Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2012
Randomized Controlled TrialHow fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial.
For children with croup controversy remains over dosage and time to onset of action of oral steroids. The Cochrane Collaboration and other reviews have suggested 0.6 mg/kg dexamethasone be used (despite some evidence that 0.15 mg/kg is effective) with no expectation of benefit before 4-6 h. This randomized double-blinded clinical trial examines whether 0.15 mg/kg dexamethasone works by 30 min. ⋯ For children with croup an oral dose of 0.15 mg/kg dexamethasone offers benefit by 30 min, much earlier than the 4 h suggested by the Cochrane Collaboration. This result might encourage doctors to treat more children with all severities of croup being less worried about potential side-effects and delayed benefit.
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Emerg Med Australas · Feb 2012
Survey of paediatric intravenous fluid prescription: are we safe in what we know and what we do?
The administration of i.v. fluids to children is common in hospital. There are risks associated with fluid therapy, especially iatrogenic hyponatraemia. The objective of this study was to assess the workplace practices and knowledge of tertiary hospital doctors regarding paediatric i.v. fluid prescription. ⋯ Most doctors in this Australian tertiary hospital have a correct method for prescribing bolus and maintenance fluid rates. However, the potential for adverse events from i.v. fluid prescription remains. Further education in this area for junior doctors, introduction of standardized guidelines for fluid use and restriction of available fluid choice may reduce the risk of iatrogenic hyponatraemia in children.
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Emerg Med Australas · Feb 2012
Health reform: is routinely collected electronic information fit for purpose?
Little has been reported about the completeness and accuracy of data in existing Australian clinical information systems. We examined the accuracy of the diagnoses of some chronic diseases in an ED information system (EDIS), a module of the NSW Health electronic medical record (EMR), and the consistency of the reports generated by the EMR. ⋯ Variations in information quality and consistency of the EDIS/EMR raise concerns about the 'fitness for purpose' of the information for care and planning, information sharing, research and quality assurance.
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Emerg Med Australas · Feb 2012
Exposure of Iranian emergency medical technicians to workplace violence: a cross-sectional analysis.
Emergency medical technicians (EMTs) in Iran experience concerning levels of workplace violence, although until now there has been no investigation of this phenomenon. The objectives of the present study were to describe the exposure of Iranian EMTs to workplace violence and to identify the importance of related factors from their viewpoint. ⋯ Iranian EMTs experience a considerable amount of workplace violence. The present study highlights the recommendation for formal training programmes and clearer protocols about how to manage workplace violence, especially verbal abuse in the Iranian prehospital setting.
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Emerg Med Australas · Feb 2012
Demand for public hospital emergency department services in Australia: 2000-2001 to 2009-2010.
Hospital EDs are a significant and high-profile component of Australia's health-care system, which in recent years have experienced considerable crowding. This crowding is caused by the combination of increasing demand, throughput and output factors. The aim of the present article is to clarify trends in the use of public ED services across Australia with a view to providing an evidence basis for future policy analysis and discussion. ⋯ This growth in demand exceeds general population growth, and the variability between states both in utilization rates and overall trends defies immediate explanation. The growth in demand for ED services is a partial contributor to the crowding being experienced in EDs across Australia. There is a need for more detailed study, including qualitative analysis of patient motivations in order to identify the factors driving this growth in demand.