Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2023
ReviewReview article: Acute superior mesenteric vessel ischaemia: A review of clinical practice and biomarkers.
A patient with acute occlusion of the superior mesenteric vessels resulting in superior mesenteric vessel ischaemia (SMVI) who presents to the ED with abdominal pain and unremarkable abdominal examination risks delay in diagnosis and treatment with adverse outcome. A comprehensive literature search was performed, and the evidence was reviewed. To-date, there are no accurate biomarkers of SMVI and so, heightened awareness among ED staff and rapidly actioning diagnostic imaging and surgical referral will help fast-track the patient with SMVI to surgical management. ⋯ Prompt surgical intervention may help reduce mortality and morbidity in SMVI. SMVI is associated with significant mortality and morbidity. With the lack of accurate biomarkers, diagnosis and management is challenging and requires heightened awareness among ED staff for prompt surgical referral and intervention.
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Arterial line insertion is a common ED procedure with considerable clinician variation in preferred technique and equipment. This article aims to review some of the controversies and evidence surrounding this common ED procedure.
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Emerg Med Australas · Feb 2023
ReviewReview article: Early steroid administration for traumatic haemorrhagic shock: A systematic review.
Haemorrhagic shock after trauma is a leading cause of death worldwide, particularly in young individuals. Despite advances in trauma systems and resuscitation strategies, mortality from haemorrhagic shock has not declined over the previous two decades. A proportion of shocked trauma patients may experience a deficiency of cortisol relative to the severity of their injury. ⋯ Both studies were at risk of bias. There are no high quality or recent studies in the English literature investigating the use of steroids for haemorrhagic shocked trauma patients. PROSPERO: CRD42021239656.
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Emerg Med Australas · Feb 2023
Epidemiology, outcomes and predictors of mortality in patients transported by ambulance for dyspnoea: A population-based cohort study.
There are currently limited data to inform the management of patients transported by emergency medical services (EMS) with dyspnoea. We aimed to describe the incidence, aetiology and outcomes of patients transported by EMS for dyspnoea using a large population-based sample and to identify factors associated with 30-day mortality. ⋯ Dyspnoea is a common presentation with a broad range of causes and is associated with high rates of hospitalisation and death.