Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2017
Ventilatory choices for intubated patients during helicopter stretcher winching.
The winching of intubated patients on a stretcher into a helicopter is a rare event. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. Theoretically automatic ventilation would provide improved oxygenation, more stable arterial carbon dioxide levels and a reduced risk of airway disconnection. Furthermore, the stretcher attendant may better perform winching procedures with higher situational awareness, contributing to crew and patient safety. However ventilator failure, and the diagnosis and management of such, is of concern. ⋯ During helicopter winching, automatic ventilation is superior in providing controlled, consistent and reliable ventilation for intubated patients. The stretcher attendant is also able to provide more attention to the winching manoeuvres with subsequent safety gains. The risk of automatic ventilator failure is low.
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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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Time is integral to emergency medicine, but the importance of time is over-rated. Media promotes a focus on time over suffering. Terms such as the 'golden hour' and 'time is muscle' are embedded into our language, but is language that corrupts thought. ⋯ This highlights the importance of nuanced judgements. We need to get into the Goldilocks zone of the 'just right' balance between speed and accuracy. This essay challenges us to focus more on the suffering human subject, rather than on time-based metrics that reflect our hope bias.
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Emerg Med Australas · Dec 2017
Letter Review Case ReportsTraumatic dislocation of the first rib: A case report and review of the literature.
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Emerg Med Australas · Dec 2017
ReviewReview article: Sepsis in the emergency department - Part 1: Definitions and outcomes.
Sepsis has recently been redefined as acute organ dysfunction due to infection. The ED plays a critical role in identifying patients with sepsis. ⋯ While overall mortality rates from sepsis appear to be falling, there is an increasing burden of morbidity among survivors. This largely reflects the growing proportion of older patients with comorbid illnesses among those treated for sepsis.