Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2020
Use of computed tomography and magnetic resonance imaging for occult neck of femur fractures: A single-centre study.
Neck of femur (NOF) fractures are common and serious injuries in the elderly. When a NOF fracture is suspected but is not clearly visible on radiographs, guidelines recommend magnetic resonance imaging (MRI), or computed tomography (CT) if MRI is not available/contraindicated. The aim of our study was to review the use of CT and subsequent MRI for suspected NOF fractures in patients with negative or equivocal radiographs. ⋯ Access to CT for evaluation of suspected occult NOF fractures is much quicker compared to MRI. When CT results are negative with on-going clinical suspicion of an occult fracture, MRI should be performed in a time efficient manner.
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Emerg Med Australas · Dec 2020
Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock.
Early recognition and treatment for sepsis is critical in improving patient outcomes. The present study sought to examine whether triage location was associated with time to appropriate antibiotics in a cohort of ED patients with septic shock. ⋯ We identified a sub-group of septic shock patients triaged to a lower acuity treatment location who received significant delays to antibiotics. This research area deserves closer examination to potentially recognise septic shock earlier in the continuum.
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Emerg Med Australas · Dec 2020
Eligibility criteria for extracorporeal cardiopulmonary resuscitation at Auckland City Hospital: A retrospective cohort study.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising adjunct to routine advanced cardiac life support. Growing worldwide interest in ECPR-use has seen more tertiary centres offering ECPR programmes. New Zealand's nationwide extracorporeal membranous oxygenation service is provided at Auckland City Hospital (ACH). Despite the potential benefits of ECPR, it is currently only offered on an ad hoc basis. It remains unknown whether ACH would manage sufficient numbers of patients to warrant an ECPR programme. ⋯ An ECPR programme at ACH using standardised and agreed criteria may benefit a small number of patients and improve rates of survival to hospital discharge with preservation of neurological function. An ECPR guideline would help clarify for referring services cases that are appropriate for extracorporeal membranous oxygenation consideration, rather than discussing on an ad hoc basis.
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Emerg Med Australas · Dec 2020
Patients with mental health conditions in the emergency department: Why so long a wait?
Patients presenting with a mental health disorder (MHD) wait longer in the ED compared to those presenting for other reasons, potentially placing vulnerable patients at further risk for deterioration. The present study identified factors associated with a long ED stay for patients with a MHD. ⋯ Some factors predictive of a long ED stay for patients presenting to the ED and diagnosed with a MHD varied based on their disposition. For admissions, the most urgent presentations were likely to stay longest. Strategies to reduce ED stay for both admissions and discharges should consider addressing modifiable aspects, including the need for certain investigations, and non-modifiable aspects, including the need for further access to after-hours mental health services in hospital and in the community.
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Emerg Med Australas · Dec 2020
Cost-benefit analysis of retrospectively identifying missed compensable billings in the emergency department.
The aim of the present study was to perform a cost-benefit analysis of retrospectively identifying missed compensable billings in a public Australian ED. ⋯ All scenarios examined led to a positive NPV favouring retrospectively identifying missed compensable billings.