Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2018
Why do 'fast track' patients stay more than four hours in the emergency department? An investigation of factors that predict length of stay.
Low-acuity 'fast track' patients represent a large portion of Australian EDs' workload and must be managed efficiently to meet the National Emergency Access Target. The current study determined the relative importance and estimated marginal effects of patient and system-related variables in predicting ED fast track patients who stayed longer than 4 h in the ED. ⋯ We identified the most important variables for predicting length of stay greater than 4 h for fast track patients in our ED. Identifying factors that influence length of stay is a necessary step towards understanding ED patient flow and identifying improvement opportunities.
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Emerg Med Australas · Oct 2018
ReviewReview article: Investigations and the pregnant woman in the emergency department - part 1: Laboratory investigations.
Accurate assessment of the pregnant patient in the ED depends on knowledge of physiological changes in pregnancy, and how these changes may impact on pathology tests, appearance on point-of-care ultrasound and electrocardiography. In addition the emergency physician needs to be cognisant of disorders that are unique to or more common in pregnancy. Part 1 of this review addresses potential deviations in laboratory investigation reference intervals resulting from physiological alterations in pregnancy, and the important causes of abnormal laboratory results in pregnancy. Part 2 will address the role of point-of-care ultrasound in pregnancy, physiological changes that may affect interpretation of point-of-care ultrasound, physiological changes in electrocardiography, and the safety of radiological procedures in the pregnant patient.
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Emerg Med Australas · Oct 2018
ReviewAmiodarone for sustained stable ventricular tachycardia in the prehospital setting.
Amiodarone is commonly used in the treatment of stable ventricular tachycardia (VT), but its efficacy has not been empirically examined in the prehospital setting. The objective of this study was to examine the safety and efficacy of amiodarone administered by paramedics to patients with stable VT. ⋯ Approximately half of the patients treated with amiodarone reverted from VT while under paramedic care. Patient deterioration was rare, with cardiac arrest or requirement for cardioversion occurring very infrequently. Amiodarone was relatively safe and moderately effective for the treatment of sustained stable VT. However, given recent evidence of increased efficacy of procainamide for stable VT, further studies are required in the prehospital setting to compare these two drugs.