Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2023
Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre-post study.
Atrial fibrillation/flutter (AF/AFL) accounts for high rates of ED presentations and hospital admissions. There is increasing evidence to suggest that delaying cardioversion for acute uncomplicated AF is safe, and that many patients will spontaneously revert to sinus rhythm (SR). We conducted a before-and-after evaluation of AF/AFL management after a change in ED pathway using a conservative 'rate-and-wait' approach, incorporating next working day outpatient clinic follow-up and delayed cardioversion if required. ⋯ Using a conservative 'rate-and-wait' strategy with early follow-up for patients presenting to ED with AF/AFL can safely reduce unnecessary cardioversions and avoidable hospitalisations.
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Emerg Med Australas · Oct 2023
Definitive management of near-hanging at major versus non-major trauma centres.
The Victorian State Trauma System recommends that all major trauma patients receive definitive care at a major trauma service (MTS). The aim of the present study was to assess the outcomes of patients with major trauma after near-hangings who received definitive management at an MTS compared to a non-MTS. ⋯ After major trauma sustained from near-hanging, definitive management at an MTS did not offer a mortality benefit or better functional outcomes. Consistent with current practice, these findings suggest that most near-hanging related major trauma patients could be managed safely at a non-MTS.
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Emerg Med Australas · Oct 2023
Drug and alcohol intoxication in major trauma: Associations, trends and outcomes over a decade.
Drug and alcohol intoxication is common among injured patients altering trauma presentation and characteristics. However, uncertainty exists regarding the effect of intoxication on injury severity, as well as outcomes. The present study aims to provide an update on substance-use patterns and their association with traumatic presentation and outcome within a contemporary Australian context. ⋯ Within this contemporary Australian population, we demonstrate escalating rates of drug intoxication and declining rates of alcohol intoxication prior to trauma. Intoxication was associated with more frequent violent and non-accidental injury, and despite no difference in severity, it was associated with worse outcomes.
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Emerg Med Australas · Oct 2023
Choosing Wisely audit: Blood gas ordering in the emergency department.
Our aim was to reduce unnecessary blood gases to improve patient flow, reduce false positives and reduce unnecessary treatments. ⋯ We have found that many blood gases are ordered for patients who are not critically unwell, and whose disposition was not affected by their result.
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Emerg Med Australas · Oct 2023
Rational clinical approach to transient ischaemic attack, stroke and associated mimics: A retrospective cohort study.
The present study was performed to identify the individual clinical features and risk factors most strongly associated with the diagnosis of transient neurological symptoms with a cerebrovascular cause (transient ischaemic attack (TIA) or stroke), as compared to common TIA mimics (including retinal ischaemia, migraine and seizure). ⋯ The present study demonstrated that specific clinical features and risk factors were associated with the final diagnosis at TIA clinic. These clinical features may assist with diagnosis of TIA in centres without access to a vascular neurologist.