Valerie Astle BMBS, BMedSci, FACEM, PEM, Meredith Louise Borland AM, MBBS, FACEM, Kim Betts PhD, MBiostats, MPH, Simon Erickson MBBS, FRACP, FCICM, Belinda Gowen BMBS, FCICM, DAME
Objective
The aim of the present study was to assess the predictors of need for paediatric intensive care unit (PICU) admission for inter-hospital transfer patients to a tertiary paediatric hospital ED on high flow (HF) or continuous positive airway pressure (CPAP) ventilation.
Methods
Single-centre retrospective study of patients transferred to the state's tertiary paediatric hospital. Demographic information and disease management information was obtained.
Results
Between October 2021 and September 2022, 53 patients were transferred to the tertiary hospital on HF or CPAP. Of these, 23 required admission to PICU. Those admitted to PICU had a higher median fraction of inspired oxygen than those not admitted (0.4 vs 0.3, respectively, P = 0.013). Patients transported by road (vs flight) were more likely (20/23 patients, RR = 3.15, P = 0.016) to be admitted to PICU (56% vs 18%). Those who had received CPAP prior to or during transfer were more likely to require PICU admission (P = 0.012).
Conclusion
We have demonstrated that children who require CPAP to manage their respiratory disease are more likely to require PICU care on transfer to the tertiary paediatric hospital. In addition, those patients being transferred from secondary metropolitan hospitals after a trial of HF are also likely to require PICU care. This suggests that these patients should be directly admitted to PICU, allowing for improved patient experience and flow as well as reducing unnecessary ED resource utilisation.
{"title":"Assessing the predictors for paediatric intensive care unit for inter-hospital transfer patients on high-flow nasal cannula or continuous positive airway pressure ventilation at a tertiary Australian paediatric hospital","authors":"Valerie Astle BMBS, BMedSci, FACEM, PEM, Meredith Louise Borland AM, MBBS, FACEM, Kim Betts PhD, MBiostats, MPH, Simon Erickson MBBS, FRACP, FCICM, Belinda Gowen BMBS, FCICM, DAME","doi":"10.1111/1742-6723.14463","DOIUrl":"10.1111/1742-6723.14463","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of the present study was to assess the predictors of need for paediatric intensive care unit (PICU) admission for inter-hospital transfer patients to a tertiary paediatric hospital ED on high flow (HF) or continuous positive airway pressure (CPAP) ventilation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-centre retrospective study of patients transferred to the state's tertiary paediatric hospital. Demographic information and disease management information was obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between October 2021 and September 2022, 53 patients were transferred to the tertiary hospital on HF or CPAP. Of these, 23 required admission to PICU. Those admitted to PICU had a higher median fraction of inspired oxygen than those not admitted (0.4 <i>vs</i> 0.3, respectively, <i>P</i> = 0.013). Patients transported by road (<i>vs</i> flight) were more likely (20/23 patients, RR = 3.15, <i>P</i> = 0.016) to be admitted to PICU (56% <i>vs</i> 18%). Those who had received CPAP prior to or during transfer were more likely to require PICU admission (<i>P</i> = 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We have demonstrated that children who require CPAP to manage their respiratory disease are more likely to require PICU care on transfer to the tertiary paediatric hospital. In addition, those patients being transferred from secondary metropolitan hospitals after a trial of HF are also likely to require PICU care. This suggests that these patients should be directly admitted to PICU, allowing for improved patient experience and flow as well as reducing unnecessary ED resource utilisation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"856-861"},"PeriodicalIF":1.7,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vanita Parekh AM MB ChB. FAChSHM (RACP). FFCFM (RCPA). FFFLM(UK) M Forensic M, Janine McMinn BA. CISA. CISM. FAICD, Anna Brkic Dip PM, David Williams B Investigation. A.Dip ComPol. A. Dip B.Mgmt, Caleb Boxx BA. Dip.Pol, Laura Bailey Dip. Pol, Kate Reid MBBS. FRANZCO
Objective
To determine the associations between lid and conjunctival injuries (LACI), non-fatal strangulation (NFS) and domestic family violence (DFV) in non-sexual assault.
Methods
The present study involves an analysis of LACI in a clinical audit of 85 sequential non-sexual assault presentations.
Results
LACI was present in 26.9% of non-sexual assault cases, and 47.4% of LACI patients also experienced NFS. LACI was sustained in the context of DFV in 62.9% of cases. Females made up 69.2% of LACI patients, with those between 14 and 29 years most at risk. Children were present in 12.8% of cases, 78.2% of perpetrators were male and 44.9% of patients had previously been assaulted by the same perpetrator.
Conclusions
LACI is frequently associated with NFS and/or DFV. Since NFS increases future homicide attempts and events more than sixfold, LACI is an important signal about a patient's homicide risk, expanding the dimensions of the care needed. Those experiencing LACI during an assault also need to be referred for comprehensive eye examination as soon as possible. With consent, systematic forensic photography of LACI enables its assessment and documentation, which assists the legal process. These conclusions should drive legislative consideration and reform, plus expanded education for clinicians and police.
{"title":"More than meets the eye: Lid and conjunctival injuries in cases of non-sexual assault are frequently accompanied by non-fatal strangulation","authors":"Vanita Parekh AM MB ChB. FAChSHM (RACP). FFCFM (RCPA). FFFLM(UK) M Forensic M, Janine McMinn BA. CISA. CISM. FAICD, Anna Brkic Dip PM, David Williams B Investigation. A.Dip ComPol. A. Dip B.Mgmt, Caleb Boxx BA. Dip.Pol, Laura Bailey Dip. Pol, Kate Reid MBBS. FRANZCO","doi":"10.1111/1742-6723.14462","DOIUrl":"10.1111/1742-6723.14462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the associations between lid and conjunctival injuries (LACI), non-fatal strangulation (NFS) and domestic family violence (DFV) in non-sexual assault.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present study involves an analysis of LACI in a clinical audit of 85 sequential non-sexual assault presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LACI was present in 26.9% of non-sexual assault cases, and 47.4% of LACI patients also experienced NFS. LACI was sustained in the context of DFV in 62.9% of cases. Females made up 69.2% of LACI patients, with those between 14 and 29 years most at risk. Children were present in 12.8% of cases, 78.2% of perpetrators were male and 44.9% of patients had previously been assaulted by the same perpetrator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LACI is frequently associated with NFS and/or DFV. Since NFS increases future homicide attempts and events more than sixfold, LACI is an important signal about a patient's homicide risk, expanding the dimensions of the care needed. Those experiencing LACI during an assault also need to be referred for comprehensive eye examination as soon as possible. With consent, systematic forensic photography of LACI enables its assessment and documentation, which assists the legal process. These conclusions should drive legislative consideration and reform, plus expanded education for clinicians and police.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"849-855"},"PeriodicalIF":1.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ogilvie Thom MBBS, Kym Roberts MN, BN, Susan Devine PhD, Peter A Leggat PhD, Richard C Franklin PhD
Introduction
No published evidence was identified regarding the use of oxygen in the treatment of drowning in two recent systematic reviews. The aim of our study was to investigate the impact of on scene, pre-Emergency Medical Services (EMS) oxygen therapy by lifeguards in the resuscitation of drowning victims.
Method
We conducted a retrospective case match analysis of drowning patients presenting to the EDs of Sunshine Coast Hospital and Health Service. Patients were matched for age, sex and severity of drowning injury. The primary outcome was in-hospital mortality. Secondary outcomes included positive pressure ventilation (PPV) by EMS and the ED, as well as admission to the Intensive Care Unit.
Results
There were 108 patients in each group. Median (IQR) age was 22 (15–43) in the oxygen group and 23 (15–44) years in the non-oxygen group. There were 45 females in the oxygen group and 41 females in the non-oxygen group. Sixteen patients had suffered cardiac arrest and three patients respiratory arrest in each group. There were five deaths in each group. Initial oxygen saturation on arrival of EMS was identical in both groups 89.2% (±19.9) in the oxygen group versus 89.3% (±21.1) (P = 0.294) in the non-oxygen group. The oxygen group required PPV more frequently with EMS (19 vs 11, P < 0.01) and in the ED (19 vs 15, P < 0.01).
Conclusion
On scene treatment with oxygen by lifeguards did not improve oxygenation or outcomes in drowning patients.
{"title":"Impact of lifeguard oxygen therapy on the resuscitation of drowning victims: Results from an Utstein Style for Drowning Study","authors":"Ogilvie Thom MBBS, Kym Roberts MN, BN, Susan Devine PhD, Peter A Leggat PhD, Richard C Franklin PhD","doi":"10.1111/1742-6723.14454","DOIUrl":"10.1111/1742-6723.14454","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>No published evidence was identified regarding the use of oxygen in the treatment of drowning in two recent systematic reviews. The aim of our study was to investigate the impact of on scene, pre-Emergency Medical Services (EMS) oxygen therapy by lifeguards in the resuscitation of drowning victims.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We conducted a retrospective case match analysis of drowning patients presenting to the EDs of Sunshine Coast Hospital and Health Service. Patients were matched for age, sex and severity of drowning injury. The primary outcome was in-hospital mortality. Secondary outcomes included positive pressure ventilation (PPV) by EMS and the ED, as well as admission to the Intensive Care Unit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 108 patients in each group. Median (IQR) age was 22 (15–43) in the oxygen group and 23 (15–44) years in the non-oxygen group. There were 45 females in the oxygen group and 41 females in the non-oxygen group. Sixteen patients had suffered cardiac arrest and three patients respiratory arrest in each group. There were five deaths in each group. Initial oxygen saturation on arrival of EMS was identical in both groups 89.2% (±19.9) in the oxygen group <i>versus</i> 89.3% (±21.1) (<i>P</i> = 0.294) in the non-oxygen group. The oxygen group required PPV more frequently with EMS (19 <i>vs</i> 11, <i>P</i> < 0.01) and in the ED (19 <i>vs</i> 15, <i>P</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>On scene treatment with oxygen by lifeguards did not improve oxygenation or outcomes in drowning patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"841-848"},"PeriodicalIF":1.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sam Freeman PhD, Jonathon Stewart MBBS, MMed(CritCare), Rebecca Kaard, Eden Ouliel, Adrian Goudie MBBS FACEM DDU, Girish Dwivedi MD, PhD, FRACP, Hamed Akhlaghi MD, PhD, FACEM
Objectives
To investigate health consumers' ethical concerns towards the use of artificial intelligence (AI) in EDs.
Methods
Qualitative semi-structured interviews with health consumers, recruited via health consumer networks and community groups, interviews conducted between January and August 2022.
Results
We interviewed 28 health consumers about their perceptions towards the ethical use of AI in EDs. The results discussed in this paper highlight the challenges and barriers for the effective and ethical implementation of AI from the perspective of Australian health consumers. Most health consumers are more likely to support AI health tools in EDs if they continue to be involved in the decision-making process. There is considerably more approval of AI tools that support clinical decision-making, as opposed to replacing it. There is mixed sentiment about the acceptability of AI tools influencing clinical decision-making and judgement. Health consumers are mostly supportive of the use of their data to train and develop AI tools but are concerned with who has access. Addressing bias and discrimination in AI is an important consideration for some health consumers. Robust regulation and governance are critical for health consumers to trust and accept the use of AI.
Conclusion
Health consumers view AI as an emerging technology that they want to see comprehensively regulated to ensure it functions safely and securely with EDs. Without considerations made for the ethical design, implementation and use of AI technologies, health consumer trust and acceptance in the use of these tools will be limited.
目的调查医疗消费者对在急诊室使用人工智能（AI）的伦理关切：通过健康消费者网络和社区团体招募健康消费者，对其进行半结构化定性访谈，访谈于 2022 年 1 月至 8 月间进行：我们对 28 位健康消费者进行了访谈，了解他们对 ED 中使用人工智能的道德观念。本文讨论的结果强调了从澳大利亚健康消费者的角度来看，有效和合乎道德地实施人工智能所面临的挑战和障碍。如果大多数医疗消费者能够继续参与决策过程，他们就更有可能支持在急诊室使用人工智能医疗工具。支持临床决策而非取代临床决策的人工智能工具得到了更多的认可。对于人工智能工具影响临床决策和判断的可接受性，人们的看法不一。医疗消费者大多支持使用他们的数据来训练和开发人工智能工具，但对谁能使用这些工具表示担忧。解决人工智能中的偏见和歧视是一些健康消费者的重要考虑因素。健全的监管和治理对于健康消费者信任和接受人工智能的使用至关重要：健康消费者认为人工智能是一种新兴技术，他们希望看到对其进行全面监管，以确保其安全可靠地与 ED 一起发挥作用。如果不考虑人工智能技术设计、实施和使用的道德问题，健康消费者对使用这些工具的信任和接受程度将受到限制。
{"title":"Health consumers' ethical concerns towards artificial intelligence in Australian emergency departments","authors":"Sam Freeman PhD, Jonathon Stewart MBBS, MMed(CritCare), Rebecca Kaard, Eden Ouliel, Adrian Goudie MBBS FACEM DDU, Girish Dwivedi MD, PhD, FRACP, Hamed Akhlaghi MD, PhD, FACEM","doi":"10.1111/1742-6723.14449","DOIUrl":"10.1111/1742-6723.14449","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate health consumers' ethical concerns towards the use of artificial intelligence (AI) in EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Qualitative semi-structured interviews with health consumers, recruited via health consumer networks and community groups, interviews conducted between January and August 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 28 health consumers about their perceptions towards the ethical use of AI in EDs. The results discussed in this paper highlight the challenges and barriers for the effective and ethical implementation of AI from the perspective of Australian health consumers. Most health consumers are more likely to support AI health tools in EDs if they continue to be involved in the decision-making process. There is considerably more approval of AI tools that support clinical decision-making, as opposed to replacing it. There is mixed sentiment about the acceptability of AI tools influencing clinical decision-making and judgement. Health consumers are mostly supportive of the use of their data to train and develop AI tools but are concerned with who has access. Addressing bias and discrimination in AI is an important consideration for some health consumers. Robust regulation and governance are critical for health consumers to trust and accept the use of AI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Health consumers view AI as an emerging technology that they want to see comprehensively regulated to ensure it functions safely and securely with EDs. Without considerations made for the ethical design, implementation and use of AI technologies, health consumer trust and acceptance in the use of these tools will be limited.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"768-776"},"PeriodicalIF":1.7,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14449","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Hollott BMed, FANZCA, FAWM, Scott Gelzinnis MD, BMedSci, BMus, Mary Morgan BHB, MBChB, FACEM, AFRACMA, MBA, Alan Garner OAM, MBBS, FACEM, MSc, PhD
Objective
To survey the current structure, capability and operational scope of pre-hospital and retrieval aeromedical teams across Australia.
Methods
The medical directors of all Australian civilian adult aeromedical retrieval organisations with pre-hospital teams and/or doctors for inter-hospital critical care patient transport were contacted in a survey to qualitatively assess capacity and team structure.
Results
All 17 organisations contacted completed the survey. While there is diversity in team structure with the pairing of doctors, paramedics and nurses, capacity for patient care is generally homogenous. A doctor/paramedic model is the more common team structure for rotary-wing missions, and doctor/nurse for fixed-wing. Differences are mostly due to state government controlled aspects of their health services. An advanced degree of intensive patient care occurs outside of the hospital. Land and sea rescue is an important aspect of Australian aeromedical work.
Conclusion
Aeromedicine in Australia has many consistent elements, but variable contexts have resulted in a diversity of operational models.
{"title":"Nationwide status of aeromedical pre-hospital and retrieval medicine in Australia","authors":"John Hollott BMed, FANZCA, FAWM, Scott Gelzinnis MD, BMedSci, BMus, Mary Morgan BHB, MBChB, FACEM, AFRACMA, MBA, Alan Garner OAM, MBBS, FACEM, MSc, PhD","doi":"10.1111/1742-6723.14448","DOIUrl":"10.1111/1742-6723.14448","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To survey the current structure, capability and operational scope of pre-hospital and retrieval aeromedical teams across Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The medical directors of all Australian civilian adult aeromedical retrieval organisations with pre-hospital teams and/or doctors for inter-hospital critical care patient transport were contacted in a survey to qualitatively assess capacity and team structure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All 17 organisations contacted completed the survey. While there is diversity in team structure with the pairing of doctors, paramedics and nurses, capacity for patient care is generally homogenous. A doctor/paramedic model is the more common team structure for rotary-wing missions, and doctor/nurse for fixed-wing. Differences are mostly due to state government controlled aspects of their health services. An advanced degree of intensive patient care occurs outside of the hospital. Land and sea rescue is an important aspect of Australian aeromedical work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aeromedicine in Australia has many consistent elements, but variable contexts have resulted in a diversity of operational models.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"759-767"},"PeriodicalIF":1.7,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paris Hoey MBBS, Kimberley Ryan BN, MN, Clancy McDonald BN, MNP, Nathan J Brown PhD, Kym Boon MBBS, FRANZCP, FFPMANZA, Florian Grimpen MD, FRACP, Mark Appleyard MBBS, FRACP
Repeated intentional foreign body ingestion (RIFBI) in patients with Emotionally Unstable Personality Disorder (EUPD) is a common clinical presentation to the emergency department. The relationship between repeated foreign body ingestion and a co-existent personality disorder diagnosis is complex, making it challenging to manage. Our institution implemented a novel interdisciplinary model of care for RIFBI as a way of improving health outcomes in this cohort of patients. Our observations following the model of care are presented herein. We encourage other health networks to adopt this model of care for managing RIBFI in EUPD.
{"title":"Repeated intentional foreign body ingestion, what can be done?","authors":"Paris Hoey MBBS, Kimberley Ryan BN, MN, Clancy McDonald BN, MNP, Nathan J Brown PhD, Kym Boon MBBS, FRANZCP, FFPMANZA, Florian Grimpen MD, FRACP, Mark Appleyard MBBS, FRACP","doi":"10.1111/1742-6723.14451","DOIUrl":"10.1111/1742-6723.14451","url":null,"abstract":"<p>Repeated intentional foreign body ingestion (RIFBI) in patients with Emotionally Unstable Personality Disorder (EUPD) is a common clinical presentation to the emergency department. The relationship between repeated foreign body ingestion and a co-existent personality disorder diagnosis is complex, making it challenging to manage. Our institution implemented a novel interdisciplinary model of care for RIFBI as a way of improving health outcomes in this cohort of patients. Our observations following the model of care are presented herein. We encourage other health networks to adopt this model of care for managing RIBFI in EUPD.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 4","pages":"659-661"},"PeriodicalIF":1.7,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iain McNeill MBChB, FACEM, Andrew Staib MBBS, PhD, Katherine Z Isoardi BMed, FACEM
Objective
We aimed to assess the impact a Virtual Toxicology Service had on the ALOS of poisoned patients.
Methods
This single-centre before-after study compares the ALOS of poisoned patients (diagnosis-related group X62, poisoning/toxic effects of drugs and other substances) following the introduction of a Virtual Toxicology Service in 2020.
Results
The ALOS decreased from 0.89 days in the 2-year pre-intervention period to 0.62 days in the 3-year post-intervention period, with a potential bed saving of 703 days.
Conclusion
The introduction of a Virtual Toxicology Service appeared to be associated with a decreased ALOS of poisoned patients.
{"title":"Virtual Toxicology Service decreases the average length of stay of poisoned patients and saves bed days","authors":"Iain McNeill MBChB, FACEM, Andrew Staib MBBS, PhD, Katherine Z Isoardi BMed, FACEM","doi":"10.1111/1742-6723.14453","DOIUrl":"10.1111/1742-6723.14453","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to assess the impact a Virtual Toxicology Service had on the ALOS of poisoned patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-centre before-after study compares the ALOS of poisoned patients (diagnosis-related group X62, poisoning/toxic effects of drugs and other substances) following the introduction of a Virtual Toxicology Service in 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ALOS decreased from 0.89 days in the 2-year pre-intervention period to 0.62 days in the 3-year post-intervention period, with a potential bed saving of 703 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The introduction of a Virtual Toxicology Service appeared to be associated with a decreased ALOS of poisoned patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"789-791"},"PeriodicalIF":1.7,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alan J Pearce PhD, Peter Wirth MBBS, FACEM, Michelle Fitts PhD
Attention and awareness regarding concussion injury in Australia have significantly increased in the last decade. Although most of this increase is because of discussion regarding concussions from sporting endeavours, the majority of concussions are from non-sport environments including motor vehicle crashes, workplace incidents, falls, accidents, assault and intimate partner violence. In all cases, hospital EDs are the first point of contact, yet as argued in our Opinion here, there are concerns regarding the consistency of care protocols, because of a number of reasons, as well as management and follow-up clinical practices. Our Opinion is to provide a constructive discussion as well as calling for ACEM to support research to provide evidence-based data. Finally, we provide some recommendations that could be implemented immediately to improve clinical practice for presentations of concussion injuries in EDs.
{"title":"Just a head knock? Emergency physicians need to get serious about concussion","authors":"Alan J Pearce PhD, Peter Wirth MBBS, FACEM, Michelle Fitts PhD","doi":"10.1111/1742-6723.14452","DOIUrl":"10.1111/1742-6723.14452","url":null,"abstract":"<p>Attention and awareness regarding concussion injury in Australia have significantly increased in the last decade. Although most of this increase is because of discussion regarding concussions from sporting endeavours, the majority of concussions are from non-sport environments including motor vehicle crashes, workplace incidents, falls, accidents, assault and intimate partner violence. In all cases, hospital EDs are the first point of contact, yet as argued in our Opinion here, there are concerns regarding the consistency of care protocols, because of a number of reasons, as well as management and follow-up clinical practices. Our Opinion is to provide a constructive discussion as well as calling for ACEM to support research to provide evidence-based data. Finally, we provide some recommendations that could be implemented immediately to improve clinical practice for presentations of concussion injuries in EDs.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"987-989"},"PeriodicalIF":1.7,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pieter Francsois Fouche PhD, Martin Nichols MHlthSc, Raquel Abrahams BHSc, Kristina Maximous BHSc, Jason Bendall MBBS, PhD
Objective
Out-of-hospital seizures demand rapid management. Midazolam plays a key role in stopping seizures. At times the first dose of midazolam proves insufficient, necessitating additional doses. Within the New South Wales Ambulance (NSWA) service, the upper limit for midazolam administration is set at 15 mg. However, the outcomes and safety of using midazolam at this maximum dosage have not been thoroughly investigated.
Methods
A retrospective analysis of out of hospital electronic health records from New South Wales, Australia, over the year 2022, was conducted. The study manually reviewed cases where adult patients received the maximum dose of midazolam for seizure management by paramedics. It focused on seizure cessation success rates and the incidence of adverse effects to evaluate the clinical implications of high-dose midazolam administration.
Results
Of 818 790 individual attendances by NSWA clinicians, a total of 11 392 (1.4%) adults had seizures noted, of which midazolam was administered in 2565 (22.5%). An algorithm shows that in 2352 (91.7%) instances the midazolam was associated with the apparent termination of seizures. Analysis revealed that 176 (1.5%) proportion of all adult's seizure patients required the maximum dose of midazolam for seizure control. These higher doses successfully terminate seizures in about half of the instances. AEs following the maximum dose of midazolam included hypoxia in 26.7% of patients and respiratory depression in 9.7%, indicating significant side effects at higher dosages.
Conclusion
In New South Wales, Australia, administering the maximum dose of midazolam to seizure patients is rare but proves effective in approximately half of the refractory seizure cases. Therefore, assessing the potential for additional doses of midazolam or the use of a second-line agent is advisable.
{"title":"Evaluating the effectiveness of the maximum permitted dose of midazolam in seizure termination: Insights from New South Wales, Australia","authors":"Pieter Francsois Fouche PhD, Martin Nichols MHlthSc, Raquel Abrahams BHSc, Kristina Maximous BHSc, Jason Bendall MBBS, PhD","doi":"10.1111/1742-6723.14432","DOIUrl":"10.1111/1742-6723.14432","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Out-of-hospital seizures demand rapid management. Midazolam plays a key role in stopping seizures. At times the first dose of midazolam proves insufficient, necessitating additional doses. Within the New South Wales Ambulance (NSWA) service, the upper limit for midazolam administration is set at 15 mg. However, the outcomes and safety of using midazolam at this maximum dosage have not been thoroughly investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of out of hospital electronic health records from New South Wales, Australia, over the year 2022, was conducted. The study manually reviewed cases where adult patients received the maximum dose of midazolam for seizure management by paramedics. It focused on seizure cessation success rates and the incidence of adverse effects to evaluate the clinical implications of high-dose midazolam administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 818 790 individual attendances by NSWA clinicians, a total of 11 392 (1.4%) adults had seizures noted, of which midazolam was administered in 2565 (22.5%). An algorithm shows that in 2352 (91.7%) instances the midazolam was associated with the apparent termination of seizures. Analysis revealed that 176 (1.5%) proportion of all adult's seizure patients required the maximum dose of midazolam for seizure control. These higher doses successfully terminate seizures in about half of the instances. AEs following the maximum dose of midazolam included hypoxia in 26.7% of patients and respiratory depression in 9.7%, indicating significant side effects at higher dosages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In New South Wales, Australia, administering the maximum dose of midazolam to seizure patients is rare but proves effective in approximately half of the refractory seizure cases. Therefore, assessing the potential for additional doses of midazolam or the use of a second-line agent is advisable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"744-750"},"PeriodicalIF":1.7,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ingrid Berling BMed, FACEM, PgD(Clin Tox), PhD, Jared Brown BPharm(Hons), MPH, GradCertClinEpi(ClinTox), Brendan Toy MBBCh, DA, Dip PEC
Objective
Vitamin B17 tablets are sold (online) as an alternative cancer therapy medication. Its use however is not benign, given that it is metabolised into hydrogen cyanide. We aimed to measure the number of calls received by the New South Wales Poisons Information Centre (NSW PIC) regarding Amygdalin exposures.
Methods
A retrospective review of all amygdalin/cyanogenic glycoside product ingestion exposure calls to NSW PIC between 2015 and 2022.
Results
There were 120 unique exposure calls. Eighty-two (68%) were regarding minor exposures, with the remaining 38 (32%) of calls involving patients who had either a signifcant history or symptoms to prompt referral to hospital or were already seeking advice from a treating hospital clinican.
Conclusion
There is a significant burden of concern generated from the misuse of cyanogenic glycoside products for cancer prevention and treatment, which can result in hospital admission carrying significant health risk and expenditure.
{"title":"‘Vitamin B17’: Killing more than cancer","authors":"Ingrid Berling BMed, FACEM, PgD(Clin Tox), PhD, Jared Brown BPharm(Hons), MPH, GradCertClinEpi(ClinTox), Brendan Toy MBBCh, DA, Dip PEC","doi":"10.1111/1742-6723.14450","DOIUrl":"10.1111/1742-6723.14450","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Vitamin B17 tablets are sold (online) as an alternative cancer therapy medication. Its use however is not benign, given that it is metabolised into hydrogen cyanide. We aimed to measure the number of calls received by the New South Wales Poisons Information Centre (NSW PIC) regarding Amygdalin exposures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of all amygdalin/cyanogenic glycoside product ingestion exposure calls to NSW PIC between 2015 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 120 unique exposure calls. Eighty-two (68%) were regarding minor exposures, with the remaining 38 (32%) of calls involving patients who had either a signifcant history or symptoms to prompt referral to hospital or were already seeking advice from a treating hospital clinican.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a significant burden of concern generated from the misuse of cyanogenic glycoside products for cancer prevention and treatment, which can result in hospital admission carrying significant health risk and expenditure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 4","pages":"650-651"},"PeriodicalIF":1.7,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14450","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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