Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2019
Comparative StudyComparison of emergency physiotherapy practitioner prescribers versus existing emergency department prescribers for musculoskeletal injuries.
The scope of selected emergency physiotherapy practitioners (EPP) in this Australian non-tertiary ED has recently extended to include the prescription of a limited drug formulary, including paracetamol, some NSAIDs and opioids, an anti-emetic, a benzodiazepine and nitrous oxide. Although there are large-scale studies investigating prescription errors made by doctors, there is a lack of data on prescribing practices of physiotherapists in the ED setting. The aim of present study is to compare the prescribing practices of EPP to their medical and nursing colleagues within the setting of treating musculoskeletal injuries in the ED. ⋯ In the management of ED patients with musculoskeletal complaints, prescription-trained EPP appear to perform similarly if not better than their medical and nursing colleagues with regards to NIMC audit tool results.
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Emerg Med Australas · Dec 2019
Role and impact of brain computed tomography in the management of drug overdoses and guideline recommendations.
Patients presenting with overdoses commonly receive computed tomography brain (CTB) scans in their assessment. There is no current guideline or validated decision support tool for neuroimaging in overdose patients. We investigated the proportion of overdose patients who received a CTB scan and its impact on management. ⋯ A high proportion of overdose patients received CTB scans. There was only a low yield in terms of management alteration. We propose that clinicians adopt a guided approach using a decision support tool to minimise unnecessary CTB scans.
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Emerg Med Australas · Dec 2019
Beta-blocker use is an independent risk factor for thunderstorm asthma.
To identify risk factors for thunderstorm asthma (TA) in subjects ≥15 years of age from information available in routine clinical records. ⋯ Oral beta-blocker medications, younger age and Asian-born heritage are risk factors for TA. Further study is required to explore the potential association between beta-blockers and TA.
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Emerg Med Australas · Dec 2019
Prehospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A retrospective eligibility study.
We sought to identify out-of-hospital cardiac arrest (OOHCA) patients who might benefit from a future prehospital extracorporeal cardiopulmonary resuscitation (ECPR) programme in a moderately sized city. We described the 2014 OOHCA data and identified those who fulfilled hypothetical prehospital ECPR eligibility criteria. ⋯ Sixty-three (30.6%) patients could have derived benefit from a prehospital ECPR programme. Further analyses of prehospital ECPR logistics and economics are necessary to ensure that any future prehospital ECPR programme is effective and efficient.
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Emerg Med Australas · Dec 2019
Multicenter Study Observational StudyHeterogeneous emergency department management of published recommendation defined hypotension in patients with acute traumatic spinal cord injury: A multi-centre overview.
Evidence-based management for patients with acute traumatic spinal cord injury (TSCI) in the ED has a critical impact on long-term outcomes. Acute hypotension post-injury may compromise spinal cord perfusion and extend neurological damage. Published guidelines recommend mean arterial blood pressure (BP) maintenance between 85 and 90 mmHg for 7 days post-injury; the extent to which this is followed in Australia is unknown. ⋯ Hypotensive patients' post-TSCI experienced heterogeneous ED care discordant with published guidelines; varying by hospital type. Specialist care and more severe injury increased likelihood of guideline adherence. Lack of adherence may influence patient outcomes. Level 1 evidence is needed along with consistent guideline implementation and clinician training to likely improve TSCI management and outcomes.