Fluid therapy is a valuable entity and a valuable clinical entity. However there is uncertainty regarding the fluid responsiveness of patients, particularly those with severe infections. Potential risks of fluid overload (i.e. too much fluid) exist. Excessive fluid administration is associated with increased morbidity and mortality.
Carotid doppler ultrasound and passive leg raise is a way of estimating fluid responsiveness. By using this technique we believe that it will tell us if a patient will tolerate an intravenous fluid bolus of 500ml.
The aim of this study is to determine if doppler ultrasound of the common carotid artery blood flow before and after PLR is a realistic method by which to determine fluid responsiveness in the acute care setting. Also the review the ease of which this can be taught to emergency doctors.READ MORE
Not infrequently, doctors working in the Emergency Department (ED) have to decide on how they are to provide treatment to dying patients. Specifically, they have to decide whether to actively treat or whether they should limit or withdraw treatment on patients who are not anticipated to live. Such decisions should be governed by legislature as well as standards set by the Australian Council on Health Care Standards (ACHCS). However, research conducted in our hospital has indicated that doctors consider a wide variety of factors including patient’s and family’s wishes when making such end-of-life decisions. We therefore raise the following questions. First, what factors do doctors take into account when they withdraw or withhold treatment in the ED? Second, are such decisions made in accordance with legislative requirements? To date, no research has examined this issue.
This study addresses this gap by focussing on the decisions leading to withdrawal of treatment in the ED. It is a multi-centre review of patients who die in 2009 in a number of Australian and New Zealand hospitals. The primary aim is to describe the factors that doctors consider when making the decisions to withdraw or withhold life-sustaining treatment. The secondary aims are to determine 1) whether Australian doctors are conducting such processes in line with ACHCS guidelines and 2) whether Queensland doctors are making such decisions in accordance with Queensland legislation.READ MORE
Acutely agitated patients are commonly seen in the emergency department (ED). As these patients may cause harm to themselves or others, a large proportion need to be managed with injectable sedative medications such as benzodiazepines (eg midazlolam) and/ or antipsychotics (e.g droperidol).
Unfortunately, these medications may precipitate life threatening events (e.g hypoventilation). Safety data related to the use of these medications for the management of acute agitation in the ED setting are scant. Acute agitation in the ED setting is usually caused by mental health issues or substance abuse, again little is known about which sedative medications are best suited for different groups of acutely agitated patients.
The aim of this study is to determine the nature and incidence of adverse events associated with parenteral sedation medication administered to acutely agitated patients in the ED and to determine the risk factors for these adverse events. It is a multicentre national observational study, aiming to recruit 2000 patients over the age of 18, over a 2 year period. It is hoped that the evidence this study generates will define the risk of AE in this population and may guide clinicians in future treatment choices in sedating this challenging group of patients, hopefully reducing future AE.READ MORE