Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2012
Case ReportsCase of scrub typhus complicated by severe disseminated intravascular coagulation and death.
Scrub typhus is an infectious disease that is caused by Orientia tsutsugamushi. The authors describe an autopsied case of scrub typhus complicated with severe disseminated intravascular coagulation (DIC). An 82-year-old man complained of fever 4 days after climbing a mountain. ⋯ The endothelial tissue of the white pulp of the spleen was markedly infiltrated by plasma cells. The authors speculated that a severe immune reaction against O. tsutsugamushi enhanced an inflammatory response, leading to DIC. This case is a warning to doctors who are not familiar with scrub typhus.
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Emerg Med Australas · Oct 2012
Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients.
Sonographic measurement of the inferior vena cava (IVC) caval index predicts central venous pressure in ED patients. Fluid responsiveness (FR) is a measure of preload dependence defined as an increase in cardiac output secondary to volume expansion. We sought to determine if the caval index is an accurate measurement of FR in ED patients. ⋯ Bedside sonographic measurement of IVC caval index does not predict FR in a heterogeneous ED patient population. Further research using this technique in targeted patient subsets and a variety of shock etiologies is needed.
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Emerg Med Australas · Oct 2012
Analysis and impact of delays in ambulance to emergency department handovers.
Delays in the clinical handover of patient care from emergency medical services (EMS) to the ED because of ED crowding are a substantial problem for many EMS systems. This study was conducted to quantify handover delays experienced by the Ambulance Service of New South Wales (ASNSW), and to investigate patient and system factors associated with handover delay. ⋯ Handover delays are relatively common at the EMS/ED interface in New South Wales, and are most pronounced at large hospitals, in urban areas and during winter.
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Emerg Med Australas · Oct 2012
Improving stress testing compliance following chest pain presentations to the emergency department.
To determine whether a booked appointment time improves early outpatient exercise stress testing (EST) guideline adherence in patients discharged from the ED following assessment for possible acute coronary syndrome (ACS). ⋯ Pre-booked appointment times for EST improve timely attendance among patients discharged from the ED with intermediate-risk ACS. Compliance might improve further with patient education.
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Emerg Med Australas · Oct 2012
Inadequate acute hospital beds and the limits of primary care and prevention.
Metropolitan Australia is suffering from a serious shortage of acute hospital beds. Simplistic comparisons with the Organisation for Economic Co-operation and Development bed numbers are misleading because of the hybrid Australian public/private hospital system. The unavailability of most private beds for acute emergency cases and urban/rural bed imbalances have not been adequately considered. ⋯ This paper directly challenges the ideology that says Australia depends too heavily on hospital-based healthcare. Rebuilding the bed base requires recognition of the need for an adequate acute hospital service and strong advocacy for bed-based care in the medical and nursing professionals who should be driving policy. The forces opposing bed-based care are strong and solutions might include legislative definition of bed numbers and availability.