Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2010
Case ReportsFatal methaemoglobinaemia induced by self-poisoning with sodium nitrite.
Inadvertent ingestion of sodium nitrite is known to precipitate metheamoglobinaemia. No cases exist, however, of intentional suicide by methaemoglobinaemia following self-poisoning with sodium nitrite. A 76-year-old man collapsed and rapidly developed brady-asystolic cardiac arrest 25 min following self-poisoning with an unknown quantity of crystalline sodium nitrite. ⋯ Despite prolonged resuscitative efforts the patient died. Resuscitation from methaemoglobinaemia-induced asystole following self-poisoning presents a unique therapeutic challenge. Treatment of methaemoglobinaemia-induced cardiovascular instability and overt cardiopulmonary arrest are discussed.
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Emerg Med Australas · Oct 2010
ReviewThe four hour target to reduce Emergency Department 'waiting time': a systematic review of clinical outcomes.
Governments in Australasia are introducing emergency department length of stay (EDLOS) time targets similar to the UK 'four hour rule'. There is debate about whether this rule had beneficial effects on health-care outcomes. We sought to determine what effects the four hour time target for EDLOS had on clinically relevant outcomes in the UK by conducting a systematic search for evidence. ⋯ One hospital demonstrated a small reduction in return rate. The impact of the introduction of an ED time target and the associated massive financial investment has not resulted in a consistent improvement in care with markedly varying effects being reported between hospitals. Countries seeking to emulate the UK experience should proceed with caution.
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Emerg Med Australas · Oct 2010
ReviewA primer for clinical researchers in the emergency department: Part II: research science and conduct.
Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. ⋯ Part I addressed ethical and regulatory aspects. In Part II, we describe important elements of research science, and practical elements of research conduct and administration, which form the basis for high-quality research.
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Emerg Med Australas · Oct 2010
Clinical TrialStress testing before discharge is not required for patients with low and intermediate risk of acute coronary syndrome after emergency department short stay assessment.
To investigate the usefulness of stress testing before discharge in patients assessed low to intermediate risk of acute coronary syndrome (ACS). ⋯ The present study showed that an ED short stay unit can effectively evaluate and manage patients with low and intermediate risk of ACS. The study suggests that patients with low and intermediate risk for ACS might safely be discharged after normal serial ECG and cardiac biomarkers, with a view to early outpatient stress testing. With strict adherence to admission criteria, there does not appear to be any benefit of stress testing before discharge.
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Emerg Med Australas · Oct 2010
A primer for clinical researchers in the emergency department: part I: ethical and regulatory background.
Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. ⋯ The ethics of research in children as a particularly vulnerable group will also be addressed. Part II will address important elements of research science and conduct.