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Hopefully we can now stop doing LP ’ s to rule out SAH if CT scan performed within 6 hours of onset
The Canadian study by Perry et al just published in the BMJ studied 3132 patients with worst ever headache across 11 ED’s between 2000-2009 of which 240 (7.7%) had subarachnoid haemorrhage. CT scanning overall had a sensitivity of 93% for detecting SAH, but if done within 6 hours of onset of headache and interpreted by an experienced radiologist, the sensitivity rose to 100% picking up ALL 121 patients with SAH of the 953 patients scanned within 6 hours. Looks like its time to modify our practices as long as we have access to experienced radiologists – overnight may be an issue when such access may not be readi...
Source: Oz E Medicine - emergency medicine in Australia - July 19, 2011 Category: Emergency Medicine Authors: admin Tags: tips and guidelines headache subarachnoid haemorrhage Source Type: blogs

News from EMA Course in New York – IT systems in ED – need for scribes
I attended the EMA Course in New York last month and although IT systems were not directly part of the course, the topic did arise and the general feeling of the many US emergency physicians appeared to be that current commercial ED software in place in the USA is NOT efficient and comments such as “terrible” were not uncommonly expressed. It seems that the consensus was that for EP’s to be productive with such software they each need to have a personal scribe to ensure adequate timely documentation while allowing them to have adequate time at the bedside with the patients. Furthermore, it seems that the ...
Source: Oz E Medicine - emergency medicine in Australia - July 8, 2011 Category: Emergency Medicine Authors: anitaliu Tags: information technology information systems Source Type: blogs

Victoria ’ s new Severe Substance Dependence Treatment Act 2010
This Act came into effect 1 March 2011 and essentially provides a mechanism for certain medical practitioners to detain and treat persons with potentially life threatening substance dependence and who are unable to consent to treatment. See details on the wiki
Source: Oz E Medicine - emergency medicine in Australia - July 7, 2011 Category: Emergency Medicine Authors: anitaliu Tags: General information drug dependency legislation Source Type: blogs

Throwing a cat amongst the pigeons – cancer risk – will it change our referral pattern for cardiac diagnostic testing?
The recently published retrospective Canadian study of 5 year cancer risk following heart attack in 1996-2006 seems to demonstrate a consistent 3% increased risk in cancer per 10 milliSv radiation dose when adjusted for sex, age, comorbities (but strangely, not for smoking status, nor for actual measured radiation dosage but for presumed, estimated dosage based on investigations and procedures which were billed). Nevertheless, the increased risk seems consistently increased as radiation dose increases and thus the results may be plausible. Given the average age of these patients being ~61 years, some 14% were diagnosed wit...
Source: Oz E Medicine - emergency medicine in Australia - February 16, 2011 Category: Emergency Medicine Authors: Gary Tags: Cardiology cancer risk diagnostic testing Source Type: blogs

New drugs: Exenatide – an injectable diabetic agent and Denosumab – a monoclonal antibody for postmenopausal osteoporosis
Exanatide (Byetta): the first injectable synthetic analogue of the incretin hormone glucagon-like peptide-1 (GLP-1) note that the glyptins inhibit incretin breakdown and are thus incretin “enhancers” not “mimics” PBS approved for type 2 diabetics as an addition to the combination of metformin and  sulphonylurea to help lower HbA1c below 7% or as dual Rx for those who cannot tolerate metformin or a sulphonylurea. dose: is given bd s/c within 1 hour BEFORE meals starting at 5 mcg per dose which should be at least 6 hours apart after 1 month, dose can be increased to 10mcg bd main adverse effect...
Source: Oz E Medicine - emergency medicine in Australia - December 11, 2010 Category: Emergency Medicine Authors: Gary Tags: new drugs Source Type: blogs