Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2012
ReviewReview article: Part two: Goal-directed resuscitation--which goals? Perfusion targets.
Haemodynamic targets, such as cardiac output, mean arterial blood pressure and central venous oxygen saturations, remain crude predictors of tissue perfusion and oxygen supply at a cellular level. Shocked patients may appear adequately resuscitated based on normalization of global vital signs, yet they are still experiencing occult hypoperfusion. ⋯ Current technologies available include sublingual capnometry, video microscopy of the microcirculation and near-infrared spectroscopy providing a measure of tissue oxygenation, whereas base deficit and lactate potentially provide a surrogate measure of the adequacy of global perfusion. The methodology and evidence for these technologies guiding resuscitation are considered in this narrative review.
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Emerg Med Australas · Apr 2012
Randomized Controlled TrialButylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic.
To evaluate the effect of adding butylscopolammonium bromide (BB) to morphine and ketorolac in the treatment of acute renal colic in the ED. ⋯ Although the addition of BB to morphine and ketorolac appeared to show a statistically significant reduction in pain compared with morphine and ketorolac alone, a reduction of 1.2 cm on VAS is unlikely to be clinically significant.
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Emerg Med Australas · Apr 2012
Pandemic (H1N1 influenza 2009 and Australian emergency departments: implications for policy, practice and pandemic preparedness.
To describe the reported impact of Pandemic (H(1)N(1) ) 2009 on EDs, so as to inform future pandemic policy, planning and response management. ⋯ This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.
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Emerg Med Australas · Apr 2012
Pain management in Australian emergency departments: current practice, enablers, barriers and future directions.
To explore current pain management practice in Australian EDs and identify enablers and barriers for best-practice pain management. ⋯ Effective and sustainable system change requires a strategy that is initiated within the ED, targets opinion leaders, is supported by evidence, and engages all levels of ED staff.
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Emerg Med Australas · Apr 2012
Comparative StudyComparison of intubation performance by junior emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques.
Endotracheal intubation is a challenging procedure in emergency medicine. Junior doctors lack experience and confidence in this task. The use of a gum elastic bougie (GEB) to facilitate intubation may improve success rates, especially in difficult situations. ⋯ The use of a GEB marginally increases the time taken to perform endotracheal intubation. Success rates for junior doctors attempting endotracheal intubation were not significantly different between the two techniques. Success rates for novice practitioners using a GEB were high after even limited instruction and practice.