Emergency medicine journal : EMJ
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Emergency Department information sharing with Community Safety Partnerships and the Police is well established, Emergency Department Data about the location, time of assault and weapon type is shared with the police to support targetted policing and licensing decisions. It is not established whether ambulance data, which routinely collects automated location and time data, provides additional information to police and emergency department data. We aimed to find out what proportion of ambulance call outs to assault was not recorded by the police or the emergency department services. ⋯ The ambulance service is responding to many victims of community violence that are not recorded by the police and probably not recorded by the emergency department. Ambulance data has potential to inform licensing and targetted policing. It is not proven whether this will reduce community violence.
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Subgaleal haematoma is associated with skull fracture in infants and young children. If the onset is reported to have appeared some time after the suggested mechanism, history may be placed in doubt raising safeguarding concerns. This can lead to social care intervention driven by medical opinion. We performed this study to evaluate our hypothesis that delay in haematoma is common in simple accidental head trauma. ⋯ Whilst every case of skull fracture in infants and young children must be thoroughly assessed for safeguarding concerns, our findings suggest that delayed onset of a subgaleal haematoma can be consistent with accidental injury. It is important to take this into account when offering medical opinion on such cases, to avoid unnecessary social care and legal intervention.
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Formative assessments support learning. Ideally then, such trainee/ trainer interaction would occur throughout the training year and include cases that are stretching. In this way areas for trainee development could be identified and a training plan refined and executed. Such an approach would give time to revisit themes with further assessments towards the end of the year. ⋯ There is a high rate of excellence recorded is assessments, and around half of assessments are performed at the end of the academic year. There were more assessments performed in the month of ARCP (June) than in the first 5 months of the academic year. Future iterations of the assessment schedule will include means of ensuring trainee/trainer interaction is scheduled throughout the year and includes a case mix that stretches the trainee with trainer support.
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Increasing ambulatory care is a goal of the College of Emergency Medicine. It reduces burden on inpatient wards, and is well received by patients and parents. Ambulatory care of children with periorbital cellulitis is not universally accepted, and warrants evaluation. ⋯ Ambulatory care of periorbital cellulitis is safe and cost effective, with very low rate of complication. We postulate that the availability of ambulatory intravenous antibiotics may be affecting clinical decision making, resulting in more children with mild periorbital cellulitis receiving intravenous rather than oral antibiotics. We suggest there is a role for developing a periorbital cellulitis scoring system to assess severity and guide treatment. Abstract 031 Figure 1Periorbital Cellulitis. Abstract 032 Figure 1Street Doctors.
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We identified that there is a cohort of people who attend our Emergency Department (ED) extremely frequently (>24 times per year) or who have frequent admissions (>12 per year). Analysing hospital clinical records identified that in many cases medically unexplained symptoms (MUS) drive the frequent presentation. The needs of these patients were not being met by a traditional dualistic approach in which people are seen in either physical or mental health settings. Indeed, despite frequent medical investigations/treatments, their symptoms persist, their problems are not resolved, they frequently complain and they keep coming back. This carries risk and distress for the patients, and heavy use of resources for the hospitals involved. ⋯ Providing a psychological intervention to this patient cohort is effective in reducing hospital costs by containing the most frequent attenders. CBT and care plans have reduced attendance to under once per month and subsequently reduced medical interventions and prescribing costs.