Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2018
ReviewReview article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series).
Neck pain and whiplash injuries are a common presentation to the ED, and a frequent cause of disability globally. This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. ⋯ Consistent evidence was found to support the use of 'red flags' to screen for serious pathologies, judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance. Clinicians may also consider applying risk-stratification methods, such as using a clinical prediction rule, to guide patient discharge and referral plans; however, the evidence is still emerging in this population. This rapid review provides clinicians managing neck pain in the ED a summary of the best available evidence to enhance quality of care and optimise patient outcomes.
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Emerg Med Australas · Dec 2018
Management of post-partum haemorrhage in the Timor Leste National Ambulance Service.
Timor Leste has one of the highest maternal death rates in the world at 215 per 100 000 live births.1 Post-partum haemorrhage (PPH) accounts for 27% of maternal deaths globally. Annually the Timor Leste National Ambulance Service (TLNAS) attends over 20 000 cases, of which 2% are diagnosed with PPH. The objective of this study was to evaluate prehospital care of PPH patients transported by the TLNAS. ⋯ This research has shown that paramedics are not consistently using available clinical interventions.
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Emerg Med Australas · Dec 2018
Testing a new form to document 'Goals-of-Care' discussions regarding plans for end-of-life care for patients in an Australian emergency department.
There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. ⋯ Having a Goals-of-Care form in emergency medicine is supported; the ideal contents of the form was not determined.
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Emerg Med Australas · Dec 2018
Case ReportsThe need for improving access to emergency care through community involvement in low- and middle-income countries: A case study of cardiac arrest in Hanoi, Vietnam.
Out-of-hospital cardiac arrest patients require immediate interventions by bystanders and emergency medical services (EMS). However, in many low- and middle-income countries (LMIC), bystanders witnessing a cardiac arrest rarely perform chest compressions and contact EMS. This paper attempts to draw lessons from a case of a patient with a cardiac arrest who could have survived with immediate interventions. ⋯ Ventricular fibrillation due to electrocution is a benign type of cardiac arrest. The chance of survival increases with immediate chest compressions and prompt defibrillation. We discuss the reasons why the bystanders did not perform resuscitation or contact EMS and identify approaches for the improvement of pre-hospital care in LMICs.
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Emerg Med Australas · Dec 2018
Low major trauma confidence among emergency physicians working outside major trauma services: Inevitable result of a centralised trauma system or evidence for change?
Regionalised civilian trauma systems improve patient outcomes, but may deskill clinicians outside major trauma services (MTSs). We aimed to characterise experience and confidence in trauma management among emergency physicians working in MTS to those working elsewhere. ⋯ Exposure to major trauma is associated with time spent working in a MTS and exposure is associated with confidence. A mature inclusive trauma system must ensure clinicians across the system gain the experience or training to provide trauma care that will result in similar outcomes for patients regardless of initial presenting hospital.