Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2022
Out-of-hospital cardiac arrest outcomes, end-tidal carbon dioxide and extracorporeal cardiopulmonary resuscitation eligibility: New South Wales pilot data.
To describe on-scene times for out-of-hospital cardiac arrests (OHCA) transferred to hospital, the number of these that were extracorporeal cardiopulmonary resuscitation (ECPR) eligible and potential association between end-tidal carbon dioxide (ETCO2 ) and survival so as to inform planned interventional studies. ⋯ Average on-scene time did not differ on survivorship. A small number of transferred patients with OHCA were ECPR eligible. ETCO2 less than 20 mmHg portends adverse prognosis. Our data will be used for future interventional studies.
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Emerg Med Australas · Jun 2022
An initial Glasgow Coma Scale score of 8 or less does not define severe brain injury.
The wide-spread use of an initial 'Glasgow Coma Scale (GCS) 8 or less' to define and dichotomise 'severe' from 'mild' or 'moderate' traumatic brain injury (TBI) is an out-dated research heuristic that has become an epidemiological convenience transfixing clinical care. Triaging based on GCS can delay the care of patients who have rapidly evolving injuries. ⋯ Nearly 50 years after the development of the GCS - and the resultant misplaced clinical and statistical definitions - TBI remains a heterogeneous entity, in which 'best practice' and 'prognoses' are poorly stratified by GCS alone. There is an urgent need for a paradigm shift towards more effective initial assessment of TBI.
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Emerg Med Australas · Jun 2022
Effect of computed tomography scanner location on time-to-computed tomography in the emergency department: A before and after study.
To compare time metrics associated with a temporary disruption to ED computed tomography (CT) scanner location from adjacent to the ED with direct access from resuscitation rooms, to a location remote to the ED. ⋯ Although rapid, proximate access to CT scanning is often considered desirable in terms of the management of trauma and other time-critical emergencies, the wider time and resource implications demonstrated in this study suggest a potential broader benefit to co-located CT scanning in ED. Our experience could be considered in future re-design of EDs.
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Emerg Med Australas · Jun 2022
Effects of staff grade, overcrowding and presentations on emergency department performance: A regression model.
To examine the effect of staffing levels by experience of medical officers and overcrowding on ED key performance indicators (KPIs). ⋯ Increasing numbers of FACEM and non-FACEM SDM, but not junior staff, and a reduction in overcrowding as measured by the number of admitted patients boarded in the ED at 8 am, were associated with improvements in the ED performance.