Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2017
Rational clinical evaluation of suspected acute coronary syndromes: The value of more information.
Many meta-analyses have provided synthesised likelihood ratio data to aid clinical decision-making. However, much less has been published on how to safely combine clinical information in practice. We aimed to explore the benefits and risks of pooling clinical information during the ED assessment of suspected acute coronary syndrome. ⋯ We showed that there is a definable point where additional information becomes uninformative and may actually lead to less certainty. This evidence supports the concept that clinical decision-making in the assessment of suspected acute coronary syndrome should be focused on obtaining the least amount of information that provides the highest benefit for informing the decisions of admission or discharge.
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Emerg Med Australas · Dec 2017
Observational StudyProspective observational study of predicted usage of intravenous cannulas inserted in a tertiary paediatric emergency department.
To determine the proportion of unused peripheral intravenous cannulas (PIVCs) inserted in a paediatric emergency department (PED) and to assess clinicians' abilities to predict future usage of PIVC. ⋯ This study is consistent with the idle PIVC rates observed in PEDs but there is potential to further reduce this rate with targeted insertion. The paediatric clinicians' reliability in predicting PIVC use has been demonstrated for the first time and we have identified four groups where targeted phlebotomy rather than i.v. cannulation would reduce unused cannulas.
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Emerg Med Australas · Dec 2017
Comparison of four methods of endotracheal tube passage in simulated airways: There is room for improved techniques.
Endotracheal intubation requires laryngoscopy followed by passage of the endotracheal tube (ETT). Tube passage can be difficult, but there is little evidence to support which adjunct for tube passage is most effective. ⋯ The data show that tube passage with a stylet ETT or a preloaded bougie is superior in terms of higher first pass success, faster time-to-intubation and higher post-test preference. The naked ETT is clearly inferior to other methods. This research supports the recommendation to use a stylet ETT or bougie for every predicted difficult intubation.
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Emerg Med Australas · Dec 2017
Patients' choice between public and private hospital emergency departments: a cross-sectional survey.
The aim of this study was to understand what factors influence patients' choice between public and private hospital ED and the relative weight of those factors among adult patients with private health insurance in Australia. ⋯ Longer waiting times in public EDs is the principal issue considered by patients choosing private EDs and the out-of-pocket payment for accessing private EDs is the principal issue considered by public ED patients. The study suggests that addressing the out-of-pocket payments will attract more patients with private health insurance to access private EDs.
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Emerg Med Australas · Dec 2017
Do antiemetic drugs benefit adult emergency department patients with nausea? The literature says no, but is it right?
Nausea is a common problem in ED patients. Antiemetic drugs have been used in the ED for decades, but a recent Cochrane review found no convincing evidence for the benefit of antiemetic drugs over placebo. This was largely based on three placebo-controlled trials, which found mean Visual Analog Scale (VAS) changes for various drugs and placebo, to be similar. ⋯ Use of a VAS cut-off level indicative of clinically significant symptom improvement would allow comparison of numbers of patients with improved nausea ratings. This is proposed as the best option currently available. Preliminary testing of this outcome measure suggests that the conclusions of past studies may be misleading, and that the question of antiemetic efficacy for ED patients is not yet answered.