Emergency medicine Australasia : EMA
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Aortic dissection (AD) is rare. Missed AD is a common reason for coronial investigations and civil claims for medical negligence. Recommendations include improved education, supervision and information transfer, reminders in chest pain pathways and higher rates of investigation for AD. ⋯ The appropriate diagnostic yield of investigation to balance risk and benefit has not been defined. The AD detection risk score pathway has been proposed as a useful diagnostic tool but concerns about its derivation, validation and utility remain. In this paper, we try to draw together published literature and local audit data to develop recommendations about what might be done to reduce the number of missed AD cases in EDs and what the impact of higher investigation rates might be.
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Emerg Med Australas · Feb 2023
Recognising risk, influencing reality and mental healthcare in a regional emergency department.
Mental health presentations to EDs continue to rise with associated challenges increasingly understood and well documented. Despite growing evidence of current and ongoing systemic issues contributing to this increase, there continues to be a lack of administrative engagement to address ED attendance, with avoidance and diversion strategies initiated during the COVID-19 pandemic no longer prioritised, despite growing need. ⋯ This is broadly unacceptable to consumers, their carers and the broader ED network. Delayed action in seeking alternative solutions only reinforces the risk and reality that people experiencing mental health concerns have 'Nowhere Else To Go'.