Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2010
ReviewThe capacity of Australian ED to absorb the projected increase in intern numbers.
As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate medical education has occurred through the provision of funding of additional medical student places. As a consequence, the number of medical graduates is anticipated to increase by as much as 90% with a peak in numbers anticipated in 2012. With ED already under pressure, this increase has serious implications for ED, particularly the delivery of intern and student teaching. ⋯ We discuss the possible impact of an increased number of medical graduates on emergency medical staff, education, supervision and feedback to interns, and given the potential impacts on the education of junior doctors; we review the purpose and implementation of the Australian Curriculum framework for Junior Doctors in relation to their learning requirements. Although there is consensus by most postgraduate bodies that the core emergency term in emergency medicine should be retained, the impact of increased intern numbers might dramatically affect the clinical experiences, supervision and educational resources in the ED. This might necessitate cultural changes in medical education and ED function.
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Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. ⋯ All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.
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Emerg Med Australas · Apr 2010
Comparative StudyIs ED length of stay before ICU admission related to patient mortality?
To describe and identify the relationship between ED length of stay (LOS) and mortality after ICU admission. ⋯ Although 20% of critically ill patients spend more than 8 h in ED before transfer to ICU, we were unable to demonstrate an adverse relationship between time in ED and hospital mortality.
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This article reviews the evidence regarding the use of phenytoin in adult and paediatric patients experiencing seizures in the ED in Australasia, including relevant pharmacokinetics, dosage, therapeutic drug monitoring and methods of administration. It summarizes current evidence regarding the use of phenytoin in a number of seizure types commonly seen in ED. A search of Medline, Embase and Cochrane was performed using appropriate keyword and MeSH headings. ⋯ It should not be given to treat or prevent eclamptic or alcohol-related seizures. There is insufficient evidence regarding its use in preventing febrile convulsions, treating or preventing seizures due to space occupying lesions or intracerebral haemorrhage and thrombosis. In conclusion, phenytoin is appropriate for treatment of some seizures seen in the ED; it is associated with significant adverse effects; trials are ongoing regarding the use of other anticonvulsants in the treatment of status epilepticus.
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Emerg Med Australas · Apr 2010
Comparative StudyAccuracy of interpretation of arterial blood gases by emergency medicine doctors.
It is not currently known how accurately emergency medicine (EM) doctors interpret arterial blood gases (ABG). The present study explores this question. ⋯ Neither group performed to the predefined 'expert level'. There was a trend to improved interpretation with progression through ACEM training. There is scope to improve the training given to EM trainees in ABG interpretation and to incorporate ABG interpretation into consultant continuing education.