African journal of emergency medicine : Revue africaine de la medecine d'urgence
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We compare the effectiveness of direct laryngoscopy (DL) to video laryngoscopy (VL) in simulated, difficult airway scenarios in a cohort of novice, prehospital, emergency care providers. ⋯ In our small sample, we found DL to be superior to VL in relation to a reduced risk of failed intubation and frequency of intubation attempts despite VL being superior in obtaining a good view of the vocal cords in a face-to-face intubation scenario. We found no statistically significant difference in the time taken to intubate in any scenarios. A larger study is required to inform practice and education around prehospital use of VL.
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Emergency centres (EC) in low- and middle-income countries often have limited diagnostic imaging capabilities. Point-of-care ultrasound (POCUS) is used in high-income countries to diagnose and guide treatment of life-threatening conditions. This study aims to identify high impact POCUS scans most relevant to practice in an Ethiopian EC. ⋯ In this urban, low-resource, academic EC in Ethiopia, POCUS provided clinically relevant information for patient management, particularly for polytrauma, undifferentiated shock and undifferentiated dyspnea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia's first emergency medicine residency program.
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The ability to deliver quality emergency care services is reliant on a well-trained workforce. Since Sierra Leone was declared Ebola free in December 2015, the country has now moved into the post-Ebola reconstructive phase focusing on specialty training of healthcare workers. This development aligns well to the growing momentum for improved emergency medicine as a speciality in other regions of Sub-Saharan Africa. The first stage in assessing how to develop an emergency nursing speciality in Sierra Leone is to conduct an assessment of what is needed in terms of educational interventions. Concurrently enhancing emergency nursing capacity requires a comprehensive understanding of the role, function and emergency nurse educational requirements. This study was conducted to fully understand the current context, elucidate current nursing functions and gain knowledge of the educational desires and needs of nurses in the emergency centre at Connaught Hospital, the largest referral hospital in Sierra Leone. ⋯ This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.
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The consequences of spinal injury as a result of trauma can be devastating. Spinal immobilisation using hard trauma boards and rigid cervical collars has traditionally been the standard response to suspected spinal injury patients even though the risk may be extremely low. Recently, adverse events due to the method of immobilisation have challenged the need for motion restriction in all trauma patients. International guidelines have been published for protection of the spine during transport and this article brings those guidelines into the South African context. ⋯ The need for motion restriction in suspected spinal injury should be properly evaluated and appropriate action taken. Not all trauma patients require spinal motion restriction.
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When weight cannot be measured during the management of medical emergencies in children, a convenient, quick and accurate method of weight estimation is required, as many drug doses and other interventions are based on body weight. Many weight estimation methodologies in current use have been shown to be inaccurate, especially in low- and middle-income countries with a high prevalence of underweight children. This meta-analysis evaluated the accuracy of weight estimation systems in children from studies from low- and middle-income countries. ⋯ The PAWPER tape, the Wozniak method and the Mercy method achieved an acceptable level of accuracy in studies from low- and middle-income countries and should preferentially be used and further advanced for clinical emergency medicine practice. Parental estimates may be considered if the regular caregiver of the child is present and a recent measured weight is known. The Broselow tape and age-based formulas should be abandoned in low- and middle-income country populations as they are potentially dangerously inaccurate.