Emergency medicine journal : EMJ
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This is the first study of suicide attempts and completions in the emergency department (ED) in a large national medical system. ⋯ Based on these results the following recommendations are made for helping to reduce suicide attempts in the ED: (1) use a systematic protocol and checklist to review mental health holding areas periodically in the ED for suicidal hazards; (2) develop and implement specialised protocols for suicidal patients that include continuous observation when possible; (3) conduct thorough contraband searches with suicidal patients; (4) designate specialised holding areas, when practically possible, for suicidal patients that are free of anchor points for hanging, sharps and medications, and medical equipment; and are isolated from exits to reduce the risk of elopement.
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Emergency departments are one of the highest risk areas in health care. Emergency physicians have to assemble and manage unrehearsed multidisciplinary teams with little notice and manage critically ill patients. With greater emphasis on management and leadership skills, there is an increasing awareness of the importance of human factors in making changes to improve patient safety. ⋯ Therefore, there remains an educational gap that we need to fill before an emergency physician is equipped to function as a team leader and manager. This review will examine the lessons from aviation and how these are applicable to emergency medicine. Solutions to averting errors are discussed and the need for formal human factors training in emergency medicine.
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A short-cut review was carried out to establish whether ambulatory patients immobilized in a below knee plaster of paris cast and administered with a prophylactic dose anticoagulation with low molecular weight heparin; LMWH can benefit from a reduced risk of venous thromboembolism within the next 90 days One Cochrane Review was relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of LMWH thromboprophylaxis is effective at reducing the incidence of VTE in these patients.
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A short-cut review was carried out to establish whether abdominal pain on hopping/jumping can assist in the initial diagnosis of appendicitis in children. Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the presence of abdominal pain when asked to hop seems to be both reasonably sensitive and specific to a diagnosis of appendicitis in children.
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To describe the common medical presenting problems of children attending a paediatric emergency department (ED) compared with 10 years previously. ⋯ Over a 10-year period, there has been a rise in the number of people attending the ED with medical conditions. The 10 most common presenting problems account for 85% of medical attendees. These results suggest the increasing utilisation of ED services for children with common medical presenting problems and should inform further research exploring the pathways for attendance and the thresholds in seeking medical advice in order to inform the commissioning of paediatric emergency and urgent care services.