Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2018
Behavioural assessment unit improves outcomes for patients with complex psychosocial needs.
We aimed to assess the impact of a new model of care for patients presenting to the ED with acute behavioural disturbance. ⋯ A unit specifically designed to improve the care of patients requiring prolonged ED care due to mental illness and/or intoxication reduces the time spent in the ED and the use of some restrictive interventions. We recommend this model of care to EDs that care for this complex and challenging group of patients.
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Emerg Med Australas · Jun 2018
Cervical spine traumatic epidural haematomas: Incidence and characteristics.
Cervical spine traumatic epidural haematomas (CSTEH) can cause potentially devastating neurological deficits if not promptly identified. Study aims were to determine the incidence, characteristics and outcomes for patients with CSTEH. ⋯ This study shows a high incidence of CSTEH among trauma patients. CSTEH is associated with significant morbidity and mortality. High clinical vigilance is required to allow the request and acquisition of urgent magnetic resonance imaging to diagnose CSTEH as the entity is often not evident on initial cervical spine computed tomography investigations.
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Gender equality and workforce diversity has recently been in the forefront of College discussions. Reasons for the difference between various groups may not be as they initially appeared. The results of comparing the outcome between two groups can sometimes be confounded and even reversed by an unrecognised third variable. ⋯ Secondly, a strong association between Department and gender: females tended to apply to Departments with lower admission rates. The explanation of differences between groups can be multifactorial. A search for possible confounders will assist in this understanding. This could apply whenever two groups initially appear to differ, but on closer analysis this difference is either unfounded, or even reversed by reference to a third, confounding variable.
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Emerg Med Australas · Jun 2018
Prehospital analgesic choice in injured patients does not impact on rates of vomiting: Experience from a New South Wales primary retrieval service.
This study aimed to explore the analgesic regimes adopted in our contemporary retrieval practice and the incidence of vomiting in ED after prehospital analgesic use. ⋯ The frequency of vomiting in the retrieved patients observed in our study was less than previously reported in the literature. Opioids still prevailed over ketamine as the preferred initial analgesic, with ketamine most commonly used as an adjunct. Multi-centre trials in this field would be preferable in future in view of the relatively low incidence of vomiting in retrieved trauma patients.
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Emerg Med Australas · Jun 2018
'What the hell is water?' How to use deliberate clinical inertia in common emergency department situations.
Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. ⋯ The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures. Awareness is key to identifying these opportunities to practice deliberate clinical inertia, as many of the situations may be so much a part of our environment that they are hidden in plain view.