Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2025
Observational StudyEvaluation of older patients with minor blunt head trauma to identify those who do not have clinically important traumatic brain injury and can be safely managed without cranial computed tomography.
Our primary aim was to identify a low-risk subgroup of older adults (aged 65 and older) presenting to ED with minor head trauma which can be safely managed without a cranial CT (cCT). ⋯ Alert, haemodynamically stable, older ED adults with suspected head trauma had a low incidence of ciTBI in the present study. Abnormal physical examination findings were consistently present in patients with ciTBI. Shared decision-making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially among those from RACFs.
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Over recent years, emergency telehealth has developed rapidly in Australasia. From the patient's perspective, establishing trust with a healthcare provider is uniquely challenging when using the audio and video modalities commonly used in telehealth. ⋯ These include ensuring privacy and an appropriate setting for the consultation; considering how eye contact and expressions are best used; providing alternative options to telehealth; and clearly identifying names, roles and qualifications. We describe how these methods can best be employed in the virtual emergency care setting.
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Emerg Med Australas · Feb 2025
Prehospital use of spinal precautions by emergency medical services in children and adolescents.
Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia. ⋯ Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric-specific evidence into prehospital guidelines to risk stratify children.
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Emerg Med Australas · Feb 2025
Utility of computed tomography brain scans in intubated patients with overdose.
Describe the yield of computed tomography brain (CTB) scans in patients intubated for drug overdose. ⋯ Routine imaging of patients intubated for overdose without clinical indication is unjustified.
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Emerg Med Australas · Feb 2025
Renal colic: Streamlining investigations to improve patient outcomes in emergency medicine.
In Australian EDs, patients experience long waits for imaging, particularly for presentations such as renal colic. Computed tomography (CT) imaging is the gold-standard for renal stones, although ultrasonography is recommended for young patients and those susceptible to radiation, an approach supported by The Canberra Hospital (TCH) ED guidelines for renal colic. This audit aims to not only assess how well these guidelines are adhered to, but also to discuss possible methods of improving flow through ED and thus patient outcomes. ⋯ We propose that patients with significant clinical and biochemical features of renal stones could be referred to urology earlier to await CT as an inpatient and those without be referred to their general practitioner for outpatient imaging and medical management. This could improve flow through the department and improve patient outcomes through reduced waiting times and radiation burden.