Australian Emergency Nursing Journal最新文献

Trauma care is part of the emergency nurse's everyday practice in Australia. It can range from a patient with a simple fracture to one with multiple traumatic injuries. Largely we have a well-developed and sophisticated prehospital service, especially in metropolitan areas. In most cases we are notified and are able to prepare for the arrival of a trauma patient. We are then able to action our trauma teams or plans and have a focussed, systematic way of assessing, resuscitating and managing the patient.

Imagine working in a hospital in a country where systems are limited. In Vietnam trauma is one of the ten leading causes of death and is the leading cause of death in people aged 5 to 45 years. It accounts for the highest number of occupied hospital beds. Road traffic accidents are responsible for half the injury deaths and they increased four fold between 1989 and 1998.

Emergency departments (EDs) in Vietnam do not receive prehospital notification of an incoming trauma victim, there is little or no prehospital care because most patients are brought to hospital by private car. Basic supplies that we take for granted, such as cervical collars, are not readily available and; on the whole, ED staff are unable to prepare for a trauma patient's arrival.

This article is a description of our visit to Vietnam in March 2003. It is a snapshot of life and trauma management in another health system, in one hospital in a developing country.

Drowning is a significant and preventable cause of death in children across the world. Early indicators for 2001–2 suggest that at least 251 incidents occurred in Australia, with 44 of these being children under five years old (The Royal Life Saving Society Australia, 2002). This figure is down by 25% from the previous five-year average. However, the loss of 44 young children in preventable water related incidents is 44 too many.

Seventy-five percent of paediatric drowning deaths in the 0–5 year age group were due to the child falling or wandering into the water (Langley, 2001). Because children of this age are curious, the message to all is that children need to be kept under constant supervision when near water.

A 15 year-old male was bought to the unit by ambulance approximately two hours after ingesting 750 mg of hydralazine tablets. The episode was marked with distinct stages of deterioration whereby the patient's symptoms changed as the effects of the drug and treatment progressed. On arrival in the unit the patient was hypotensive and tachycardic but otherwise asymptomatic. Over the course of the next four hours his cardiovascular and respiratory status deteriorated. Widespread electrocardiogram (ECG) changes with related chest pain indicated cardiac ischemia, which was later confirmed by rises in cardiac enzymes. The patient's respiratory status deteriorated with the onset of acute pulmonary oedema (APO). These symptoms progressed to such an extent that he required ionotropic support, intubation and extended ventilation. The possible mechanisms involved in the overdose are discussed.

The incidence of acute hydralazine overdose is rare with only scant mention in the literature of similar incidents. ECG changes have been noted in the literature (Smith & Ferguson, 1992), however the progression of the symptoms to include APO and heart failure have not been noted.

Violence in the emergency department (ED) is a significant problem world wide. Psychiatric and emergency settings are widely considered as high-risk areas, with the incidence of nurses' exposure to violence ranging from 60% to 90%. Besides the impact on the health professionals, violence also directly and indirectly affects the quality of patient care and satisfaction of patients. Inevitably, it also contributes to an escalation of health care costs.

Understanding the nature of violence in the ED, its risk factors (patient, staff, situational and interaction factors) and the perceptions of health professionals is an important step towards minimising this problem. Knowledge about the theories of violence and the culture that contributes to violence is also critical to the development of effective long-term violence management strategies for the ED. However, a review of the literature about violence in the ED has revealed many gaps in the research such as the potential for identifying the indicators of violence at triage, over reliance on the reactive and coercive traditional violent management strategies, and the paucity of perception from patient perspective pertaining to this problem.

This paper provides a descriptive review of the contemporary research in this area and identifies gaps in the research.

Emergency departments (EDs) need to engage with the community to ensure fairer access to health resources.

A particularly vulnerable group in the general community are people from non English speaking backgrounds (NESB). The ED at St George Hospital in Sydney developed an innovative project aimed at bringing relevant information to diverse groups about community services and EDs. This became known as the BRIDGE project.

The project involved a diverse group of stakeholders from the community, the area health service and the hospital. As an education program it sought to inform our local NESB community about health care choices. Part of the program involved the development of a video, which has been produced in six different languages. We believe a community better informed about health care services will improve personal health care decision-making and resource utilisation.