Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2017
Blood cultures and bacteraemia in an Australian emergency department: Evaluating a predictive rule to guide collection and their clinical impact.
The objective of the present study is to determine whether a predictive rule could safely reduce the number of negative blood cultures collected in an Australian ED and to assess the clinical impact of positive results from blood cultures taken in the ED. ⋯ Bacteraemia detected in the ED alters subsequent patient management. The predictive rule can be safely applied in the ED to determine need for blood culture collection. Blood cultures should not be omitted in the ED based entirely on preliminary diagnosis given the high discordance seen between ED and discharge diagnosis.
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Emerg Med Australas · Feb 2017
Competence in the use of supraglottic airways by Australian surf lifesavers for cardiac arrest ventilation in a manikin.
Lifesavers in Australia are taught to use pocket mask (PM) rescue breathing and bag valve mask (BVM) ventilation, despite evidence that first responders might struggle with these devices. Novices have successfully used the Laryngeal Mask Airway (LMA) Supreme and iGel devices previously, but there has been no previous comparison of the ability to train lifesavers to use the supraglottic airways compared to standard techniques for cardiac arrest ventilation. ⋯ Lifesavers using the PM and BVM perform ventilation for cardiopulmonary resuscitation well. There appears to be a limited role for supraglottic airway devices because of limitations in terms of time to first effective ventilation and reliability. Clinical validation of manikin data with live resuscitation performance is required.
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Emerg Med Australas · Feb 2017
In situ simulation in emergency medicine: Moving beyond the simulation lab.
In situ simulation (ISS), a point of care training strategy that occurs within the patient care environment involving actual healthcare team members, provides additional benefits to centre-based simulation. ISS can serve several roles within emergency medicine (EM): improves provider/team performance, identifies and mitigates threats to patient safety and improves systems and infrastructure. The effective use of ISS fosters inter-professional team training and a culture of safety essential for high performance EM teams and resilient systems. Using a case example, this article addresses the uses of ISS in EM, strategies for implementation and mitigation strategies for ED-specific challenges.
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Emerg Med Australas · Feb 2017
Prehospital ketamine use by paramedics in the Australian Capital Territory: A 12 month retrospective analysis.
The aim of this study was to describe prehospital use of ketamine by ACT Ambulance Service, and frequency of endotracheal intubation. ⋯ Median dose for analgesia was comparable with other studies; dose for sedation was less than reported elsewhere. Intubation rate for patients receiving prehospital ketamine was 17%. Further study is recommended to assess the ED course of the non-intubated group of patients, and consideration should be given to non-weight-based methods of dose selection.
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Emerg Med Australas · Feb 2017
Acute appendicitis in adults: Diagnostic accuracy of emergency doctors in a university hospital in Hong Kong.
The aim of this study was to assess the diagnostic accuracy of ED doctors with variable training levels in detecting acute appendicitis, without access to advanced imaging in admitted patients with acute abdominal pain in a university hospital of Hong Kong. ⋯ Diagnostic accuracy of emergency doctors with variable training levels and no access to advanced imaging in a Hong Kong hospital in detecting appendicitis in patients with acute abdominal pain is higher in male patients than in female patients, but lower than that achieved by CT scanning.