Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2021
Factors predictive for computed tomography use and abnormality in paediatric head injuries in Australia and New Zealand.
To investigate patient-level factors predictive for computed tomography of the brain (CTB) use and abnormality in head injured children in Australia and New Zealand. ⋯ Patient-level drivers of CTB use in children in Australia and New Zealand are consistent with international data.
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Emerg Med Australas · Feb 2021
Consent and refusal of treatment by older children in emergency settings.
The law recognises that children can exert an increasing level of autonomy and decision-making about their healthcare as they mature, and that intelligence and maturity levels will vary from one child to the next. Therefore, the parameters for when older children can consent to healthcare can be a complex area for clinicians to navigate. Refusal of treatment provides additional challenges for clinicians because the law is less clear about when older children can be involved in refusing treatment which is in their best interests. This article outlines relevant legislation concerning child consent to treatment across Australian jurisdictions and examines refusal of treatment by children using the 2018 case of Mercy Hospitals Victoria v D1 & Anor.
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Emerg Med Australas · Feb 2021
Is lactate lower in septic patients who are prescribed beta blockers? Retrospective cohort study of an intensive care population.
Elevated serum lactate has long been considered an important marker of sepsis severity. Increasing evidence supports catecholamine-stimulated aerobic glycolysis being a major contributor to the hyperlactataemia seen in sepsis. Beta-blockade may blunt such catecholamine mediated rise in lactate analogous to the way it can mask tachycardia. This could impact the way we evaluate sepsis severity and adequacy of initial treatment. The objective of this study is to investigate whether septic patients who were on beta-blocker treatment at presentation have lower serum lactate level. ⋯ In our cohort pre-existing beta blocker treatment was associated with lower serum lactate measurements in patients presenting with sepsis. Pre-existing beta blocker treatment may reduce serum lactate at presentation in patients with sepsis.
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A trauma patient with cardiac tamponade may not survive transfer to the operating theatre for pericardial decompression. This article describes an approach to a resuscitative thoracotomy in the ED, which may be life-saving in these patients when a cardiothoracic surgeon is not immediately available.
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Emerg Med Australas · Feb 2021
Observational StudyDoes location of rapid influenza diagnostic testing influence treatment time and ancillary testing in a paediatric emergency department?
Influenza causes a significant burden of disease. Our aim was to assess whether location of rapid influenza diagnostic testing (RIDT) for patients with influenza-like illness (ILI) has an impact on ED treatment time or ancillary testing. ⋯ Location of RIDT may not have a significant impact on treatment time, ancillary testing and treatment with antibiotics. When RIDT was not performed, patients had the shortest treatment time.