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Results in Journal Emergency Medicine Australasia: 3,432

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, Michael Ben-Meir
Published: 26 October 2017
Emergency Medicine Australasia, Volume 30, pp 122-124; https://doi.org/10.1111/1742-6723.12879

The publisher has not yet granted permission to display this abstract.
Geoff Hughes
Published: 19 September 2017
Emergency Medicine Australasia, Volume 29, pp 485-485; https://doi.org/10.1111/1742-6723.12860

Jeremy Furyk, Colin Banks
Published: 19 September 2017
Emergency Medicine Australasia, Volume 29, pp 607-609; https://doi.org/10.1111/1742-6723.12849

Matthew Murray,
Published: 11 October 2017
Emergency Medicine Australasia, Volume 30, pp 293-308; https://doi.org/10.1111/1742-6723.12864

The publisher has not yet granted permission to display this abstract.
Jonathan L Begley, , Paul Kwa
Published: 19 September 2017
Emergency Medicine Australasia, Volume 29, pp 570-575; https://doi.org/10.1111/1742-6723.12850

, , Shane Anthony
Published: 23 September 2017
Emergency Medicine Australasia, Volume 30, pp 36-41; https://doi.org/10.1111/1742-6723.12861

The publisher has not yet granted permission to display this abstract.
Amar Winayak, Alyza Gossat, Jenny Cooper, Peter Ritchie, Wei Lim, ,
Published: 23 September 2017
Emergency Medicine Australasia, Volume 30, pp 42-46; https://doi.org/10.1111/1742-6723.12865

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, Michael Yeoh
Published: 23 September 2017
Emergency Medicine Australasia, Volume 30, pp 119-121; https://doi.org/10.1111/1742-6723.12871

The publisher has not yet granted permission to display this abstract.
, , Rob Eley, Chantelle Judge, Sarah Cochrane, Connie Reed, Jessica Riordan, Kym Roberts, , Gabriella Wood, et al.
Published: 14 September 2017
Emergency Medicine Australasia, Volume 30, pp 95-102; https://doi.org/10.1111/1742-6723.12854

The publisher has not yet granted permission to display this abstract.
Ji Quan Koh, David C Tong, Rumes Sriamareswaran, Allysha Yeap, Bryan Yip, Sam Wu, Padeepa Perera, Shyaman Menon, Saad Al Noaman,
Published: 12 September 2017
Emergency Medicine Australasia, Volume 30, pp 222-227; https://doi.org/10.1111/1742-6723.12855

The publisher has not yet granted permission to display this abstract.
Sanj Fernando, , Anna Holdgate,
Published: 1 October 2009
Emergency Medicine Australasia, Volume 21, pp 373-378; https://doi.org/10.1111/j.1742-6723.2009.01214.x

Abstract:
Purpose: The objective of the present study was to identify and report on the key challenges confronted by emergency doctors following the introduction of Computerised Provider Order Entry system in a major metropolitan hospital in Sydney. Basic procedures: A qualitative study was undertaken during the period May 2006 to December 2006. The study included a series of eight interviews with three senior doctors and one focus group involving six registrars. Participants were chosen on the basis of their experience of planning for, or working with the new electronic ordering system. The study also incorporated five observation sessions and document analysis. Data were analysed iteratively, which led to the identification and elaboration of issues relevant to the research question. Findings: Three major issues emerged from the findings: (i) the implementation of the new system was accompanied by major shifts in ED work responsibilities and tasks; (ii) the appearance of dysfunctional consequences of the new system related to the excess time it took to electronically order and the usability of some features of the new system; and (iii) doctors' concerns that their views and opinions about the design and implementation of the new system had not been adequately addressed. Conclusion: The implementation of electronic ordering has important implications for ED functioning and the delivery of patient care. The complexity of the ED makes it vulnerable to disruption caused by inadequate system design and ineffective channels of communication across the hospital.6 page(s
, Julian Stella, Herman Chiu,
Emergency Medicine Australasia, Volume 16, pp 274-279; https://doi.org/10.1111/j.1742-6723.2004.00622.x

Abstract:
To examine the pattern of anatomical injury in victims of motor vehicle crashes who die prior to reaching hospital. Cases were identified where death was an unexpected outcome. A retrospective review of autopsy case records including police reports, of all persons who died in motor vehicle crashes between 1 January 1998 and 31 December 1999 and underwent full autopsy at the Victorian Institute of Forensic Medicine (VIFM). Those cases where the victim died in the prehospital phase were examined. Abbreviate Injury Scores and Injury Severity Scores were calculated in each case. Bull's probit analysis was used to identify unexpected deaths. There were 352 motor road crash fatalities identified that underwent autopsy at the VIFM in the study period. Two hundred and six of these were prehospital deaths involving motor vehicles, which satisfied specified criteria. 82% (95% CI: 77.7-86.3%) of cases had Abbreviated Injury Scores of 5 (critical) or 6 (incompatible with life). 80.1% (95% CI: 75.7-84.5%) had an Injury Severity Score greater than 40. 36.9% (95% CI: 34.5-39.3%) of cases had the maximum Injury Severity score of 75. 88.8% (95% CI: 85-92.7%) of cases sustained a head injury and 83.9% (95% CI: 79.8-88.2%) a chest injury. Possibly preventable fatality was identified in 30 (14.6% 95% CI: 13.9-15.3%) cases. In motor vehicle crash fatalities, most victims who die before reaching hospital do so because of major injury, with the head and chest the commonest regions involved. A large proportion of these injuries could be considered unsurvivable regardless of treatment. Earlier intervention or retrieval of such patients is unlikely to influence outcome in the majority of cases.
Daniel D Wong, Reginald Pc Wong,
Emergency Medicine Australasia, Volume 19, pp 196-202; https://doi.org/10.1111/j.1742-6723.2007.00924.x

Abstract:
Self-rated health (SRH) has been shown to be a reliable predictor of functional decline and mortality. These studies, however, have largely focused on well community-dwelling elderly. We assessed whether the predictive value of SRH would still be valid for the acutely unwell older person presenting to the ED. The present study was a secondary analysis of data obtained from the Discharge of Elderly from Emergency Department (DEED II) study. The sample consisted of 741 older people sent home from an ED. On enrollment, patients were asked the SRH question, 'In general, would you say your health is excellent, very good, good, fair or poor?' Phone interviews were conducted at 3, 6, 12 and 18 months. Functional status was assessed using the Barthel index of activities of daily living (ADL), modified instrumental activities of daily living (IADL) and the Short Portable Mental Status Questionnaire (MSQ). An SRH of fair/poor produced a hazard ratio of 3.1 (95% confidence interval 1.3-7.2, P = 0.010) for predicting mortality after controlling for confounders. The rate of decline in ADL and IADL (but not MSQ) over time was also more pronounced for those with an SRH of fair/poor (P < 0.001 for both ADL and IADL). An SRH of fair/poor had a relative risk of 3.4 for predicting decline in ADL at 18 months (95% confidence interval 1.7-7.1, P = 0.001). The effects of SRH on IADL and MSQ were not statistically significant. The ability of SRH to predict functional decline and mortality persists for the acutely unwell elderly presenting to the ED. SRH is a simple and valuable tool to assess the elderly in the ED and to identify high-risk patients who would benefit from comprehensive geriatric assessment aimed at delaying such outcomes.
Vidya Ramcharitar Maharaj, Phuong Phan, Fenton M O'leary
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 576-577; https://doi.org/10.1111/j.1742-6723.2010.01361.x

, , David Gemmell, Peter Doyle, Vibhore Gupta, David F Gorman
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 568-570; https://doi.org/10.1111/j.1742-6723.2010.01357.x

Abstract:
Acute abdominal pain is a common presentation to the ED. Most patients undergo a chest radiograph as part of their initial investigations, which occasionally reveals pneumoperitoneum. Pneumoperitoneum on imaging suggests a perforated hollow abdominal viscus and therefore often constitutes a surgical emergency. However, if the patient is neither peritonitic nor septic a management dilemma is faced. Some cases of pneumoperitoneum might be managed conservatively thus avoiding unnecessary laparotomy. We present a case of recurrent spontaneous pneumoperitoneum with abdominal pain that was managed conservatively and discuss the possible aetiologies and management issues of spontaneous pneumoperitoneum.
, Keng Yean Wong, , Teng Hong Tan
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 565-567; https://doi.org/10.1111/j.1742-6723.2010.01356.x

Abstract:
A case of traumatic haemopericardium, sustained after blunt thoracic trauma, is described in a paediatric patient that was successfully drained by needle pericardiocentesis under 2D-echocardiographic guidance, via an intercostal approach, in the Children's Intensive Care Unit. The patient was haemodynamically unstable with obvious signs of cardiac tamponade. Drainage of the haemopericardium resulted in immediate improvement in haemodynamics. There was no re-accumulation of the haemopericardium. There were no complications as a result of the pericardiocentesis. No further surgical intervention was required.
, Peter Day, Chris Salonikas, Daya Naidoo, , Rebecca Thomas
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 548-555; https://doi.org/10.1111/j.1742-6723.2010.01354.x

Abstract:
Panadol Extend (PEx) is an over-the-counter, modified-release formulation of paracetamol. Each 665 mg tablet contains 69% slow-release and 31% immediate-release paracetamol. In simulated human overdose, PEx exhibits lower and later peak serum concentrations and a lower area-under-the-curve (AUC) than comparable doses of immediate-release paracetamol (APAP-IR). The lower AUC might result from incomplete absorption of paracetamol or simultaneous metabolism with absorption. Do differences in pharmacokinetics (PK) between PEx and APAP-IR result from incomplete absorption or simultaneous absorption and metabolism of paracetamol? Cross-over study of 80 mg/kg of PEx or APAP-IR in nine volunteers. Serial plasma paracetamol, glucuronide, sulphate and cysteine metabolite estimates performed over 24 h. Peak plasma concentration (Cmax), AUC((0-∞),) time to peak concentration (Tmax) and elimination half-life (t(1/2) ) were compared. PEx exhibited significantly lower paracetamol Cmax (252.33 µmol/L vs 565.56 µmol/L, P= 0.0421), AUC((0-∞)) (2133 µmol/h/L vs 2637 µmol/h/L, P= 0.0004) and delayed Tmax (2.889 h vs 1.389 h, P= 0.0189) than APAP-IR. Sulphate metabolite PK parameters for both preparations, PEx vs APAP-IR, showed similar AUC((0-∞)) (1369 µmol/h/L vs 1089 µmol/h/L), Tmax (3.889 h vs 4.444 h), Cmax (95.889 µmol/L vs 95.889 µmol/L) and t(1/2) (3.895 h vs 3.810 h). Glucuronide metabolite concentrations revealed that PEx produced a lower Cmax (257.44 µmol/L vs 335.22 µmol/L, P= 0.0239) than APAP-IR. All other pharmacokinetic parameters were similar. Cysteine metabolite was not detected. There were minor differences between the PK parameters of the two major paracetamol metabolites of these two preparations in simulated overdose. The variability in paracetamol AUC seen between the two preparations in moderate overdose might be explained by concurrent metabolism of paracetamol during slower absorption with PEx.
, , Caroline Nicolas, Geoff White,
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 537-547; https://doi.org/10.1111/j.1742-6723.2010.01353.x

Abstract:
The aim of the present study is to describe ACEM trainees' perspectives on assessment and feedback during their training. From May to July 2009, an anonymous Web-based survey on training and supervision in emergency medicine was conducted, addressing trainees' perceptions of mandatory assessments (primary examination, fellowship examination and mandatory trainee research requirement) and feedback at work. Qualitative data were analysed using grounded theory methodology--themes were identified by close examination of full text responses. In total, 622 trainees responded to the survey (response rate of 37%). Trainees report that general clinical supervision is adequate; however, direct supervision at the bedside and feedback could be significantly improved. They perceive that the primary examination is necessary, although they feel it is irrelevant to their development as emergency trainees and are keen for more clinically applied knowledge to be tested. They dislike mandatory trainee research, feel inadequately supported and distracted from other aspects of their training. The fellowship examination was overall thought to be fair; however, there were concerns with the time pressures and restrictions to the written component of the examination. Additionally, the structured clinical examination was popular, whereas short cases and long cases were very unpopular. ACEM trainees' views of training may help inform curriculum development, and might assist those providing education to improve local training programs.
Stephen Brierley, , Janet Brack, Sgt Peter Cunningham
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 532-536; https://doi.org/10.1111/j.1742-6723.2010.01350.x

Abstract:
To alter staff perceptions, and to examine alternative management processes for intoxicated patients brought to Ipswich ED under mental health emergency examination orders by comparing disposition outcomes with non-intoxicated patients. Consultation-Liaison mental health nursing staff completed surveys on all patients assessed under emergency examination orders over a 6 month period in 2008. Patients were classified as intoxicated if they recorded alcometer readings of greater than 0.05%, or self-reported drug use during the events leading to their transport to the ED. Outcomes were retrospectively collated with entries in Clinical Liaison nursing logbooks. Outcome measures recorded were rates of admission, outpatient referrals to the Integrated Mental Health Service, follow up by other community services or no follow up. Differences in outcomes for intoxicated and non-intoxicated patient groups were tested for significance using χ(2) or Fisher's exact test. One hundred and sixty-eight cases were included in the audit. No cases were excluded. Sixty patients were identified as intoxicated. The age and sex distributions were similar between intoxicated and non-intoxicated patients. There were no significant differences in admission or referral rates. The average length of assessment time in the ED was longer in the intoxicated group. This audit showed similar outcomes for both patient groups contrary to the perceptions expressed by ED staff in informal surveys. The admission and referral rate for both groups indicate they are an at-risk population. The admission rate of 16% has led to this department negotiating alternative accommodation for patients while they sober up.
, Kevin H Lai, Karen Byth
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 524-531; https://doi.org/10.1111/j.1742-6723.2010.01349.x

Abstract:
To determine whether CO₂ GAP [(a-ET) PCO₂] value differs consistently in patients presenting with shortness of breath to the ED requiring ventilatory support. To determine a cut-off value of CO₂ GAP, which is consistently associated with measured outcome and to compare its performance against other derived variables. This prospective observational study was conducted in ED on a convenience sample of 412 from 759 patients who underwent concurrent arterial blood gas and ETCO₂ (end-tidal CO₂) measurement. They were randomized to test sample of 312 patients and validation set of 100 patients. The primary outcome of interest was the need for ventilatory support and secondary outcomes were admission to high dependency unit or death during stay in ED. The randomly selected training set was used to select cut-points for the possible predictors; that is, CO₂ GAP, CO₂ gradient, physiologic dead space and A-a gradient. The sensitivity, specificity and predictive values of these predictors were validated in the test set of 100 patients. Analysis of the receiver operating characteristic curves revealed the CO₂ GAP performed significantly better than the arterial-alveolar gradient in patients requiring ventilator support (area under the curve 0.950 vs 0.726). A CO₂ GAP ≥10 was associated with assisted ventilation outcomes when applied to the validation test set (100% sensitivity 70% specificity). The CO₂ GAP [(a-ET) PCO₂] differs significantly in patients requiring assisted ventilation when presenting with shortness of breath to EDs and further research addressing the prognostic value of CO₂ GAP in this specific aspect is required.
, Theane Theophilos
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 499-506; https://doi.org/10.1111/j.1742-6723.2010.01345.x

Abstract:
The impact of work related stressors on emergency clinicians has long been recognized, yet there is little formal research into the benefits of debriefing hospital staff after critical incidents, such as failed resuscitation. This article examines current models of debriefing and their application to emergency staff through a review of the literature. The goal being, to outline best practice, with recommendations for guideline development and future research directives. An electronic database search was conducted in Ovid and Psychinfo. All available abstracts were read and a hand search was completed of the references. Included articles were selected by a panel of two experts. Models and evidence relating to their efficacy were identified from the literature, and detailed evaluation included. The reviewed literature revealed a distinct paucity regarding the efficacy of debriefing of clinicians post CI and in particular randomized controlled trials. Despite this debriefing is perceived as important by emergency clinicians. However evidence presents both benefits and disadvantages to debriefing interventions. In the absence of evidence based practice guidelines, any development of models of debriefing in the emergency healthcare setting should be closely evaluated. And future research directives should aim towards large randomized control trials.
David A Bradt, Peter Aitken
Published: 8 December 2010
Emergency Medicine Australasia, Volume 22, pp 483-487; https://doi.org/10.1111/j.1742-6723.2010.01342.x

The publisher has not yet granted permission to display this abstract.
, Ellen MacDonald, , on behalf of the Alcohol Harm in Emergency Departments (AHED) Investigators
Published: 28 August 2017
Emergency Medicine Australasia, Volume 29, pp 531-538; https://doi.org/10.1111/1742-6723.12837

The publisher has not yet granted permission to display this abstract.
, Jackie Holt
Published: 16 August 2017
Emergency Medicine Australasia, Volume 29, pp 686-691; https://doi.org/10.1111/1742-6723.12846

The publisher has not yet granted permission to display this abstract.
Carmel Crock, Kim Hansen, Toby Fogg, Angela Cahill, Anita Deakin,
Published: 16 August 2017
Emergency Medicine Australasia, Volume 30, pp 55-60; https://doi.org/10.1111/1742-6723.12836

The publisher has not yet granted permission to display this abstract.
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