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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There is sometimes dissonance between the medical services that the general public expects an ED to provide and the acute critical care that emergency clinicians hope to provide. One explanation for this is that the ED is both a territory and a meeting place for a cornucopia of clinicians, some of whom are not ED clinicians themselves. ⋯ This perspective aims to reflect on several pertinent questions: Should suicide risk be treated as a medical emergency? Is suicide prevention everyone's business? Is suicide risk assessment and management a core component of ED? How common, precise and non-stigmatising is the language around suicide? To what extent is that language underpinned by mythology rather than fact? For some, these will be inconvenient questions. How they are answered is undoubtedly framed within the language used when discussing suicide.
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Emerg Med Australas · Dec 2017
Observational StudyProspective observational study of predicted usage of intravenous cannulas inserted in a tertiary paediatric emergency department.
To determine the proportion of unused peripheral intravenous cannulas (PIVCs) inserted in a paediatric emergency department (PED) and to assess clinicians' abilities to predict future usage of PIVC. ⋯ This study is consistent with the idle PIVC rates observed in PEDs but there is potential to further reduce this rate with targeted insertion. The paediatric clinicians' reliability in predicting PIVC use has been demonstrated for the first time and we have identified four groups where targeted phlebotomy rather than i.v. cannulation would reduce unused cannulas.
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Emerg Med Australas · Dec 2017
Patients' choice between public and private hospital emergency departments: a cross-sectional survey.
The aim of this study was to understand what factors influence patients' choice between public and private hospital ED and the relative weight of those factors among adult patients with private health insurance in Australia. ⋯ Longer waiting times in public EDs is the principal issue considered by patients choosing private EDs and the out-of-pocket payment for accessing private EDs is the principal issue considered by public ED patients. The study suggests that addressing the out-of-pocket payments will attract more patients with private health insurance to access private EDs.
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Emerg Med Australas · Dec 2017
Patterns of paediatric emergency presentations to a tertiary referral centre in the Northern Territory.
To describe epidemiological data concerning paediatric attendances at the ED of Royal Darwin Hospital (RDH). ⋯ This study provides important information regarding paediatric presentations to a major referral hospital in the Northern Territory. Overall, there was a disproportionate rate of presentation and admission among Indigenous children. Other key findings were higher proportions of cellulitis, head injury and adolescent presentations. These findings can assist in service planning and in directing future research specific to children in the Northern Territory.