David Teubner

Calcific Uremic Arteriolopathy: Advances in Pathogenesis and Treatment

Calcific uremic arteriolopathy (CUA) is a rare but serious life‐threatening complication of CRF that manifests as painful nonhealing eschars in association with panniculitis and dermal necrosis. This condition is being increasingly recognized and reported as a contributing factor to death in dialysis patients. The pathognomic lesion is vascular calcification with intimal arterial hypertrophy and superimposed small vessel thrombosis. Hyperparathyroidism and elevated concentrations of serum phosphate remain consistent clinical features of most cases reported. Controversy still exists regarding the role of parathyroidectomy in this condition with some studies suggesting improved outcome with surgical intervention. A number of potential new etiological factors have been identified including reduced serum levels of a calcification inhibitory protein α,2‐Heremans–Schmid glycoprotein (Fetuin‐A) and abnormalities in smooth muscle cell biology in uremia. Promising new treatment options including hyperbaric oxygen therapy and sodium thiosulfate infusion have been reported in case series. Benefits from biphosphonates and tissue plasminogen activator have also been reported. Overall these new treatment approaches and understanding of potential mechanisms underlying this important severe clinical condition offer new hope in the diagnosis and management of this severely morbid and often fatal condition.

Predicting admission of patients by their presentation to the emergency department.

The present study aims to determine the importance of certain factors in predicting the need of hospital admission for a patient in the ED.

Retrospective audit of the investigation of patients with suspected acute subarachnoid haemorrhage.

Introduction:  Recommended investigational care (RIC) of emergency department (ED) patients with suspected subarachnoid haemorrhage comprises lumbar puncture (LP) to detect xanthochromia if the preceding CT scan is negative.

ORIGINAL ARTICLE: Retrospective audit of the investigation of patients with suspected acute subarachnoid haemorrhage

Introduction:  Recommended investigational care (RIC) of emergency department (ED) patients with suspected subarachnoid haemorrhage comprises lumbar puncture (LP) to detect xanthochromia if the preceding CT scan is negative.

Fluid bolus therapy in emergency department patients: Indications and physiological changes.

The aim of the present paper is to study the indications for fluid bolus therapy (FBT) and its associated physiological changes in ED patients.

Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study

The aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline.

Application of process mining to assess the data quality of routinely collected time-based performance data sourced from electronic health records by validating process conformance.

Effective and accurate use of routinely collected health data to produce Key Performance Indicator reporting is dependent on the underlying data quality. In this research, Process Mining methodology and tools were leveraged to assess the data quality of time-based Emergency Department data sourced from electronic health records. This research was done working closely with the domain experts to validate the process models. The hospital patient journey model was used to assess flow abnormalities which resulted from incorrect timestamp data used in time-based performance metrics. The research demonstrated process mining as a feasible methodology to assess data quality of time-based hospital performance metrics. The insight gained from this research enabled appropriate corrective actions to be put in place to address the data quality issues.

Presenting characteristics and processing times for culturally and linguistically diverse (CALD) patients with chest pain in an emergency department: Time, Ethnicity, and Delay (TED) Study II

BACKGROUND To date there has been limited published data presenting the characteristics and timeliness of the management in an Emergency Department (ED) for culturally and linguistically diverse (CALD) patients presenting with chest pain. This study aimed to describe the presenting characteristics and processing times for CALD patients with chest pain compared to the Australian-born population, and current guidelines. METHODS This study was a cross sectional analysis of a cohort of patients who presented with chest pain to the metropolitan hospital between 1 July 2012 and 30 June 2014. RESULTS Of the total study population (n=6640), 1241 (18.7%) were CALD and 5399 (81.3%) were Australian-born. CALD patients were significantly older than Australian-born patients (mean age 62 vs 56years, p<0.001). There were no differences in the proportion of patients who had central chest pain (74.9% vs 75.7%, p=0.526); ambulance utilisation (41.7% vs 41.1%, p=0.697); and time to initial treatment in ED (21 vs 22min, p=0.375). However, CALD patients spent a significantly longer total time in ED (5.4 vs 4.3h, p<0.001). There was no difference in guideline concordance between the two groups with low rates of 12.5% vs 13%, p=0.556. Nonetheless, CALD patients were 22% (95% CI, 0.65, 0.95, p=0.015) less likely to receive the guideline management for chest pain. CONCLUSIONS The initial emergency care was equally provided to all patients in the context of a low rate of concordance with three chest pain related standards from the two guidelines. Nonetheless, CALD patients spent a longer time in ED compared to the Australian-born group.

Survival from a prolonged out of hospital cardiac arrest (OHCA): The chain of survival linked by teams

Survival rates from Out of Hospital Cardiac Arrest (OHCA) re often dismal1–3 and more so when resuscitation efforts are engthy.4–6 We wish to report a case where, despite requiring over 0 minutes of manual CPR and multiple direct-current counterhocks (DCCS), the patient made a full recovery. We attribute his urvival not to any one individual or intervention, but rather to the any individuals/interventions by the teams that took part in his are. This report relates to a 51 year old, 70 kg male in an outer etropolitan area of a South Australian city, who in the latter art of the evening called out to his wife complaining of chest ain, he was also vomiting. The patient rapidly deteriorated and ollapsed with a short seizure as the first sign of cardiac arrest. e was described as “well that day”, but had a previous medial history of ischaemic heart disease and recent femoral bypass urgery. The teams and brief summary of interventions consisted of:

ORIGINAL ARTICLE: Retrospective audit of the investigation of patients with suspected acute subarachnoid haemorrhage: Investigation of possible SAH in the ED

Introduction:  Recommended investigational care (RIC) of emergency department (ED) patients with suspected subarachnoid haemorrhage comprises lumbar puncture (LP) to detect xanthochromia if the preceding CT scan is negative.