Emergency Medicine Australasia最新文献

{"title":"Radiological ‘Tension’ – Clinical Correlation is Required","authors":"Gerben Keijzers","doi":"10.1111/1742-6723.70066","DOIUrl":"https://doi.org/10.1111/1742-6723.70066","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECPR in the Emergency Department","authors":"Julia Coull,&nbsp;Brooke Riley,&nbsp;David Anderson,&nbsp;Sacha Richardson","doi":"10.1111/1742-6723.70073","DOIUrl":"https://doi.org/10.1111/1742-6723.70073","url":null,"abstract":"<div>\u0000 \u0000 <p>Extracorporeal cardiopulmonary resuscitation (ECPR) is a time-critical, resource-intensive intervention used in select cases of refractory cardiac arrest. Its success depends on rapid initiation, streamlined workflows, and coordination across multidisciplinary teams. This article outlines the phases of ECPR, key resuscitation modifications, and inclusion criteria. It also provides practical guidance on equipment, personnel roles, environmental setup, and post-initiation priorities.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Reflections on the Impact of High-Sensitivity Troponin I Assay Changes on Emergency Department Diagnosis and Disposition","authors":"Erkan Boğa","doi":"10.1111/1742-6723.70075","DOIUrl":"https://doi.org/10.1111/1742-6723.70075","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Shifts of Clinicians Who Become Clinician-Coaches: An Exploratory Qualitative Study of Emergency Physicians","authors":"Andrew Rixon,&nbsp;Victoria Lister,&nbsp;Lee Yung Wong,&nbsp;Elizabeth Elder,&nbsp;Samuel Wilson","doi":"10.1111/1742-6723.70076","DOIUrl":"https://doi.org/10.1111/1742-6723.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore how emergency physicians experience and sustain the shift from clinicians to clinician-coaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were interviewed about how they made sense of their coaching roles and coaching practice within the emergency department.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using reflexive thematic analysis, five themes were developed that pertain to the key learning shifts that characterised their journey from clinician to clinician-coach. These involved a shift from problem-solving to possibility-finding; from authority to partnership; from certainty to curiosity; from expertise to humility; and from doing to being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fostering a supportive environment for these five shifts could facilitate the transformations in identity and practice necessary for clinicians to become clinician-coaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phlebotomists on Emergency Department Performance: A Retrospective Comparative Study","authors":"Abdi D. Osman,&nbsp;Jahar Bhowmik,&nbsp;Daryl Yeak,&nbsp;Michael Ben-Meir,&nbsp;Negar Mansouri,&nbsp;George Braitberg","doi":"10.1111/1742-6723.70081","DOIUrl":"https://doi.org/10.1111/1742-6723.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Emergency departments (ED) in Australia have experienced an increase in patient presentations. To address this demand, we introduced phlebotomists at ED triage seeking to reduce ED waiting and disposition times. We report the impact of this intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Using a quantitative retrospective comparative study design guided by the STROBE checklist, we investigated the impact on ED performance before and after the introduction of phlebotomists (the intervention). Data from two periods—T1 (January–June 2021) and T2 (January–June 2023) were obtained and analysed for all ED presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 90,020 patients were included (T1: 46,639; T2: 43,381). Post-intervention improvements included an increase in short stay unit–admissions from triage (3.1% vs. 5.9%, <i>p</i> &lt; 0.001) and a decrease in the proportion of patients transferred to a cubicle from the waiting room (T1: 78.8%; T2: 76.4%). However, patients who left the ED before treatment was completed (known as ‘Did not Wait’) rose significantly (9.8% vs. 11.5%) as did waiting room times (80.02 vs. 112.91 min). Overall, ED length of stay (EDLOS) increased significantly (mean T1: 305.1 to T2: 319.4 min; <i>p</i> &lt; 0.001). There were significant increases in blood tests (T1: 52.0% vs. T2: 59.9%) and ECGs (16.5% vs. 19.1%) performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The introduction of phlebotomists at triage failed to reduce waiting, treatment and disposition times and increased the number of investigations performed with an overall increase in EDLOS. We observed an increase in the number of patients directed from the waiting room to the short stay unit and fewer patients transferred from the waiting room to an ED cubicle.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Clinical Reflections on the Impact of High-Sensitivity Troponin I Assay Changes on Emergency Department Diagnosis and Disposition","authors":"John W. Pickering,&nbsp;Laura R. Joyce,&nbsp;Martin P. Than","doi":"10.1111/1742-6723.70079","DOIUrl":"https://doi.org/10.1111/1742-6723.70079","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal CPR: What Future FACEMs Need to Know","authors":"Joshua I. Smith,&nbsp;Daphne Cohen","doi":"10.1111/1742-6723.70074","DOIUrl":"https://doi.org/10.1111/1742-6723.70074","url":null,"abstract":"<div>\u0000 \u0000 <p>Use of extracorporeal CPR (ECPR) has been increasing rapidly worldwide since the early 2010s. Emergency physicians will become more involved as ECPR systems develop in Australasia. This editorial provides an introduction to essential ECPR concepts. Evidence and controversies are reviewed. Current and potential roles for emergency physicians in ECPR cases are described. Emergency physicians must participate in ECPR system governance.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a Partnership-Based Approach to Strengthen Acute Care Systems in the Pacific and Timor-Leste","authors":"Sarah Bornstein,&nbsp;Rob Mitchell,&nbsp;Steven McGloughlin,&nbsp;Melanie Wratten,&nbsp;Karen Hammad,&nbsp;Colin Banks,&nbsp;Peter Cameron,&nbsp;Benjamin Dingle,&nbsp;Ann-Maree Guirguis,&nbsp;Chris Guy,&nbsp;Lamour Hansell,&nbsp;Jennifer Jamieson,&nbsp;Arabella Koliwan,&nbsp;Lewis McLean,&nbsp;Naomi McLean,&nbsp;Silina Motofaga,&nbsp;Georgina Phillips,&nbsp;Sally Reid,&nbsp;Cath Tacon,&nbsp;Gerard O'Reilly","doi":"10.1111/1742-6723.70063","DOIUrl":"https://doi.org/10.1111/1742-6723.70063","url":null,"abstract":"<p>Emergency and critical care services are essential to universal health coverage. World Health Assembly (WHA) Resolution 76.2, adopted in 2023, outlined the importance of integrated emergency, critical and operative care systems in strengthening primary healthcare capabilities. Recent research has determined that system strengthening and partnership-based approaches to healthcare capacity development have the potential to achieve greater equity and sustainability. The Regional Emergency and Critical Care Systems Strengthening Initiative (RECSI) is an Australian Government funded programme under the Partnerships for a Healthy Region (PHR) initiative. It aims to enhance acute care capacity and healthcare system resilience across the Pacific and Timor Leste. RECSI is led by a consortium of acute care organisations and provides a vehicle for progressing WHA 76.2. The programme focuses on four thematic areas: workforce capacity and training, systems and processes, data and research, and leadership and governance. As part of RECSI's inception, a structured programme logic was developed, which describes programme activities and outputs, and how they contribute to defined intermediate and end-of-programme outcomes. RECSI's monitoring, evaluation and learning (MEL) plan, which supplements the programme logic, incorporates sustainability indicators that are focused on monitoring the impact of mechanisms designed to enable ongoing benefits from programme outcomes. Utilising a partner-led and context-specific programme design, RECSI represents a rigorous approach to acute care system strengthening. This strategy aims to build genuine partnerships to leverage skills, knowledge and opportunity across the Pacific and Timor-Leste.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SUPraclavicular Block for Emergency Reduction of Upper Limb Injuries Versus Bier Block (SUPERB): An Open-Label, Noninferiority Randomised Controlled Trial","authors":"Henry Tsao,&nbsp;Christopher Tang,&nbsp;Adam Cureton,&nbsp;Laura Maskell,&nbsp;Mark Trembath,&nbsp;Philip Jones,&nbsp;Peter J. Snelling","doi":"10.1111/1742-6723.70069","DOIUrl":"https://doi.org/10.1111/1742-6723.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness of ultrasound-guided supraclavicular block (UGSCB), performed by emergency physicians, for closed reduction of upper limb fractures or dislocations when compared with Bier block (BB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an open-label, noninferiority randomised controlled trial. Adults aged ≥ 18 years presenting to an urban district ED with distal radius and/or ulnar fractures requiring emergent reduction were included. Patients were randomised to either UGSCB using 0.75% ropivacaine or BB using 0.5% lignocaine or 0.5% prilocaine, performed by emergency physicians. The primary outcome was patient-reported maximal pain during closed reduction measured via a 10 cm visual analogue scale (VAS), with a noninferiority margin of 2 cm. Secondary outcomes included post-reduction pain at 1-h and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 78 patients with 39 per group. Intention-to-treat analysis showed that maximal pain during closed reduction following UGSCB was noninferior compared with that after BB (UGSCB: median 0.1 cm, interquartile range [IQR] 0 to 2.1; BB: 0.6 cm, IQR 0 to 3.3; difference in medians −0.5 cm, 95% Confidence Interval [95% CI] −1.7 to 0.7 cm; <i>p</i>_{<i>noninferiority</i>} &lt; 0.001). Pain at 1-h post-intervention was significantly lower in the UGSCB (difference in median −1.8 cm, 95% CI −2.6 to −1.0). There were no between-group differences in adverse events (Odds ratio 2.1; 95% CI 0.18 to 24).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency physician-performed UGSCB provides safe and effective regional anaesthesia that was non-inferior to BB for maximal pain during closed reduction, with the potential advantage of prolonged analgesia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Virtual Emergency Department Reduces Unnecessary Transfers to Hospital of Residential Aged Care Residents Who Fall With Headstrike","authors":"Tim Tse,&nbsp;Alan George Mackenzie Jardine,&nbsp;Lorcan Taylor,&nbsp;Suzanne M. Miller,&nbsp;Jason Talevski,&nbsp;Adam Semciw,&nbsp;Hazel Heng,&nbsp;Jennie E. Hutton,&nbsp;Loren Sher","doi":"10.1111/1742-6723.70067","DOIUrl":"https://doi.org/10.1111/1742-6723.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the effectiveness of the Victorian Virtual Emergency Department (VVED) in reducing unnecessary transfers to hospital of patients who fall with head strike in Residential Aged Care Facilities (RACFs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of patients aged 65 and over residing in RACFs in Northern Melbourne who presented to the VVED with a fall and headstrike between May 2022 and June 2024. VVED referrals were categorised as from: (i) onscene Paramedic (VAM); (ii) nurse at RACF (VRACF); or (iii) diverted Emergency Services call (VACRA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and sixty patients (55.8% female; mean age 86 years) had a fall and headstrike. A similar number of patients were taking anticoagulant (20.8%) or antiplatelet medications (23.9%). The overall rate of transfer to hospital was 24.2% (63 of 260 patients) (VACRA 29.7%, VAM 28.2%, VRACF 18.0%). Anticoagulant use increased the likelihood of transfer (OR: 5.64, 95% CI: 2.81–9.35, <i>p</i> &lt; 0.001). Chart review was performed on 42 of 63 patients transferred to hospital. CT Head was performed on 36 patients (86%) with one patient (2.8%) reported to have an intracranial haemorrhage. Eight patients (19%) were admitted with no patients requiring surgical intervention. No patients remaining at the RACF had an unexpected death related to their presentation at 7 days post-VVED consultation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prehospital consultation with a Virtual Emergency Department for RACF residents who present with a fall and head strike can lead to a reduction in ambulance transfers to a physical ED without compromising safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}