Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2024
Observational StudyComputed tomography pulmonary angiogram ordering, adherence to decision rules and yield in the emergency department: An observational study.
Pulmonary embolism (PE) frequently requires diagnosis through CT pulmonary angiogram (CTPA). Appropriate application of evidence-based clinical decision tools can reduce unnecessary CTPAs. This study assessed adherence to and the efficacy of various aspects of the Queensland Health suspected PE diagnostic pathway, including Wells score, PE rule out criteria (PERC) and age-adjusted D-dimer interpretation. ⋯ Guideline adherence can be improved, and adherence to existing clinical decision tools may reduce unnecessary CTPA ordering and increase diagnostic yield. The use of the age-adjusted D-dimer had good sensitivity, whereas the new PTP approach will require further prospective research.
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Emerg Med Australas · Oct 2024
Observational StudyGender differences in female and male Australian football concussion injury: A prospective observational study of emergency department presentations.
To examine gender differences in Australian football (AF)-related concussion presentations to EDs in regional Australia. ⋯ Concussion rates for community-level AF presentations to regional EDs were similar between genders. Serious head injury was rare, although hospital admission for observation was common. Concurrent injuries were common, with associated neck injury most often identified. Match play accounted for the majority of head injuries.
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Emerg Med Australas · Oct 2024
Cost-effectiveness analysis of an ambulance service-operated specialised cardiac vehicle with mobile extracorporeal cardiopulmonary resuscitation capacity for out-of-hospital cardiac arrests in Queensland, Australia.
Extracorporeal CPR (E-CPR) has been primarily limited to the in-hospital setting. A few systems around the world have implemented pre-hospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians required for the performance of E-CPR on-scene. However, evidence of the outcomes and cost-effectiveness of mobile E-CPR remain to be established. We evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service in the state of Queensland, Australia. ⋯ Pre-hospital E-CPR may be cost-effective. Successful implementation of a pre-hospital E-CPR programme requires substantial planning, training, logistics and operational adjustments.
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Emerg Med Australas · Oct 2024
Post-lockdown burden of road injury involving hospitalisation in Victoria, Australia: A statewide, population-based time series analysis.
Ever since COVID-19, short-term changes in transport injury patterns have been observed. The aim is to examine both the initial and the enduring impact of government lockdown and the pandemic on road injuries requiring hospitalisation and road fatalities. ⋯ Road injury requiring hospitalisation decreased significantly during governmental lockdown and has returned to three-quarters of pre-pandemic levels (except bicyclist injuries that have remained constant), but there is an increasingly disproportionate number of fatalities. This represents a new baseline of injury burden for EDs and hospitals that manage trauma patients.
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Emerg Med Australas · Oct 2024
ReviewPractical strategies for caring for patients with functional neurological disorder in the ED.
Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. ⋯ A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.