Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2019
ReviewReview article: Common emergency department presenting complaints of prisoners: A systematic review.
Prisoners are a particularly vulnerable minority group whose healthcare needs and management differ substantially from the general population. The overall burden of disease of prisoners is well documented; however, little is known regarding the aetiology and frequency of prisoners' acute medical complaints requiring an ED visit. Objectives of the review were to identify, review and appraise existing literature regarding prisoners' presentations to EDs. ⋯ Apart from two European studies in the past 5 years, there is a scarcity of literature primarily addressing the common presenting complaints to EDs by prisoners. Existing studies demonstrated that prisoners have a disproportionately high burden of traumatic, infectious and psychiatric disease requiring emergency treatment. With the increasing number of emergency presentations made by prisoners each year, it is vital that further research is undertaken to identify trends of these acute medical complaints in order to ensure optimal therapeutic outcomes for prisoners.
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Emerg Med Australas · Apr 2019
ReviewReview article: Antiemetics in the pre-hospital setting: A systematic review of efficacy and safety.
Antiemetics are medications that are frequently used in the pre-hospital setting. However, recent evidence indicates that antiemetics are ineffective in reducing undifferentiated nausea scores and vomiting rates. The aim of this study is to evaluate the efficacy and safety of antiemetics administered in the pre-hospital setting. ⋯ Further rigorous studies, preferably randomised and double blinded control trials are required to establish the efficacy of antiemetics in the pre-hospital setting. Consequently, antiemetics should be used more selectively and reserved for severe nausea and intractable vomiting in the pre-hospital setting. PROSPERO registration number: CRD42016044090.
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Emerg Med Australas · Apr 2019
Multicenter Study Comparative StudyEffect of a clinical flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer on pulmonary embolism diagnosis, scan rates and diagnostic yield.
To assess the association between the use of a flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer and subsequent imaging and yield rates of computed tomography pulmonary angiogram and nuclear medicine ventilation perfusion scans being ordered in the ED for the assessment of pulmonary embolism. ⋯ The introduction of a clinical flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer was associated with an increase in ED computed tomography pulmonary angiogram and nuclear medicine ventilation perfusion yield rate from 9.9% to 16.5% across the three enrolment hospitals when investigating possible pulmonary embolism. This corresponded to a 40% relative reduction in pulmonary embolism imaging. Diagnosis rates remained unchanged and no cases of missed pulmonary embolism attributable to the flowchart were identified.