Emergency medicine (Fremantle, W.A.)
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Emerg Med (Fremantle) · Sep 2001
Case ReportsAcute opioid withdrawal in the emergency department: inadvertent naltrexone abuse?
From July 1999 it became evident that a rising number of heroin users were presenting to the Dandenong Hospital Emergency Department with a rapid onset, florid opioid withdrawal syndrome following the intravenous injection of what they had believed to be heroin. We suspect that the injected substance was in fact naltrexone. This paper describes two such cases and reviews the literature on naltrexone. Recommendations regarding the management of the acute opioid withdrawal syndrome are made.
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Emerg Med (Fremantle) · Sep 2001
ReviewEthical relationships in paediatric emergency medicine: moving beyond the dyad.
Most areas of health-services research concentrate on a dyadic relationship between doctor and patient. In paediatric emergency medicine it may be necessary to focus on a more complicated relationship because the parents of the child play an important role in the delivery of medical services. ⋯ Such models allow the inclusion of the parents and possibly other family members, medical providers and community members. If the paediatric setting is considered in such a framework, it may be possible to deliver a more socially beneficial medical service.
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Emerg Med (Fremantle) · Sep 2001
Comparative StudyHow valuable is a lumbar puncture in the management of patients with suspected subarachnoid haemorrhage?
The aim of the study was to determine the range of cerebrospinal fluid findings associated with emergency department disposition and treatment of patients with headache suspicious of subarachnoid haemorrhage but a negative or equivocal computed tomography head scan, in particular the role of xanthochromic index. ⋯ In the study institution, cerebrospinal fluid results appeared to have a variable influence on clinical decision-making for patients with suspected subarachnoid haemorrhage and a non-diagnostic computed tomography head scan. Of particular concern is the lack of validation of the tests used in this investigative approach, the frequency of patients having a lumbar puncture where the results did not influence their management, the inconsistency in the laboratory's technique for performing tests on cerebrospinal fluid and the very low yield of detecting patients with subarachnoid haemorrhage and a potentially treatable causative lesion.
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Emerg Med (Fremantle) · Sep 2001
Delayed ultrasound in patients with abdominal pain and vaginal bleeding during the first trimester of pregnancy.
To determine if patients with abdominal pain and vaginal bleeding during the first trimester of pregnancy who have a low clinical likelihood of ectopic pregnancy are put at risk of adverse events by delaying ultrasonography 12-18 h after emergency department presentation. ⋯ Preliminary results suggest that pregnant patients with abdominal pain and vaginal bleeding in the first trimester who meet specific low-risk clinical criteria could potentially have ultrasound delayed 12-18 h without risk of adverse event. Further prospective studies are warranted to confirm the safety of this strategy.
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Emerg Med (Fremantle) · Sep 2001
Clinical TrialAccuracy of emergency department bedside ultrasonography.
To determine which focused ultrasound examinations can be interpreted accurately by emergency physicians who have limited training and experience. To determine whether image quality and/or the operator's level of confidence in the findings correlates with accurate scan interpretation. ⋯ Neophytes can accurately perform and interpret aortic scans; additional training and/or experience appear to be necessary to achieve proficiency in conducting most of the other scans studied. Inexperienced operators are unable to discern whether their scan interpretations will prove accurate.