Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2018
Observational StudyOut-of-hospital arrests attending an Australian tertiary paediatric emergency department over 13 years: An observational study.
In paediatric cardiopulmonary arrest, International Liaison Committee on Resuscitation (ILCOR) states, 'there are no simple guidelines to determine when resuscitative efforts become futile'. Considerations to assist this decision-making include cause of arrest, pre-existing medical conditions, age, site of arrest, duration of untreated cardiopulmonary arrest, witnessed arrest and presence of shockable rhythm. Outcomes are poor in out-of-hospital cardiac arrests (OHCA), particularly for infants. This single-centre observational study describes the characteristics and outcomes of the subgroup of children presenting to our hospital's ED following OHCA still receiving cardiac compressions, to assist development of guidelines for future resuscitation efforts in our ED, particularly for cessation of cardiopulmonary resuscitation (CPR). ⋯ Children presenting to ED still receiving cardiac compressions following OHCA had a universally poor outcome, regardless of age and underlying cause. This implies resuscitative efforts could be discontinued earlier in this subgroup. A national, multicentre study is needed to determine if this finding is reproducible with a larger population.
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Emerg Med Australas · Oct 2018
oneED: Embedding a mindfulness-based wellness programme into an emergency department.
ED staff are subject to many stressors, but there are few descriptions of collective approaches to enhancing wellness in this setting. We aim to describe a programme developed to address these issues at department level, to report the feasibility and sustainability of the programme, and its impact on staff. ⋯ A departmental wellness programme embedding mindfulness practice is feasible and sustainable. Potential for success is enhanced by an approach that is open to modification according to each institution's culture.
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A number of new time critical medical interventions are highly specialised. As such, they are not available in many hospitals and EDs. This necessitates transfer to another facility, which is often associated with some degree of delay. Processes to facilitate timely access to these interventions should aim to replicate or improve on that which would have been available should the patient have been in the community, and responded to, primarily, by an emergency medical service.