Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2023
Multicenter StudyProthrombinex®-VF in chronic liver disease: Friend or foe?
Management of coagulopathy in chronic liver disease (CLD) poses a challenge for critical care physicians. Prothrombinex®-VF is a low-volume product with rapid onset of action. Evidence for its efficacy and safety in CLD is limited and cases of acute intravascular coagulation and fibrinolysis (AICF) and/or disseminated intravascular coagulation (DIC) have been reported. Our objective was to evaluate the role of Prothrombinex®-VF in reversal of coagulopathy and the incidence AICF/DIC, thromboembolic events and mortality. ⋯ Prothrombinex®-VF did not lead to meaningful reversal of coagulopathy and should be used with caution in CLD. Patients with ACLF were more likely to develop AICF/DIC following Prothrombinex®-VF, although the association is uncertain. Further studies are needed to evaluate the safety and efficacy of Prothrombinex®-VF use in CLD.
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Emerg Med Australas · Feb 2023
Observational StudyImpact of COVID-19 Pandemic on Emergency Department Patient Volume and Flow: Two Countries, Two Hospitals.
COVID-19 greatly disrupted the provision of emergency care across the globe. ED service delivery was urgently redesigned as human and material resources were mobilised, and patients with respiratory symptoms were isolated. This study aimed to compare ED patient volume and flow metrics before and during the COVID-19 pandemic. ⋯ Total daily presentations varied considerably according to government mandated social restrictions and testing requirements in both EDs. The reductions in waiting and admission delay times corresponded with improvements in hospital capacity.
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Emerg Med Australas · Feb 2023
Characteristics of First Nations patients who take their own leave from an inner-city emergency department, 2016-2020.
Using a strength-based framework, we aimed to describe and compare First Nations patients who completed care in an ED to those who took their own leave. ⋯ A lower triage category is a strong predictor of First Nations patients taking their own leave. It has been documented that First Nations patients are under-triaged. One proposed intervention in the metropolitan setting is to introduce practices which expediate the care of First Nations patients. Further qualitative studies with First Nations patients should be undertaken to determine successful approaches to create equitable access to emergency healthcare for this population.
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Emerg Med Australas · Feb 2023
CommentImproving the safety of anticoagulation initiation in patients discharged from the emergency department.
To improve the safety of anticoagulation initiation by increasing the proportion of patients reviewed by a pharmacist. ⋯ The real-time electronic intervention improved the number of patients reviewed by a pharmacist. ED pharmacist reviewed patients were more likely to have safe anticoagulation initiation.