Emergency medicine Australasia : EMA
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As a complex space that can be interpreted on individual, societal and systemic levels, there is a need for analysis of emergency medicine that transcends the biomedical paradigm to explore its sociological influences. The ED is a social structure of different roles, responsibilities and relationships that can be analysed through observation of the different institutionalised activities which highlight the hierarchies and culturally influenced interactions taking place between actors. Institutionalised activities that provide insight into the social structure of the ED include deference to doctors by patients in the context of environmental chaos, segregated handover of information and discharge-oriented patient care that de-emphasises the impact of social background.
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Emerg Med Australas · Oct 2020
Utility of lumbar puncture after a normal brain computed tomography scan in patients presenting to the emergency department with suspected subarachnoid haemorrhage: A new more rational approach?
The diagnostic approach for patients presenting to EDs with headaches suspicious for subarachnoid haemorrhage (SAH) remains challenging. Modern third-generation computed tomography (CT) has been shown to be extremely sensitive in identifying SAH and may eliminate the need for lumbar puncture (LP) which is an invasive, time-consuming procedure with limited accuracy and complications. The aim of this study is to assess the utility of LP in patients being evaluated for possible SAH in the ED after a negative non-contrast CT scan of the brain, as well as addressing the knowledge gap in regard to rational diagnostics among clinicians. ⋯ LP is not required in all patients with suspected SAH who have a negative CT scan. There are defining patient characteristics that can be used to risk stratify patients and may eliminate the need for LP.
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EDs in Indonesia face an unprecedented increase in patient influx after the expansion of national health insurance system coverage. The present study aims to describe EDs' characteristics and capabilities utilisation in Jakarta. ⋯ Physicians with limited experience and EDs with heterogeneous emergency care capabilities likely threatened the consistency of quality emergency care, particularly for time-sensitive conditions. Our study provides a benchmark for future improvements in emergency care.
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Emerg Med Australas · Oct 2020
Observational StudyWhat is the distribution of Aortic Dissection Detection Risk Score in an undifferentiated emergency department chest pain population?
To determine the distribution of Aortic Dissection Detection Risk Score (ADDRS) in undifferentiated chest pain patients. ⋯ Widespread use of the ADDRS and its investigation protocol cannot be supported.