Emergency Medicine Australasia最新文献

We publish a valuable paper comparing management of primary spontaneous pneumothorax before and after completion of a multi-centre study that shows non-inferiority between conservative and interventional treatment for the condition.

Abdominal and pelvic pain accounted for 4.7% of ED presentations in Australia in 2022–2023. A survey of 8657 people living in NSW found prevalence rates of abdominal pain or discomfort in the preceding 3 months of 13% in individuals with diabetes mellitus (DM) compared with 10.8% in controls. The prevalence of type 2 DM in Australia increased from 1985 to 3429 per 100 000 population between 1990 and 2019. Incidence rates of type 1 DM remained stable between 2000 and 2018. We publish a comprehensive review of abdominal pain in patients with diabetes mellitus of relevance to the ED.

A fascinating, multicentre study reports on the current use of TEM in Australasia. The COVID-19 pandemic catapulted telehealth to the forefront of EM as an alternative way of assessing and managing patients, challenging the traditional idea that EM can only be practised in bricks-and-mortar EDs. Many clinicians may find the idea of practising TEM confronting, particularly without training and practice guidelines.

A team from Queensland report on ‘Deadly-RED’, a project aiming to improve culturally competent care to reduce the number of First Nations people presenting to a Queensland ED who ‘take own leave’ (TOL). They report significant discrepancies in the data points of TOL and the story of the First Nations peoples' experience of appropriate and completed care. Staff awareness and cultural capability improved significantly and yarning allowed knowledge translation and improved communication, contributing to better health care experiences for First Nations people attending an ED.

In overdose, gamma-hydroxybutyrate (GHB) and its precursors can cause decreased level of consciousness, coma, and death. A team from Sydney analysed the databases of four Sydney metropolitan EDs for presentations relating to GHB exposure between 2012 and 2021. 3510 GHB related presentations were recorded across the four hospitals. Data for all hospitals were only available from 2015 onwards; between 2015 and 2021 there was a 114% increase in annual presentations from 228 to 487. The proportion of them with a triage category one increased from 19.7% to 34.5%. These changes are a major public health concern.

Reducing perceived unnecessary resource use, a team from NSW modified their unit's tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. Their study reports interesting results. This new team structure was safe, reduced admissions, pathology and imaging, but led to an increased ED length of stay and time to surgical review.

Indonesia and French Guiana share some geographic and medical concerns regarding access to care. Organizational needs in emergency mana

Objectives: Emergency medicine (EM) doctors are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. The objective of the present study was to explore the research question: 'What are the experiences and perceptions of leadership by EM doctors?'

Methods: This single-site qualitative study was undertaken using semi-structured in-depth individual interviews to collect data. Interviews were audio recorded, transcribed and de-identified. Reflexive thematic analysis was performed by the research team with the aid of DelveTool software.

Results: Our sample included nine participants incorporating consultants and registrars. Three major themes were identified: (i) situational tensions, (ii) relational tensions and (iii) leadership style tensions. Each of these was further explored with subthemes discussed separately.

Conclusions: Leadership within the ED is complex and multifaceted, with doctors required to navigate many competing tensions. The present study highlighted key areas for future leadership development, including situational awareness, emotional intelligence and a fluid approach to leadership styles. The present study provides an important step towards enhancing the development of targeted leadership training for EM doctors.

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.

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.