Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2012
Factors associated with failure to follow up with a general practitioner after discharge from the emergency department.
To identify factors associated with failure to follow up with a general practitioner (GP) after discharge from the ED or emergency medicine unit (EMU). ⋯ Participants who were aware of the reason for follow up with a GP, who were admitted to EMU, had health insurance or had a regular GP were more likely to comply with follow-up advice. This highlights that good patient communication is important for successful follow up, and that alternative avenues for completion of management need to be explored for patients without health insurance or a regular GP.
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Suprapubic aspiration (SPA) is the gold standard for obtaining uncontaminated urine specimens in young febrile children. The use of real-time ultrasound (RTUS) has been shown to increase the success rate of SPA. The BladderScan (BSUS) Verathon(®) is an alternative portable ultrasound device designed to provide automated measurement of bladder volume. Although simple and requiring minimal training, there are no data on the success rate of SPA using the device. ⋯ The success rate of SPA in 'real-life' non-standardised clinical practice was low at 53% overall. The BSUS-assisted SPA success rate was higher in patients with readings ≥20 mL. These rates are lower than success rates reported using RTUS. Parameters for using BSUS to assist SPA should be established.
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Emerg Med Australas · Dec 2012
Case ReportsLemierre's syndrome: diagnosis in the emergency department.
A 15-year-old boy presented with signs of sepsis and a history of sore throat, fevers and shortness of breath. Full examination revealed an erythematous oropharynx and mild tonsillar swelling. He rapidly deteriorated requiring admission to intensive care. ⋯ Internal jugular vein thrombosis ensues with septic emboli and metastatic infections that most frequently involve the lungs. Although increasing in incidence, diagnosis is often delayed. We discuss why and describe its clinical presentation, investigations of choice and treatment strategies.
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Emerg Med Australas · Dec 2012
Is the increase in emergency short-stay admissions sustainable? Trends across Melbourne, 2000 to 2009.
To describe the trends in emergency admissions over 10 years in terms of volume, age-specific rates, hospital length of stay (LOS) and clinical reasons. ⋯ Emergency hospital admissions have risen over the last decade even after adjustment for population changes. There was a disproportionate rise in same day/overnight admissions, with overrepresentation of the elderly. This is possibly related to changes in ED models of care, including introduction of short-stay units, improved diagnostic and therapeutic capability, and risk-averse management to optimise safe discharge, within the context of time-based performance targets.
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Emerg Med Australas · Dec 2012
Case ReportsPenetrating head injury with bilateral eye avulsion due to Himalayan bear bite.
The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35-year-old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully.