Emergency medicine journal : EMJ
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Facial injuries are a common presentation to the ED with data suggesting that this may be as high as 4%. There is little data on the epidemiology of paediatric facial injuries and how these are managed by the ED team. The exposure of structures such as the eyes, brain and thyroid to ionising radiation may be potentially harmful and at present there are no nationally agreed guidelines on which patients require imaging in the ED. The aim of this study was to look at the patterns of imaging in a cohort of paediatric facial injuries presenting to an ED in the West Midlands.emermed;31/9/782-b/SA13EMERMED2014204221TB1T1sa13-EMERMED2014204221TB1 A comparison of the imaging requests for the paediatric and adult facial injuriesCT HeadCT FacePA MandibleOPGTMJOMOrbitChild8117404864Adult100241714022669411 METHODS: A retrospective note review of all facial injuries presenting to any one of the three sites that make up the Heart of England NHS Foundation Trust in 2012 was conducted. Electronic records were examined to look for the mechanism of injury, disposal as well if any imaging had been performed during the initial presentation. Where imaging was performed the actual imaging as well as formal radiology reports were accessed to ascertain for the presence or absence of a facial fracture. ⋯ The study highlights that paediatric facial injuries are less common than adult facial injuries and that facial fractures make up only 1.5% of all paediatric facial injuries. Clinicians should consider this when requesting facial X-rays given the potential harm of ionising radiation to the head and neck region. Further studies are in progress to develop evidence based guidelines for imaging children with facial injuries within the ED.The table refers to the total number of different imaging requests and not the number of patients imaged. Some patients had more than one type of imaging requested.
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Traumatic cardiac arrest (TCA) in children is associated with poor survival (<5% in the majority of studies) and even worse neurological outcome.Since 2003, over 600 seriously injured local national children have been treated at deployed UK military medical treatment facilities during the Iraq and Afghanistan conflicts. A number of these were in cardiac arrest after sustaining traumatic injuries.emermed;31/9/790-a/SA2EMERMED2014204221TB7T1sa2-EMERMED2014204221TB7 Mechanism of InjuryMechanismIED13GSW7MVC4Drowning4Other (RPG, UXO)4Total32Trauma care has continually advanced during the recent conflicts, leading to many unexpected survivors (1). The objective of this study was to define outcomes from paediatric TCA in this cohort. ⋯ Outcomes from this cohort show better survival rates in paediatric traumatic cardiac arrest compared to the most other studies. The reason for this is not known, although this mirrors the unexpected survivors previously reported in recent military series. Further work is necessary to define the optimal management of paediatric patients in TCA.
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To explore the increasing numbers of Emergency Medicine registrars that obtained their primary medical degree from United Kingdom (UK) or Irish universities, who work in Emergency Departments (ED) throughout Australia and New Zealand. emermed;31/9/777-a/SA4EMERMED2014204221TB1T1sa4-EMERMED2014204221TB1 Table 1 Trends in Australasian Emergency Medicine registrar numbers 2008-2013 (courtesy of ACEM Policy & Research Department) Year Total registrars Total IMGs UK/Ire IMGs % UK/Ire of total IMGs % UK/Ire of total registrars 2008 1420 787 285 36.2 20.1 2009 1654 958 329 34.3 19.9 2010 1952 1137 413 36.3 21.2 2011 1973 1144 437 38.2 22.1 2012 2078 1185 481 40.6 23.1 2013 2258 1252 566 45.2 25.1 METHODS: The VERS-2013 (Victoria Emergency Registrar Study) was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013.(1) As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working in Australasian EDs. ⋯ Many IMGs (in particular from UK and Ireland) leave their country of origin to work overseas in Australia and New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to the UK to work at consultant level. However, evidence from ACEM (table 1) and the VERS-20131 study show clearly that these doctors are now migrating to Australia for the long-term, leaving EDs the length and breath of the British Isles bereft of talented senior EM decision-making personnel. Meanwhile in Australia, continued IMG influx is at odds with a stated Health Workforce Australia taskforce aim to achieve self-sufficiency by 2025.2 The challenge is set for the College of Emergency Medicine, in conjunction with the UK and Irish governments, to enhance the attractiveness of Emergency Medicine as a credible and sustainable career option. emermed;31/9/777-a/EMERMED2014204221F4F1EMERMED2014204221F4.
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Demonstrating educational interventions improve patient care can been difficult. This study aimed to perform an extensive assessment of a bespoke e-learning package on the NICE Feverish illness in Children Guideline to aid the development of an evaluation model. ⋯ It is important any educational intervention is thoroughly examined as positive findings in respect of satisfaction or knowledge gain may not equate to behaviour change. The continued poor assessment of educational interventions results in potentially continued poor practice or educational technique. A new framework for evaluation (the 7Is) will be presented as a solution.
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Emergency Departments (ED) typically offer walk-in services for minor injuries, and patients arriving at peak times may experience delays. Other NHS services (e.g. GP, dentists and GUM) utilise booked appointments even for urgent problems.We wished to ascertain whether patients attending our ED (a DGH with a very large rural catchment area) with minor injuries would find an appointment system accessed via phone/internet acceptable, and also their views on perhaps being asked to return for an appointment later the same (or following) day, should they arrive when waiting times are unacceptably long. ⋯ This study confirms acceptance of the concept of ED offering appointments to minor injury patients. Participants would prefer pre-booked appointments over being asked to return later or next day, but they would accept either in preference to enduring excessive delays.