Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2007
Case ReportsManaging cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy.
Flecainide overdose can rapidly result in profound cardiovascular collapse, and is associated with a relatively high mortality. A case is described where a woman with major toxicity and high serum levels was managed without recourse to invasive modalities such as cardiopulmonary bypass or extracorporeal therapies. Hypertonic sodium bicarbonate is recognized as effective therapy for hypotension and arrhythmias. ⋯ Sodium bicarbonate should be given early in the resuscitation, and re-administered as frequently as required, targeting an alkaline pH and improved cardiac output, while accepting hypernatraemia. This case demonstrates the maxim that the correct dose of hypertonic sodium bicarbonate is 'enough'. Cardiopulmonary bypass support can be considered as a salvage therapy.
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Emerg Med Australas · Apr 2007
Comparative StudyEffect of a holiday service reduction period on a hospital's emergency department access block.
To study the effect of holiday service reductions, consisting of bed and theatre closures, in a tertiary paediatric hospital on various measures of ED occupancy, including access block. ⋯ At this hospital, unacceptably high levels of ED access block persist both during and outside holiday periods, despite there being mild improvement in access block during the holiday period where bed closures were balanced against the effect of other service cutbacks (e.g. closing operating theatres).
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Emerg Med Australas · Apr 2007
Case ReportsUncommon cause of cardiac arrest in the emergency department.
A previously healthy 48-year-old woman presented to a peripheral ED with non-specific signs and symptoms, including vomiting, abdominal cramping, shortness of breath, tachycardia and hypertension. Despite supportive measures the patient rapidly deteriorated, resulting in a cardiac arrest during an interhospital transfer. This required aggressive resuscitation, but without success. The case represents a diagnostic dilemma in the ED regarding the diagnosis and initial management of the patient's presentation.
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Emerg Med Australas · Feb 2007
Multicenter StudyImproving asthma discharge management in relation to emergency departments: The ADMIRE project.
The present paper describes the process, outcomes and lessons learned from a federally funded, multicentre action research project aimed at improving discharge practices for asthma patients who attend ED and are discharged home. Thirty-two ED participated and worked locally to improve discharge practices using previously published best-practice guidelines. Although they achieved some improvements, major barriers to best-practice discharge outside ED control were identified, including access to GP, hospital policies regarding supply of medications and access to appropriate asthma education. The ED developed some useful tools to assist with improving asthma management that have been compiled as a toolkit and are available online.