Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2012
'Lessons learned': A comparative case study analysis of an emergency department response to two burns disasters.
The Royal Perth Hospital (RPH; Perth, Australia) has been the receiving facility for burns patients in two separate disasters. In 2002, RPH received 28 severely injured burns patients after the Bali bombing, and in 2009 RPH received 23 significantly burnt patients as a result of an explosion on board a foreign vessel in the remote Ashmore Reef Islands (840 km west of Darwin). The aim of this paper is to identify the interventions developed following the Bali bombing in 2002 and review their effectiveness of their implementation in the subsequent burns disaster. ⋯ There were a number of lessons observed from the Bali experience in 2002 that have led to improvements in practice and lessons learned.
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Appendicitis is the most common paediatric surgical emergency. In our institution, the majority of inter-hospital transfers are for suspected appendicitis. We undertook an audit to assess the accuracy of the provisional diagnosis of the transferred cases. ⋯ Of the surgical referrals for appendicectomy, 60% did not have appendicitis. An improved assessment protocol is required to reduce the margin of diagnostic error and transfer cost, while maintaining clinical safety.
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Emerg Med Australas · Aug 2012
Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre.
To evaluate the performance of a newly implemented prehospital trauma triage (T1) protocol in New South Wales for patients transported to an inner city major trauma centre. ⋯ The sensitivity and undertriage rates associated with the T1 protocol indicate the ongoing need for secondary triage at designated trauma centres and refinement of the protocol to include age as a criterion.
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Emerg Med Australas · Aug 2012
Case ReportsVascular hyperpermeability in pulmonary decompression illness: 'the chokes'.
Decompression illness (DCI) develops during or after diving. Pulmonary decompression illness ('Chokes') is rarely seen because the affected individual usually dies in the water. We encountered a rare and interesting case. ⋯ Despite large-volume fluid therapy, severe intravascular dehydration and shock status remained. We assume that the injured endothelial cells induced vascular hyperpermeability and increased levels of inflammatory cytokines leading to the high serum PCT level. PCT might be a useful stress marker of endothelial damage and severity in DCI, including Chokes.
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Emerg Med Australas · Aug 2012
Initial resuscitation for Australasian Triage Scale 2 patients in a Nepalese emergency department.
Triage is recognized as important in providing timely care to emergency patients. However, systematic triage is only practised in two EDs in Nepal. The first objective of this study was to assess the performance of one of these departments in seeing triaged patients in a timely fashion. Second, an epidemiological survey of patients presenting to the ED was performed to describe the conditions seen and initial resuscitation undertaken. ⋯ Patients triaged as ATS 2 were seen in a timely fashion. Seriously ill patients requiring resuscitation present commonly to this ED. This is a big challenge for junior doctors. Improved training, treatment protocols and equipment are needed to help manage this burden.