Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2021
When patients behave badly: Consent, breach of the duty of care and the law.
Patients who are abusive or aggressive in ED raise special clinical and legal challenges. These include what steps clinicians should take to exclude serious illness/injury as the cause of the behaviour and when investigations or treatments can be imposed on these patients without their consent. Using a case illustration, this paper discusses legal issues which arise in this context, including how the standard of care owed by clinicians is determined and what may constitute a breach of duty; such patients' right to consent to (or decline) tests and treatment; and when clinicians may lawfully act without consent and/or control the patient's behaviour.
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Emerg Med Australas · Feb 2021
Is lactate lower in septic patients who are prescribed beta blockers? Retrospective cohort study of an intensive care population.
Elevated serum lactate has long been considered an important marker of sepsis severity. Increasing evidence supports catecholamine-stimulated aerobic glycolysis being a major contributor to the hyperlactataemia seen in sepsis. Beta-blockade may blunt such catecholamine mediated rise in lactate analogous to the way it can mask tachycardia. This could impact the way we evaluate sepsis severity and adequacy of initial treatment. The objective of this study is to investigate whether septic patients who were on beta-blocker treatment at presentation have lower serum lactate level. ⋯ In our cohort pre-existing beta blocker treatment was associated with lower serum lactate measurements in patients presenting with sepsis. Pre-existing beta blocker treatment may reduce serum lactate at presentation in patients with sepsis.
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Emerg Med Australas · Feb 2021
Impact of a new specialist alcohol and drug brief intervention service model integrated into the emergency department: An interrupted time series analysis.
To describe and examine the impact of a new specialist drug and alcohol brief intervention team (DABIT) model integrated into the ED on the identification of individuals at risk of future alcohol and other drug (AOD)-related harm. A cost-outcome analysis was conducted to assess the impact on costs per referral. ⋯ Integration of a specialist brief intervention AOD model to support ED care may increase uptake of specialist AOD treatment and could be beneficial from an economic efficiency viewpoint.
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A trauma patient with cardiac tamponade may not survive transfer to the operating theatre for pericardial decompression. This article describes an approach to a resuscitative thoracotomy in the ED, which may be life-saving in these patients when a cardiothoracic surgeon is not immediately available.
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Emerg Med Australas · Feb 2021
Incidence, bystander emergency response management and outcomes of out-of-hospital cardiac arrest at exercise and sport facilities in Australia.
Despite growing emphasis on automated external defibrillators (AEDs) at sport venues in Australia, the risk of cardiac events at such locations is unknown. The aim of the present study was to investigate the incidence of out-of-hospital cardiac arrest (OHCA) at exercise and sport facilities (ESF) in Australia and the impact of effective bystander-initiated CPR and AED use on return of spontaneous circulation (ROSC) to hospital admission. ⋯ These findings have implications for policy development by government agencies and major sport and exercise organisations to improve bystander CPR and AED. This can help to ensure that ESF can properly respond to cardiac emergencies to save lives.