Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2020
Lactate, bicarbonate and anion gap for evaluation of patients presenting with sepsis to the emergency department: A prospective cohort study.
A serum lactate level >2 mmol/L has been chosen as the preferred cut-off value for screening of patients with suspected sepsis. In patients with suspected sepsis presenting to the ED, we aimed to determine the outcomes of patients with initial lactate levels ≤2 mmoL/L, but abnormal bicarbonate or anion gaps (AGs). ⋯ A normal lactate level alone should not be used to exclude life-threatening sepsis. Patients with metabolic acidosis characterised by low bicarbonate or high AG levels, but with normal lactate levels, have high rates of ICU requirement and mortality and should also be considered for early, aggressive therapy.
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Emerg Med Australas · Feb 2020
Emergency first aid readiness in Antarctica: Australian Antarctic expeditioners' first aid credentials and self-efficacy.
To help prevent future morbidity and mortality, this study examined Australian Antarctic expeditioners' first aid credentials and self-efficacy in providing emergency first aid in extreme environments. ⋯ These findings revealed that many Antarctic expeditioners may not be adequately prepared for first aid emergencies and have low confidence in handling complex medical situations. Based on these findings, we recommend higher first aid qualifications and training tailored to the Antarctic context. These modest steps can help prevent unnecessary and costly morbidity and mortality for extreme-condition expeditioners.
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Emerg Med Australas · Feb 2020
Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study.
While cervical spine injuries (CSIs) are rare in the paediatric population, presentations to EDs with possible neck injuries are common. Based on a lack of Australian data we set out to determine how many possible injuries are clinically cleared, what imaging is used on the remainder and the incidence and characteristics of confirmed paediatric CSIs. ⋯ While two-thirds of children with potential CSIs undergo radiological evaluation, actual injuries are rare (<4%). These data suggest that there is a potential for improved targeting of cervical spine imaging for trauma. The development of a clinical decision tool may help reduce neck radiography.