Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2005
Clinical TrialRelative utility of serum troponin and the OESIL score in syncope.
To investigate the utility of both a random troponin T level taken greater than 4 h after a syncopal event and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score in predicting outcome post syncope. ⋯ A normal serum troponin T has a poor negative predictive value for adverse cardiac outcomes following syncope. A simple risk stratification system, such as the OESIL score, can predict those patients most at risk after a syncopal episode.
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Emerg Med Australas · Feb 2005
Comparative StudyAmbulance diversion is not associated with low acuity patients attending Perth metropolitan emergency departments.
To examine the relationship between ambulance diversion and low acuity patient (LAP) attendances to EDs. ⋯ Inner metropolitan hospitals experience low LAP attendance rates. Attempts to further reduce LAP attendance rates at Perth inner metropolitan hospitals have limited scope to reduce ambulance diversion.
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Emerg Med Australas · Feb 2005
Randomized Controlled Trial Clinical TrialCPR before defibrillation in out-of-hospital cardiac arrest: a randomized trial.
Current resuscitation guidelines recommend that defibrillation be undertaken as soon as possible in patients suffering a cardiac arrest where the cardiac rhythm is either ventricular fibrillation (VF) or ventricular tachycardia (VT). Evidence from animal and clinical studies suggests that outcomes may be improved if a period of cardiopulmonary resuscitation (CPR) is given prior to defibrillation. The objective of this study was to determine if 90 seconds of CPR before defibrillation improved survival. ⋯ Ninety seconds of CPR before defibrillation does not improve overall survival in patients suffering VF/VT cardiac arrests. Further studies to evaluate various aspects of this treatment strategy are required as published outcomes to date are inconclusive.
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Emerg Med Australas · Feb 2005
ReviewChronic pain syndromes in the emergency department: identifying guidelines for management.
To explore current literature on chronic pain syndromes and develop ED recommendations for the management and minimalization of chronic non-cancer pain. ⋯ Emergency Medicine lacks a cohesive, informed strategy for management of chronic pain. The proposed guidelines represent the first step toward establishing consistency in the management of patients with chronic pain syndromes. Further work needs to be undertaken at a national level in developing evidence based guidelines.
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Tramadol is a synthetic analgesic new to the Australasian market where its use is rapidly increasing. It is used extensively overseas, particularly in Europe where it has been popular since its introduction in Germany in the late 1970s. Tramadol has a dual mechanism of action: weak mu opioid receptor agonist and a reuptake inhibitor of serotonin and noradrenaline. ⋯ Its use is advocated in a variety of acute and chronic pain states as well as some non-analgesic applications. The use of tramadol in an emergency setting is not well studied, with most published trials assessing its efficacy and tolerability in postoperative or dental models. This literature review concludes that tramadol does not offer any particular benefits over existing analgesics for the majority of emergency pain relief situations.