Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2020
Multicenter Study Comparative StudyEmergency Department utilisation by vulnerable paediatric populations during COVID-19 pandemic.
To determine if changes to community-based services have effected paediatric ED attendances for mental health issues and neonates during the COVID-19 pandemic. ⋯ Vulnerable paediatric patients are seeking care elsewhere during the pandemic because of the closure of community services.
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While the Australasian College for Emergency Medicine (ACEM) encourages all emergency physicians to be competent in at least the five core areas of emergency ultrasound (US), departmental training in most hospitals does woefully little to prepare most ACEM members to attain these competencies. While full day courses are a common method of mandatory and discretionary in-service training, that method has not been adopted for US training. We propose the development of full day courses for each of the five core competencies, taught by accredited US instructors and with emphasis on hands-on training. These courses alone will not produce fully competent US users but will provide a solid foundation for further training.
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Emerg Med Australas · Oct 2020
Observational StudyEmergency Medicine Advanced Ultrasound Service: A new paradigm.
Point-of-care ultrasound (POCUS) is now ubiquitous in emergency medicine. Increased accessibility does not, however, ensure expertise in its use. We present a unique model of an Emergency Medicine Advanced Ultrasound Service (EMAUS). In our model specialist emergency physicians with advanced ultrasound (US) qualifications (emergency sonologists), provide images and reports for the entire department. The service is considered an extension of the traditional radiology model. It is consultative, diagnostic and procedural, and includes full US examinations as well as POCUS examinations. ⋯ Globally POCUS has proliferated with varying expertise and data to support its use. The EMAUS provides a trusted and accountable service with the advantages of simultaneously integrating consultative US into the clinical context by an emergency physician. A diverse range of indications, scan types and pathology was recorded over the period demonstrating the utility of combining the roles of senior clinician, sonographer and radiologist and the benefits of advanced training and credentialing.
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Emerg Med Australas · Oct 2020
Utility of lumbar puncture after a normal brain computed tomography scan in patients presenting to the emergency department with suspected subarachnoid haemorrhage: A new more rational approach?
The diagnostic approach for patients presenting to EDs with headaches suspicious for subarachnoid haemorrhage (SAH) remains challenging. Modern third-generation computed tomography (CT) has been shown to be extremely sensitive in identifying SAH and may eliminate the need for lumbar puncture (LP) which is an invasive, time-consuming procedure with limited accuracy and complications. The aim of this study is to assess the utility of LP in patients being evaluated for possible SAH in the ED after a negative non-contrast CT scan of the brain, as well as addressing the knowledge gap in regard to rational diagnostics among clinicians. ⋯ LP is not required in all patients with suspected SAH who have a negative CT scan. There are defining patient characteristics that can be used to risk stratify patients and may eliminate the need for LP.