Current guidelines for the assessment of patients with chest pain mandate that patients remain in hospital for a minimum of 6 to 12 hours, with many staying overnight. We have developed an accelerated assessment protocol for patients who present to Emergency Departments with chest pain; the Brisbane Accelerated CHest pain protocol (BACH protocol). This strategy should support the accelerated assessment of more than 70% of all ED patients presenting with possible symptoms of a heart attack.
Research into the effectiveness of the BACH protocol was completed in 2014, and showed it to be safe and effective. As such, it was immediately recommended as usual care at the Royal Brisbane and Women's Hospital (RBWH). However, a major concern for health care services is that clinical practice may not change despite quality research identifying ways to improve patient care. Studies show that it takes around 17 years from an idea to progress from the research stage to a change in clinical practice. The current proposal is to assess whether the BACH protocol has been successfully translated into clinical care. That is, has clinical practice really changed as a result of the investment in research? If we are able to show that clinicians use this safe strategy routinely, it will support efforts to more widely use this protocol in Emergency Departments across Australia, potentially saving significant health care costs.
Irukandji Syndrome (IS) is a condition caused by the venom of jellyfish found in the tropical waters of Australia and has received significant media attention over the past decade. The syndrome most commonly presents with a variable combination of severe generalised pain, involving the torso and limbs, nausea and vomiting, sweating, headache and severely elevated blood pressure and pulse. Documented complications of IS include myocardial (heart) damage and failure, intracerebral haemorrhage (bleeding on the brain) and death.
The signs and symptoms of IS are believed to be due to excessive release of endogenous catecholamines (stress hormones). A number of in-vitro and animal studies have documented elevated adrenaline and noradrenaline levels after exposure to venom from Carukia barnesi and related jellyfish. To date, no human trials have measured serum catecholamines in patients with suspected IS.
This elevation in serum catecholamines may account for the profoundly elevated blood pressure and heart rate seen with IS. However, it is unclear what association the severe generalised pain of IS has with elevation of the endogenous catecholamines, i.e. cause or effect. The research team will conduct a prospective, observational, case-control study on patients with IS at The Townsville Hospital to measure serum levels of noradrenaline and adrenaline.READ MORE
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