Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2017
Rational clinical evaluation of suspected acute coronary syndromes: The value of more information.
Many meta-analyses have provided synthesised likelihood ratio data to aid clinical decision-making. However, much less has been published on how to safely combine clinical information in practice. We aimed to explore the benefits and risks of pooling clinical information during the ED assessment of suspected acute coronary syndrome. ⋯ We showed that there is a definable point where additional information becomes uninformative and may actually lead to less certainty. This evidence supports the concept that clinical decision-making in the assessment of suspected acute coronary syndrome should be focused on obtaining the least amount of information that provides the highest benefit for informing the decisions of admission or discharge.
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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
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
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
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.