Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2007
ReviewEmergency department personal protective equipment requirements following out-of-hospital chemical biological or radiological events in Australasia.
Recent events have led to a revision in ED equipment, preparedness and training for disasters. However, clinicians must still decide when, and what level of personal protection is required when a toxic threat exists. ⋯ Following an off-site Australasian chemical biological or radiological incident, current evidence indicates that the initial receiving ED staff will be adequately protected from all known chemical biological and radiological inhalational threats by wearing a properly fitted P2 (N95) mask, or its equivalent. Protection from serious contact injury is offered by wearing double gloves, disposable fluid-repellent coveralls or gown, eye protection, surgical mask, and ideally, a cap and shoe covers; in conjunction with universal precautions and procedures.
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Emerg Med Australas · Apr 2007
Case ReportsManaging cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy.
Flecainide overdose can rapidly result in profound cardiovascular collapse, and is associated with a relatively high mortality. A case is described where a woman with major toxicity and high serum levels was managed without recourse to invasive modalities such as cardiopulmonary bypass or extracorporeal therapies. Hypertonic sodium bicarbonate is recognized as effective therapy for hypotension and arrhythmias. ⋯ Sodium bicarbonate should be given early in the resuscitation, and re-administered as frequently as required, targeting an alkaline pH and improved cardiac output, while accepting hypernatraemia. This case demonstrates the maxim that the correct dose of hypertonic sodium bicarbonate is 'enough'. Cardiopulmonary bypass support can be considered as a salvage therapy.
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Emerg Med Australas · Apr 2007
Accuracy of electrocardiogram interpretation improves with emergency medicine training.
To assess whether electrocardiogram (ECG) interpretation accuracy improves with advancing years of emergency medicine training. ⋯ There is an improvement in ECG interpretation accuracy with advancing years of emergency medicine training in Victoria. There exists, however, a low level of accuracy for some critical ECG diagnoses. There is a call by trainees for more formalized and regular ECG education to begin earlier in their training.
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Emerg Med Australas · Apr 2007
Comparative StudyEffect of a holiday service reduction period on a hospital's emergency department access block.
To study the effect of holiday service reductions, consisting of bed and theatre closures, in a tertiary paediatric hospital on various measures of ED occupancy, including access block. ⋯ At this hospital, unacceptably high levels of ED access block persist both during and outside holiday periods, despite there being mild improvement in access block during the holiday period where bed closures were balanced against the effect of other service cutbacks (e.g. closing operating theatres).
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Emerg Med Australas · Apr 2007
Case ReportsUncommon cause of cardiac arrest in the emergency department.
A previously healthy 48-year-old woman presented to a peripheral ED with non-specific signs and symptoms, including vomiting, abdominal cramping, shortness of breath, tachycardia and hypertension. Despite supportive measures the patient rapidly deteriorated, resulting in a cardiac arrest during an interhospital transfer. This required aggressive resuscitation, but without success. The case represents a diagnostic dilemma in the ED regarding the diagnosis and initial management of the patient's presentation.