Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2012
Assessment of the effect of Advanced Paediatric Life Support training on level of self-perceived preparedness among health-care workers in Cambodia.
The objective of this study was to survey the self-perceived preparedness of Cambodia's Advanced Paediatric Life Support (APLS) providers towards their APLS training and accreditation 5 years post-implementation. ⋯ APLS training has increased the self-perceived preparedness of paediatric health-care workers in Cambodia. RESULTS indicate moderate relevance to real patient resuscitations experienced by health workers, and the perceived recall of the teachings and sense of preparation from APLS training does not significantly decline over time. However, our results suggest subsequent further APLS instructor courses might maintain resuscitation preparedness.
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Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo-controlled human trials. ⋯ No case series using dicobalt edetate or 4-dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.
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Emerg Med Australas · Jun 2012
Randomized Controlled Trial Comparative StudyAustralian triage tags: a prospective, randomised cross-over trial and evaluation of user preference.
The aim of this study was to determine if any disaster triage tag is superior to others, based on objective parameters (time, accuracy) and subjective parameters (user preference). A secondary aim was to determine the average time to perform triage assessment using 'sieve and sort'. ⋯ The SMART card was preferred by participants based on design issues, which supports its implementation. We suggest that doctors are best used in the casualty clearing post.
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Emerg Med Australas · Jun 2012
ReviewSelection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project.
Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in New Zealand were selected and validated. ⋯ Through literature review and consultation with stakeholders, an evidence-based and clinically relevant set of indicators was compiled with which to measure the effect of the SSED target. This indicator set is consistent with recent international recommendations for measuring quality of care in EDs.
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Ectopic pregnancy after hysterectomy is a rare but potentially life-threatening condition requiring prompt diagnosis to prevent the increased mortality associated with rupture. Twenty-seven cases of late post-hysterectomy ectopic pregnancy reported in the English literature since 1918 were reviewed and analysed for presenting symptoms, missed diagnosis rate at initial presentation, location of ectopic and rupture rate at diagnosis. The presenting symptoms were found to be non-specific. ⋯ The majority of late post-hysterectomy ectopic pregnancies (62%) were located in the fallopian tubes. Because of the potential risk of mortality, emergency physicians should always consider the possibility of ectopic pregnancy in childbearing women whose surgical history includes hysterectomy without oophorectomy. Evaluation of abdominal pain in this population should include a pregnancy test to ensure prompt diagnosis when the possibility of pregnancy exists clinically.