Emergency medicine Australasia : EMA
-
Emerg Med Australas · Apr 2020
Demand for global health training and experiences among emergency medicine trainees in Australia and New Zealand.
Demand for global health (GH) training and experiences among emergency medicine trainees is unknown. The primary objective of the Trainee Interest in Global Health Training (TIGHT) study was to quantify the number of trainees interested in completing a rotation in a resource-limited environment within a low- or middle-income country during their specialty training. ⋯ Notwithstanding the limitations of a self-reporting survey with a sub-optimal response rate, there is significant demand for GH training and experiences among ACEM trainees. These findings should inform the development of safe and effective global emergency care training pathways, underpinned by mutually beneficial, international partnerships with educational and development objectives.
-
Emerg Med Australas · Apr 2020
Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004-05 to 2016-17.
To examine trends of ED presentations with a mental health (MH) diagnosis in Australia and its jurisdictions by diagnostic group between 2004-05 and 2016-17. ⋯ Between 2004-05 and 2016-17, rates of ED presentations increased across most MH diagnostic groups, but particularly psychoactive substance use-related disorders. To reduce the need for MH crisis care in Australian EDs, strategies are required to reduce psychoactive substance use in the community, and policies may be needed to strengthen the capability of community MH services and primary care professionals to recognise, diagnose and treat earlier in the course of illness.
-
Emerg Med Australas · Apr 2020
Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: A retrospective cohort study.
To assess whether the initiation of vasopressor infusions via peripheral venous catheters (PVC) compared to central venous catheters (CVC) in ED patients with early septic shock was associated with differences in processes of care and outcomes. ⋯ The practice of commencing a vasopressor infusion via a PVC was common in the ARISE trial and more frequent in trial participants with higher severity of illness. Commencement of a vasopressor infusion via a PVC was associated with some improvements in processes of care and, after adjustment, was not associated with an increased risk of death.
-
Emerg Med Australas · Apr 2020
Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review.
Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paediatric population, there has been limited uptake of these principles and a paucity of data to support a change in practice. This paper summarises the available evidence in the published literature through a systematic review, presented in narrative format. ⋯ The early identification of hypo-fibrinogenemia and acute traumatic coagulopathy in paediatric trauma using VHA testing and subsequent early fibrinogen replacement with a concentrated off the shelf product is an attractive treatment option. However, there is currently insufficient high-level evidence to support the use of fibrinogen concentrate over cryoprecipitate in the paediatric trauma population. Pilot studies currently under way will go some way to addressing this important knowledge gap, and facilitate the design of larger definitive multi-centre randomised trials.
-
Emerg Med Australas · Apr 2020
Observational StudyRisk variables associated with abnormal calcium, magnesium and phosphate levels among emergency department patients.
The utility of calcium, magnesium and phosphate measurement in the ED is limited. We aimed to determine clinical risk variables for abnormal levels of these electrolytes in order to inform the development of an ordering guideline. ⋯ A range of demographic, comorbid, medication and clinical variables are associated with abnormal calcium, magnesium and phosphate levels. These findings will inform the development of clinical guidelines to rationalise calcium, magnesium and phosphate testing. Justification may be required for testing patients with no risk variables.