Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2022
Hypofibrinogenaemia and hypocalcaemia in adult trauma patients receiving pre-hospital packed red blood cell transfusions: Potential for supplementary pre-hospital therapeutic interventions.
To report the arrival ionised calcium (iCa) and fibrinogen concentrations in trauma patients treated with packed red blood cells by the road-based high-acuity response units of a metropolitan ambulance service. ⋯ Hypocalcaemia and hypofibrinogenaemia on ED arrival were common in this cohort. Future work should evaluate whether outcomes improve by correction of these deficits during the pre-hospital phase of trauma care.
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Emerg Med Australas · Jun 2022
Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study.
To investigate the association between timing and volume of intravenous fluids administered to ED patients with suspected infection and all-cause in-hospital mortality. ⋯ We observed a reduction in risk of in-hospital mortality for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU suggesting illness severity to be a likely effect modifier.
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Emerg Med Australas · Jun 2022
Exploring nursing and medical perceptions of sepsis management in a New Zealand emergency department: A qualitative study.
Early sepsis recognition and treatment are essential in order to reduce the burden of disease. Initial assessment of patients with infection is often undertaken by ED nurses and resident doctors. This descriptive qualitative study aimed to explore their perceptions and perspectives regarding the factors that impede the identification and management of patients with sepsis. ⋯ ED nurses and doctors have identified important factors that limit and enhance their capacity to recognise and respond to patients with sepsis. Complex interactions exist between clinical and organisational structures that can affect the care of patients and the ability of clinicians to provide optimal care. The three major themes and specific subthemes provide a useful framework and stimulus for service improvements and research that could help foster future sepsis management improvement strategies.
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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.