Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2020
Observational StudyPatients with life-limiting illness presenting to the emergency department.
To examine characteristics, outcomes and flow for patients over the age of 45 years with a life-limiting illness (LLI) presenting to a regional ED. ⋯ A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.
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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.
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Emerg Med Australas · Apr 2020
Leadership challenges of directors of emergency medicine: An Australasian Delphi study.
Emergency medicine (EM) is an emerging profession with complex clinical and leadership demands. However, studies of leadership in EM are in their infancy. The present study makes a novel contribution to empirical research in this area by examining the leadership challenges faced by Australasian directors of emergency medicine (DEMs). ⋯ The recommendation for DEMs is that they need to engage in programmes which will support the development of the leadership and non-clinical skills required to enable them to cope with responsibilities of hybrid role of physician-leader. The development and delivery of specialised leadership programmes attuned to the hybridity of the director role and the complexity of hospitals is vital for ensuring high-quality patient care and successful running of EDs.
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Emerg Med Australas · Apr 2020
Electronic intravenous N-acetyl cysteine ordering tool: A retrospective review.
To examine if the electronic N-acetyl cysteine (NAC) order reduced prescribing errors. ⋯ The use of this electronic NAC order removed errors in NAC prescription and should be considered for prescribing and administering i.v. NAC.
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Emerg Med Australas · Apr 2020
Clinician-led design for optimising flow: Seizing the opportunity for a new-build Australian Emergency Department.
A new ED build creates a unique opportunity to improve the way we provide clinical care. Often, the focus is primarily on increasing clinical cubicle numbers but this may have a negligible, or even negative impact on care delivery. ⋯ This relationship between clinicians and architects should remain collaborative but requires re-alignment. Independent, expert ED-specific designers can empower and provide valuable support for clinician-led design teams in their interactions with architects.