Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2018
Observational StudyFactors associated with patient-reported procedural memory following emergency department procedural sedation with ketamine and propofol: A prospective cohort of 563 patients.
To describe the proportion of patients reporting procedural memory following procedural sedation and analgesia (PSA) with ketamine and propofol (KP) administered premixed together (ketofol) or individually (sequential KP) in ED attendees. Identify any clinical or demographic variables associated with procedural memory. ⋯ Procedural memory was uncommon for both mix types; however, a greater proportion of the premixed ketofol group had unpleasant memory. Associations with sex, opiates, moderate sedation and propofol dose were identified, and respiratory adverse events were more common in the premixed ketofol group.
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Emerg Med Australas · Apr 2018
Randomized Controlled Trial Observational StudyTiming of antibiotics in the management of community-acquired sepsis: Can a randomised controlled trial of prehospital therapy provide answers?
Significant tension surrounds the application of antibiotics in suspected infection. Guidelines stress the importance of early empirical broad-spectrum therapy, with select observational data suggesting inferior outcomes when this is delayed. ⋯ Controlled trial data are urgently needed, although many clinicians would find withholding of antibiotic therapy unethical. A trial of prehospital antibiotic administration (by paramedics) in patients with suspected sepsis would therefore provide crucial data, and go a long way to determining whether earlier empirical therapy does actually improve outcomes.
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Emerg Med Australas · Apr 2018
Predicting re-presentation following discharge from the emergency department with non-specific chest pain.
To determine the 30 day major adverse cardiac events (MACE) and re-presentation rates of non-specific chest pain (NSCP) patients following four different disposition pathways and to contrast re-presentation rates of patients with NSCP with those for all other patients presenting to the ED. ⋯ Despite a slightly increased rate of re-presentation in patients with NSCP sent home from the ED, we conclude that there is minimal advantage in admitting many patients who lack a diagnosis for their chest pain. For a selected patient population, discharge from the ED may become a safe and cost-effective approach. A prospective randomised study is required.
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Emerg Med Australas · Apr 2018
Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin-Fab.
The aim of the present study was to compare clinical features of patients with elevated serum digoxin concentrations who were treated with digoxin-Fab with those where the immunotherapy was not given by a tertiary hospital toxicology service. ⋯ Digoxin-Fab was more commonly administered when heart rate was <51/min. It had a small effect on increasing heart rate; however, individual response to digoxin-Fab was variable as patients were using other negative chronotropic medications. In symptomatic bradycardic patients on multiple heart failure medications, positive chronotropic and potassium-lowering therapies should be considered in concert with digoxin-Fab.