface (EDii) is poorly characterised. ⋯ The EDii is characterised by a complex interplay of patient, hospital and system factors. A clear definition of the EDii and an understanding of its importance will assist future research and interventions to improve patient outcomes.