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Automatic devices are used to take postural blood pressures in the emergency department despite research proving their inaccuracy in taking single blood pressures. This study assessed the accuracy of an automatic device compared with a manual aneroid reference standard for determining orthostatic hypotension and postural drops at triage. Supine and standing blood pressures were taken with an automatic and a manual device in a sequential and random order, and postural drops were calculated. The manual device indicated 10/150 emergency department patients had orthostatic hypotension (7%) and the automatic device detected this with a sensitivity of 30% and a specificity of 91%. The automatic-manual differences were clinically significant in 13% of systolic drops and 37% of diastolic drops. Findings suggest that automatic devices cannot reliably detect or rule out orthostatic hypotension, indicating that triage nurses need to use manual devices to take accurate postural blood pressures for optimal patient care.

Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority. Ongoing trials will provide more information on the role of non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices in persistent ischaemia and early automatic implantable cardioverter-defibrillators for inducible ventricular tachycardia.

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(MACE) and readmission to hospital within 30 days. Results: 24 patients were included in the primary analysis. 10 (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were readmitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post elective percutaneous structural heart condition closure, SDD yielded a cost saving of $4,817 per case. Conclusion: SDD following elective percutaneous structural heart condition closure was demonstrated to be a safe and effective strategy for managing patients that was also associated with significant cost savings to hospitals.