Emergency Medicine Australasia最新文献

{"title":"Prescription Practises in the Emergency Department of a Tertiary Level Hospital of a Lower-Middle Income Country: Drug Use Indicator Analysis","authors":"Anjan Khadka,&nbsp;Sammodavardhana Kaundinnyayana,&nbsp;Kabir Thakali,&nbsp;Jebish Pradhan,&nbsp;Mili Koirala,&nbsp;Niranjan Chapagain,&nbsp;Madhu Sudan Aryal","doi":"10.1111/1742-6723.70145","DOIUrl":"10.1111/1742-6723.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Emergency departments are constantly overcrowded with patients in lower-middle-income countries (LMICs) like Nepal, where there is a high likelihood of prescription-related problems and deviations from lists of essential medicines. Few studies have reported the prescribing patterns in emergency departments in LMICs like Nepal. The objective of this study was to assess World Health Organization (WHO) core drug use indicators in the emergency department of a tertiary-level teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional descriptive study was conducted in a tertiary level hospital, assessing 384 prescriptions after obtaining Institutional Review Committee (IRC) permission. A validated proforma was used to collect demographic data, diagnoses, prescriptions, and patient outcomes. The time taken to administer the first drug, total turnaround time, commonly prescribed drug groups with commonly prescribed drugs, and common disease patterns were also recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average age of a total of 384 patients was 51.58 ± 28.94 years. The average turnaround time was 100.37 ± 3.01 min. Gastrointestinal illnesses (26.37%) were the most prevalent illness, pantoprazole (11.05%) being the most frequently used drug. The average number of drugs per encounter was 2.38, and injections accounted for 86.76%, generic prescribing 18.70%, antibiotics for 8.10%, and 81.73% of the drugs were from the National List of Essential Medicines (NLEM) of Nepal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found a higher average number of drugs per encounter than the WHO optimal value, with 81.73% of prescriptions containing medicines from the NLEM. While the study provides valuable insights into prescribing practises, there is a need to enhance generic prescribing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205912","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 Outcomes and Management of Body Stuffing: A Retrospective Review.","authors":"Angela L Chiew, Abbey Tan, Bash Jagarlamudi, Dinuka Dadallage, Betty S H Chan, Katherine Z Isoardi","doi":"10.1111/1742-6723.70146","DOIUrl":"https://doi.org/10.1111/1742-6723.70146","url":null,"abstract":"<p><strong>Introduction: </strong>Body stuffing involves hastily ingesting poorly sealed drug packets for concealment. Management varies from no imaging to CT scans and observation for 6-24 h or until packet passage. This study describes the characteristics, management, and outcomes of body stuffers.</p><p><strong>Method: </strong>A retrospective review was conducted on body stuffers reported to the NSW Poisons Information Centre and South-East Area Toxicology Service (2014-2023). Patients who ingested drugs for concealment were included. Body packers, body pushers, and cases without medical records were excluded. Data were collected from databases and medical records.</p><p><strong>Results: </strong>Of 192 patients, 126 met inclusion criteria (85% male, median age 30 years). Median time to presentation was 3.2 h (IQR: 1.7-6.6, n = 84). The median number of packages was one (IQR: 1-3), with balloons being the most common (56%). Concealed substances included opioids (39%) and amphetamines (29%). Thirty-two ingested multiple substances, while 26 denied or had unknown ingestion. Symptoms were present in 61 (48%), commonly sedation (19) or agitation (13). Symptomatic patients mostly concealed sedatives (29) or stimulants (28), while those ingesting tobacco or denying ingestion were usually asymptomatic. Imaging included abdominal X-ray (63) and CT (50). Sensitivity for X-ray and CT was 25% and 52% respectively. No asymptomatic patients developed symptoms during their stay. Twelve re-presented with new symptoms following discharge.</p><p><strong>Conclusion: </strong>This study found that body stuffers concealed various drugs, with opioids and stimulants more likely to cause symptoms. Asymptomatic patients typically had a benign course. Imaging has limited sensitivity; reserving it for those with more high-risk features of exposure seems reasonable.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":"e70146"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279132","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":"Journal Editors: The Invisible Architects of Academia","authors":"Viet Tran","doi":"10.1111/1742-6723.70142","DOIUrl":"https://doi.org/10.1111/1742-6723.70142","url":null,"abstract":"<div>\u0000 \u0000 <p>Journal editors play a pivotal yet often unseen role in shaping the direction and integrity of academic discourse. Their responsibilities include coordinating peer review, ensuring ethical oversight and curating content that reflects both relevance and scholarly merit. In an era marked by misinformation and growing scepticism toward experts, editorial processes serve as a safeguard for public trust in scientific publishing. This reflective account draws on personal experience as a section editor for <i>Emergency Medicine Australasia</i>, highlighting the transition from trainee contributor to a steward of original research and reviews. Editorial servitude has offered valuable insights into academic publishing, improved writing skills and a deeper understanding of complex subject matters. Editors influence scholarly inquiry through thoughtful manuscript selection, reviewer engagement and constructive feedback. Although the path to editorial roles is rarely direct, it begins with opportunities to demonstrate capability. Far from passive arbiters, editors are the invisible architects of academia and custodians of academic credibility.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146898","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":"Invalid Results With a Point-Of-Care High Sensitivity Troponin Assay in the Emergency Department","authors":"Simone Canovi,&nbsp;Rocco Pio D'Andrea,&nbsp;Nicola Macarone Palmieri,&nbsp;Rossana Colla","doi":"10.1111/1742-6723.70141","DOIUrl":"10.1111/1742-6723.70141","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130430","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":"Lignocaine Liberation: Reclaiming Patient Centred Care During Emergency Department Speculum Examinations","authors":"Haddijatou Hughes","doi":"10.1111/1742-6723.70139","DOIUrl":"10.1111/1742-6723.70139","url":null,"abstract":"<div>\u0000 \u0000 <p>This article examines the importance of analgesia during speculum exams in the emergency department (ED). As ED physicians, we can promote a comprehensive approach to pelvic examinations and advocate for peri-procedural analgesia for these patients. Emergency doctors should routinely inquire about women's needs and address them before the speculum exam. I discuss which populations may experience heightened pain and explore both non-pharmacological and pharmacological options for pain relief. There is a paucity of ED-based research addressing this issue, which urgently requires attention. Ensuring equitable access to analgesia is a fundamental clinical obligation.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069267","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":"Computed Tomography Head Ordering Practices in Residential Aged Care Facility Residents Presenting to Emergency Department After an Unwitnessed Fall","authors":"Elizabeth Chen,&nbsp;Clover Donohue,&nbsp;Amy Sweeny,&nbsp;Nemat Alsaba,&nbsp;Megan McGonagle,&nbsp;Gerben Keijzers","doi":"10.1111/1742-6723.70137","DOIUrl":"10.1111/1742-6723.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine CT head imaging rates, yield and emergent intervention rate (neurosurgery, cessation or reversal of anticoagulants) in residential aged care facility (RACF) residents presenting to ED with an unwitnessed fall. Secondary objectives included a description of shared decision-making discussions with patients or substitute decision makers regarding ED transfer and CT head imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cross-sectional study of residential aged care residents aged over 65 years presenting with unwitnessed falls at two university-affiliated tertiary EDs between 1 January and 30 June 2024. Dual independent data extraction of medical records assessed CT imaging use and yield, which was defined as new intracranial haemorrhage on the radiology report. Change of management and shared decision-making were defined by documentation in the medical record. Data analyses were descriptive, and associations were reported using the odds ratio with 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 398 patients, 235 (59%) underwent CTH imaging and intracranial haemorrhage was identified in 10 patients (4.3%). No patients underwent neurosurgery. Anticoagulation was ceased in four patients. Shared decision-making was documented for hospital transfer in 14.1% of patients, 13.8% of patients receiving CTH and 25.1% among patients who did not undergo imaging. Patients with signs of head injury, on anticoagulation or evidence of polytrauma were more likely to receive a CTH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CT head imaging was common among RACF residents with unwitnessed falls despite low diagnostic yield and infrequent changes in management, with no neurosurgical intervention in our cohort. Limited documentation of SDM calls for stronger integration of meaningful patient-centred discussions to reduce avoidable transfers and imaging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069259","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":"Antibiotic Therapy for Pyelonephritis in the Emergency Department","authors":"Jessica Yu,&nbsp;Christine Koolstra,&nbsp;De Villiers Smit,&nbsp;Biswadev Mitra","doi":"10.1111/1742-6723.70130","DOIUrl":"10.1111/1742-6723.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018–2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was <i>E. coli</i>, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1–6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. <i>E. Coli</i> in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033217","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":"In-Flight Deterioration Occurs Early in Aeromedical Trauma Patients","authors":"Benjamin Powell,&nbsp;Susanna Cramb","doi":"10.1111/1742-6723.70140","DOIUrl":"10.1111/1742-6723.70140","url":null,"abstract":"<p>Reliably defining the risk of adverse in-flight events in aeromedical trauma patients could enable more informed pre-departure treatment and guide central asset allocation to achieve better system-level outcomes. Unfortunately, the current literature base specifically examining the in-flight period is sparse. Flight duration is often considered a proxy for the risk of in-flight deterioration; however, there is limited data to support this commonly held assumption. This paper examines the association between flight duration and the risk of in-flight deterioration in aeromedical trauma patients. A total of 2927 cases of aeromedical transport for acute trauma were retrospectively examined, and the time to first hypotension was recorded. Cases were categorised as either primary or inter-hospital transfer retrievals. Cases were also subclassified as being a primary Traumatic Brain Injury or not based on several criteria, including initial GCS. The median time to hypotension was 11.5 min overall, 10 min in primary retrieval cases, and 15 min in inter-hospital transfer cases (<i>p</i> = 0.049). Notably, after approximately 50 min, a significant plateau in cumulative risk was observed. Isolated TBI cases had a significantly higher overall rate of in-flight hypotension, at 39.5% compared to 9.2%. Overall, this paper supports the physiologically plausible assumption that longer aeromedical transfer times are associated with an increased risk of deterioration during flight. It also demonstrates that deterioration tends to occur early in flight, raising questions as to why this might occur.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033214","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":"Authors' Reply to Merz et al. on eCPR in New Zealand","authors":"S. Wiebe,&nbsp;A. Boehm","doi":"10.1111/1742-6723.70136","DOIUrl":"https://doi.org/10.1111/1742-6723.70136","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022144","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":"What Proportion of Emergency Department Headache Patients With Normal Neurology Have a Serious Secondary Headache Cause? A HEAD Study Report","authors":"Anne Maree Kelly,&nbsp;Kevin H. Chu,&nbsp;Win Sen Kuan,&nbsp;Gerben Keijzers,&nbsp;Frances B. Kinnear,&nbsp;Alejandro Cardozo-Ocampo,&nbsp;the HEAD Study and HEAD Colombia Investigators","doi":"10.1111/1742-6723.70138","DOIUrl":"https://doi.org/10.1111/1742-6723.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To estimate the proportion of Emergency Department (ED) headache patients without neurological features who are diagnosed with a serious secondary headache cause.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Unplanned secondary analysis of HEAD Study/HEAD Colombia data. Patients without a known history of cerebral conditions and with a normal neurological assessment were included. The outcome of interest was the proportion of patients diagnosed with a serious secondary headache cause.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred ninety-one patients were diagnosed with a serious secondary headache cause (191/3951, 4.8%, 95% CI 4.2%–5.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Absence of neurological features alone cannot be used to reliably exclude a serious secondary headache cause in ED patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022263","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}