Emergency medicine journal : EMJ
-
There is limited epidemiological data for allergy Emergency Department (ED) presentations. Following recent launch of NICE guidelines and World Allergy Organisation (WAO) severity descriptions we investigated the epidemiology, management and outcomes of allergy patients presenting to a single ED. ⋯ NICE guidelines were not consistently followed but this did not seem to result in measurable short terms complications. A significant number of patients had a known precipitant.
-
Anaphylaxis is under-reported in emergency settings and the potential for diagnostic confusion with acute asthma has been reported, especially in children who experience predominantly respiratory symptoms. However, no previous study has directly investigated the probability of unrecognised anaphylaxis in either adults or children presenting with acute asthma. ⋯ The results support the conclusion that some cases of anaphylaxis are unidentified and managed as acute asthma in children. The local frequency was estimated at 4.1% of children admitted to PICU but larger prospective multi-centre studies are required to better define the true prevalence nationally.
-
International guidance has recently recommended serial proximal compression ultrasound (CUS) as first line imaging for suspected deep vein thrombosis (DVT). Limitations with this strategy include attrition, lack of a clear diagnosis, and increased costs associated with serial resource use / clinical review. Single whole-leg CUS is a routine alternative diagnostic strategy that can reduce repeat attendance and identify alternative pathology. We sought to assess the performance characteristics of an established emergency department ambulatory protocol incorporating whole-leg CUS by non-physicians for exclusion of DVT. ⋯ Patients who have anticoagulation withheld following a negative or inconclusive whole leg CUS for suspected DVT have a low rate of adverse events at 3 months. Including the calf in ultrasound examination aided and clarified diagnosis in approximately one third of patients. Technical failure remains an issue: several factors were significantly associated with inconclusive results in our cohort and may warrant an alternative diagnostic approach Abstract 008 Table 1Measuring ED crowding Measure Operational DefinitionAbility of ambulances to offload patients.An ED is crowded when the 90th percentile time between ambulance arrival and offload is greater than 15 minutesPatients who leave without being seen or treated (LWBS)An ED is crowded when the number of patients who LWBS is greater than or equal to 5%.Time until TriageAn ED is crowded when there is a delay greater than 5 minutes from patient arrival to begin their initial triage.ED occupancy rate.An ED is crowded when the occupancy rate is greater than 100%.Patients' total length of stay in the EDAn ED is crowded when the 90th percentile patient's, total length of stay is greater than 4 hours.Time until a physician first sees the patientAn ED is crowded when an emergent (1 or 2) patient waits longer than 30 minutes to be seen by a physicianED boarding timeAn ED is crowded when less than 90% of patients have left the ED 2 hour after the admission decision.Number of patients boarding in the ED.Boarders are defined as admitted patients waiting to be placed in an inpatient bed. An ED is crowded when there is greater than 10% occupancy of boarders in the ED ED; Emergency Department Abstract 008 Table 2Performance of the ICMED against clinician perception of crowding Sensitivity (95% CI)Specificity (95% CI)Ambulance Offload55.9 (45.3-66.5)90.0 (83.6-96.4)Nurse Triage70.6 (60.8-80.3)76.0 (66.9-85.1)Occupancy55.9 (45.3-66.5)78.0 (69.1-86.9)Total stay55.9 (45.3-66.5)100.0 (88.8-100)ED Boarding Time55.9 (45.3-66.5)100.0 (88.8-100)Time to see a Physician32.4 (22.4-42.4)84.0 (76.2-91.8)Patients Boarding85.3 (77.7-92.9)70.0 (60.2-79.8)One Violation100.0 (89.7-100)38.0 (27.6-48.4)Two Violations100.0 (89.7-100)60.0 (49.5-70.5)Three Violations91.2 (85.1-97.2)100.0 (92.9-100)Four Violations50.0 (39.3-60.7)100.0 (88.8-100)Five Violations26.5 (17.0-35.9)100.0 (88.8-100)Six Violations23.5 (14.5-32.6)100.0 (88.8-100)Seven Violations8.8 (2.8-14.9)100.0 (88.8-100).
-
WHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5-5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and impact on local service delivery of a five-day course may limit training opportunities in some settings. In this context, we aimed to determine whether a shorter, more focused course would be feasible. ⋯ 'Essential ETAT' was well received by participants and improvements in post-course test scores compared well to results from standard ETAT courses. Further evaluation is required to indicate whether knowledge is retained and changes clinical practice. Focused, short duration resuscitation training may offer a pragmatic and potentially cost-effective alternative to standard courses.
-
Paediatric trauma team leaders (TTL) may be trained in different clinical sub specialties. The purpose of this study was to compare TTL trained in adult and paediatric emergency medicine in ordering pan CT scans in a similar category of trauma patient. Radiation doses received are often extremely high and carry with them a significantly increased risk for the child of developing cancer in the future. ⋯ Trauma team leaders from paediatric and adult emergency background have a similar propensity to order CT pan scans in trauma. Regardless of who the TTL was, the overall yield of the CT pan scans was only 50%, so the need for weighing up the risks/benefits is imperative in this group.