Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2020
Overuse of opioids for acute migraine in an Australian emergency department.
Acute migraine is associated with significant personal, economic and work-related disability. Management guidelines advise the use of simple analgesia, triptans, chlorpromazine and anti-emetics based on severity, with avoidance of opioids. We aimed to determine consistency of prescribing patterns in our ED with national guidelines. ⋯ We observed considerable polypharmacy in ED migraine management with inconsistent prescribing patterns. Recommended medications were infrequently used and opioid use was common. Factors influencing prescribing patterns require further investigation in order to improve rates of guideline recommended treatment.
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Emerg Med Australas · Oct 2020
Emergency department care for low back pain: Should we adopt recommendations from primary care guidelines?
ED visits for low back pain are increasing, but the lack of specific guidance for emergency physicians impedes evidence-based care, and adopting primary care recommendations may not be appropriate. The ED sees a different spectrum of low back pain presentations, where physicians are likely to encounter a larger proportion of patients with an underlying serious pathology or non-spinal diseases than in primary care. Current low back pain guidelines do not adequately cover screening for these conditions, but making a differential diagnosis is crucial in emergency patients with low back pain. In this article, we also discuss the challenges in developing specific ED guidelines for low back pain, the limited evidence on the profile of these patients and the surprising dearth of randomised trials.
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Emerg Med Australas · Oct 2020
High-sensitivity troponin T use in non-chest pain presentations in the emergency department.
To explore troponin testing yield in patients who present to the ED without chest pain. ⋯ Despite ED troponin testing in the absence of chest pain being common practice, it rarely assisted in a meaningful diagnosis. Consequences of testing may include delays to patient discharge and additional downstream testing.
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As a complex space that can be interpreted on individual, societal and systemic levels, there is a need for analysis of emergency medicine that transcends the biomedical paradigm to explore its sociological influences. The ED is a social structure of different roles, responsibilities and relationships that can be analysed through observation of the different institutionalised activities which highlight the hierarchies and culturally influenced interactions taking place between actors. Institutionalised activities that provide insight into the social structure of the ED include deference to doctors by patients in the context of environmental chaos, segregated handover of information and discharge-oriented patient care that de-emphasises the impact of social background.