Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2018
In-hospital 'CODE STEMI' improves door-to-balloon time in patients undergoing primary percutaneous coronary intervention.
Reducing time to reperfusion for ST-segment elevation myocardial infarction (STEMI) is essential in improving outcomes. Consequently, numerous strategies have been employed to reduce median door-to-balloon time (DTBT). ⋯ The novel in-hospital in-hours CODE STEMI notification system significantly reduced DTBT in patients undergoing PPCI.
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Emerg Med Australas · Apr 2018
Managing non-serious low back pain in the emergency department: Time for a change?
Low back pain is a common condition seen in the ED. However, its management in this setting has received relatively little attention and there have been few efforts to develop strategies to improve emergency care of low back pain. ⋯ In this paper, we describe the usual emergency care provided for non-serious low back pain and present possible strategies for restructuring ED practice and approaches for changing physician and patient behaviour. A better understanding of how non-serious low back pain is currently being managed and discussion on how to provide evidence-based care according to current guideline recommendations will help emergency physicians improve the value of care for these patients.
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Emerg Med Australas · Apr 2018
Non-invasive ventilation use in status asthmaticus: 16 years of experience in a tertiary intensive care.
To describe the use of non-invasive ventilation (NIV) in adults presenting with status asthmaticus to Middlemore Hospital Critical Care Complex (CCC, South Auckland, New Zealand) from 2000 to 2015. ⋯ The use of NIV appears to be safe and effective in patients with severe asthma, including selected patients with an altered level of consciousness. NIV was well tolerated with a low need for subsequent intubation.
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Emerg Med Australas · Apr 2018
Don't just do something, stand there! The value and art of deliberate clinical inertia.
It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. ⋯ The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted. Several strategies to promote deliberate clinical inertia are outlined, with an emphasis on shared decision-making. Preventing medical harm must become one of the pillars of modern health care and the art of not intervening, that is, deliberate clinical inertia, can be a novel patient-centred quality indicator to promote harm reduction.
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Emerg Med Australas · Apr 2018
Patient perspectives on priorities for emergency medicine research: The PERSPEX study.
To determine the priorities for emergency medicine research of patients currently in an ED and to compare their priorities with those of ACEM researchers. ⋯ The top 5 emergency medicine research priorities nominated by patients in ED were cardiology, trauma, ED processes, mental health and haematology/oncology, although many 'system priorities' were identified as well. These priorities were generally consistent with ACEM researchers, but patients also suggested alternative directions for future research.