European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Blood gas analysers provide electrolyte and metabolic data. In the author's institution, these values were not used clinically because of the risk of inaccuracy. To discover whether this approach was warranted, we compared values from our Radiometer point-of-care (POC) analyser and the laboratory. ⋯ Thus, sodium and potassium showed negative bias on the Radiometer compared with the laboratory. Creatinine and haemoglobin agreed well. We advocate the clinical use of POC values when taken in clinical context.
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The use of point-of-care ultrasound in the emergency department has expanded considerably in recent years, allowing enhanced evaluation of the patient with an emergent eye or vision complaint. The technique is simple and quick to perform, and can yield clinical information that may not be readily obtainable through physical or slit-lamp exams. ⋯ Optic nerve sheath diameter can be measured in patients with a suspected intracranial process as a surrogate for intracranial pressure, and may aid emergency diagnosis and management. This article reviews common emergency ophthalmic pathologies diagnosed with ultrasound in the emergency setting and a mnemonic for the use of bedside ocular ultrasound is proposed to aid in thoroughly scanning the eye and its surrounding structures.
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Comparative Study
Identification of adult septic patients in the prehospital setting: a comparison of two screening tools and clinical judgment.
Timely identification and treatment of sepsis is crucial for patient outcome. The aim of this study was to compare two previously unvalidated prehospital sepsis screening tools with clinical judgment by emergency medical services (EMS) personnel with respect to identification of septic patients. ⋯ The Robson screening tool had a sensitivity superior to both BAS 90-30-90 and clinical judgment. This supports our hypothesis that the implementation of a screening tool could lead to increased prehospital identification of sepsis, which may enable a more timely treatment of these patients.
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Observational Study
What is the 30-day rate of adverse cardiac events in chest pain patients with ED troponin I assays≤99th centile using a contemporary sensitive assay? An exploratory analysis.
For nonhigh-risk patients who 'rule out' for acute coronary syndrome, Australasian guidelines recommend further testing to identify coronary artery disease. Testing is usually performed as an outpatient procedure. This recommendation has not changed with the advent of sensitive biomarker assays. We aimed to determine the 30-day rate of adverse cardiac events in emergency department (ED) chest pain patients without known coronary artery disease who had ED troponin I (TnI) assays≤99th centile using a contemporary troponin assay, stratified by the Heart Foundation (HF; Australia) risk group. ⋯ Among ED patients presenting with suspected acute coronary syndrome, adverse cardiac events at 30 days are rare in nonhigh-risk patients with contemporary TnI assays<99th centile.
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The aim of this study was to identify a reliable tool for the early prognostic stratification of septic patients admitted to the emergency department-high dependency unit (ED-HDU), a clinical setting providing a subintensive level of care; we also estimated the cost saving associated with HDU stay compared with ICU stay. ⋯ SOFA score is a feasible and accurate tool for an early risk stratification of septic patients admitted to the ED-HDU.