Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.
{"title":"Practical strategies for caring for patients with functional neurological disorder in the ED","authors":"Alexander Lehn MD, FRACP","doi":"10.1111/1742-6723.14489","DOIUrl":"https://doi.org/10.1111/1742-6723.14489","url":null,"abstract":"<p>Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"786-788"},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234724","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}
<p>In their article, Craig <i>et al</i>.<span><sup>1</sup></span> eloquently describe how current Australasian ED administrative data sets do not address quality of care and benchmarking and research opportunities. This is unsurprising because these data sets were not designed for these purposes. I agree that the clinical data that <i>could</i> be available would provide valuable insights into the quality of care, areas for improvement and opportunities for research. I admire the ambition of this initiative, but big data comes with big issues.</p><p>Any analysis of big data is only as good as the data entered. For maximum effectiveness and validity, data need to be clean, complete, accurate and formatted consistently. The differences in the design and implementation of health information systems (including electronic medical records [EMRs]) challenge data quality and consistency. For example, not all EMR systems require procedures be specifically captured and there may be differences in coding sets and how they are used.</p><p>Current administrative data sets are jurisdiction-based and government-owned. Development of a national/binational data set will need the participation of governments. With the potential political impacts of comparisons between jurisdictions, obtaining government support will not be easy.</p><p>Also, a data set of the size generated by this initiative will demand sophisticated stewardship, curation and data governance. Who will ‘own’ the data? Who will decide how it is used and by whom? Governments will want a stake in ownership which will open the possibility of influence in project selection and reporting.</p><p>The privacy and consent issues are complex and full discussion is beyond this editorial's remit. The authors' assertion that the use of routinely collected healthcare data for quality improvement and research is generally acceptable to people may be true when people are asked about data in general. It may be less so when asked about the use of their data. Australian evidence suggests that while most patients attending ED expect that data are used in this way, about 20% report that this use without consent will not be acceptable to them; a majority will prefer a consent requirement.<span><sup>2</sup></span> How this can be made workable is challenging, especially if re-identifiability for data linkage is included.</p><p>I do not agree that data collection without consent will be acceptable under legislation. Previous approaches, such as use of privacy notices stating that information may be used for quality improvement and research, are unlikely to be acceptable under privacy legislation.<span><sup>3</sup></span> In my experience, jurisdictions vary in their interpretation of what can be defined as a ‘directly related secondary purpose’ for use of health information, a potentially valid exemption from requiring consent. Also, bundled consent – ‘bundling’ together multiple requests for an individual's consent to a r
{"title":"Big data, big promise and big issues","authors":"Anne-Maree Kelly MD, FACEM, MHealth&MedLaw","doi":"10.1111/1742-6723.14483","DOIUrl":"https://doi.org/10.1111/1742-6723.14483","url":null,"abstract":"<p>In their article, Craig <i>et al</i>.<span><sup>1</sup></span> eloquently describe how current Australasian ED administrative data sets do not address quality of care and benchmarking and research opportunities. This is unsurprising because these data sets were not designed for these purposes. I agree that the clinical data that <i>could</i> be available would provide valuable insights into the quality of care, areas for improvement and opportunities for research. I admire the ambition of this initiative, but big data comes with big issues.</p><p>Any analysis of big data is only as good as the data entered. For maximum effectiveness and validity, data need to be clean, complete, accurate and formatted consistently. The differences in the design and implementation of health information systems (including electronic medical records [EMRs]) challenge data quality and consistency. For example, not all EMR systems require procedures be specifically captured and there may be differences in coding sets and how they are used.</p><p>Current administrative data sets are jurisdiction-based and government-owned. Development of a national/binational data set will need the participation of governments. With the potential political impacts of comparisons between jurisdictions, obtaining government support will not be easy.</p><p>Also, a data set of the size generated by this initiative will demand sophisticated stewardship, curation and data governance. Who will ‘own’ the data? Who will decide how it is used and by whom? Governments will want a stake in ownership which will open the possibility of influence in project selection and reporting.</p><p>The privacy and consent issues are complex and full discussion is beyond this editorial's remit. The authors' assertion that the use of routinely collected healthcare data for quality improvement and research is generally acceptable to people may be true when people are asked about data in general. It may be less so when asked about the use of their data. Australian evidence suggests that while most patients attending ED expect that data are used in this way, about 20% report that this use without consent will not be acceptable to them; a majority will prefer a consent requirement.<span><sup>2</sup></span> How this can be made workable is challenging, especially if re-identifiability for data linkage is included.</p><p>I do not agree that data collection without consent will be acceptable under legislation. Previous approaches, such as use of privacy notices stating that information may be used for quality improvement and research, are unlikely to be acceptable under privacy legislation.<span><sup>3</sup></span> In my experience, jurisdictions vary in their interpretation of what can be defined as a ‘directly related secondary purpose’ for use of health information, a potentially valid exemption from requiring consent. Also, bundled consent – ‘bundling’ together multiple requests for an individual's consent to a r","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"670-671"},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234837","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}
Functional neurological disorders (FNDs) are conditions of nervous system malfunctioning, rather than a clearly identifiable pathophysiological disease.1 FND can present with an array of symptoms, including functional seizures, weakness and paralysis, movement disorders, speech disturbances, globus sensation, sensory complaints, visual and cognitive symptoms. These symptoms may be acute or chronic, episodic or sustained and patients often have a high rate of representation to the ED.2 These factors make FND a challenge to manage within the constraints of the ED.
Previously, FND was considered a diagnosis of exclusion. Recently, FND has been described as a ‘rule-in’ diagnosis, with positive findings offering the possibility of early diagnosis and management in the ED. Shorter time from symptom onset to diagnosis is an important positive prognostic factor, leading to reduced ED utilisation and improved patient outcomes.3
{"title":"An introduction to functional neurological disorders in the emergency department","authors":"Melanie Eden BBiomedSci (Hons), MD","doi":"10.1111/1742-6723.14492","DOIUrl":"https://doi.org/10.1111/1742-6723.14492","url":null,"abstract":"<p>Functional neurological disorders (FNDs) are conditions of nervous system malfunctioning, rather than a clearly identifiable pathophysiological disease.<span><sup>1</sup></span> FND can present with an array of symptoms, including functional seizures, weakness and paralysis, movement disorders, speech disturbances, globus sensation, sensory complaints, visual and cognitive symptoms. These symptoms may be acute or chronic, episodic or sustained and patients often have a high rate of representation to the ED.<span><sup>2</sup></span> These factors make FND a challenge to manage within the constraints of the ED.</p><p>Previously, FND was considered a diagnosis of exclusion. Recently, FND has been described as a ‘rule-in’ diagnosis, with positive findings offering the possibility of early diagnosis and management in the ED. Shorter time from symptom onset to diagnosis is an important positive prognostic factor, leading to reduced ED utilisation and improved patient outcomes.<span><sup>3</sup></span></p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 5","pages":"777-778"},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234725","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}
Alla Melman BAppSci, MSc, PhD, Min J Teng BAppSci, MHSM, Danielle M Coombs BAppSci, PhD, Qiang Li MSc, Laurent Billot MSc, MRes, Thomas Lung MSc, PhD, Eileen Rogan MBBS, MHSM, PhD, Mona Marabani MBBS, Owen Hutchings MBBS, Joshua R Zadro BAppSci, PhD, Chris G Maher BAppSci, DMedSc, PhD, Gustavo C Machado BPhty, PhD, The Back@Home Investigators
Objectives
Low back pain was the sixth most common reason for an ED visit in 2022–2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes.
Methods
Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care.
Results
This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724–AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function.
Conclusions
Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.
{"title":"Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home)","authors":"Alla Melman BAppSci, MSc, PhD, Min J Teng BAppSci, MHSM, Danielle M Coombs BAppSci, PhD, Qiang Li MSc, Laurent Billot MSc, MRes, Thomas Lung MSc, PhD, Eileen Rogan MBBS, MHSM, PhD, Mona Marabani MBBS, Owen Hutchings MBBS, Joshua R Zadro BAppSci, PhD, Chris G Maher BAppSci, DMedSc, PhD, Gustavo C Machado BPhty, PhD, The Back@Home Investigators","doi":"10.1111/1742-6723.14487","DOIUrl":"10.1111/1742-6723.14487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Low back pain was the sixth most common reason for an ED visit in 2022–2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (<b>rpa</b>virtual), and be cared for remotely in their own homes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724–AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"929-937"},"PeriodicalIF":1.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282194","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}
Andrew Rixon B.Sc(hons), GCLT, FCHSM, PhD, Samuel Wilson BA, BCom, MPsych, PhD, Lee Wong MBBS (hons), GradDipClinEd, FACEM, PhD, Elizabeth Elder BA, BN, MAdvPrac, MNurs, PhD
Objective
To explore how clinicians understand coaching and their clinician-coach practice in emergency medicine.
Methods
Participants were surveyed about the value of coaching and their beliefs about the enablers of, and barriers to, being a clinician-coach.
Results
Three themes were developed for the value of coaching: empowerment and growth; enhanced interpersonal dynamics; and reflective transformation. Key enablers were supportive infrastructure, self-driven development and recognition of value. Key barriers were time constraints and scheduling conflicts, cultural challenges and financial and structural obstacles.
Conclusions
Fostering a supportive environment for coaching could significantly enhance clinician competence and well-being, healthcare delivery and professional development.
{"title":"Exploring the value, enablers and barriers of being a clinician-coach: A qualitative pilot study of clinician-coaches in emergency medicine","authors":"Andrew Rixon B.Sc(hons), GCLT, FCHSM, PhD, Samuel Wilson BA, BCom, MPsych, PhD, Lee Wong MBBS (hons), GradDipClinEd, FACEM, PhD, Elizabeth Elder BA, BN, MAdvPrac, MNurs, PhD","doi":"10.1111/1742-6723.14501","DOIUrl":"10.1111/1742-6723.14501","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore how clinicians understand coaching and their clinician-coach practice in emergency medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were surveyed about the value of coaching and their beliefs about the enablers of, and barriers to, being a clinician-coach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three themes were developed for the value of coaching: empowerment and growth; enhanced interpersonal dynamics; and reflective transformation. Key enablers were supportive infrastructure, self-driven development and recognition of value. Key barriers were time constraints and scheduling conflicts, cultural challenges and financial and structural obstacles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fostering a supportive environment for coaching could significantly enhance clinician competence and well-being, healthcare delivery and professional development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"983-986"},"PeriodicalIF":1.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252037","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}
Emmanuelle Fauteux‐Lamarre, Stephen Hearps, Michelle McCarthy, Nuala Quinn, Andrew Davidson, Donna Legge, Katherine J Lee, Greta M Palmer, Sandy M Hopper, Franz E Babl
ObjectiveIntranasal (IN) fentanyl and nitrous oxide (N2O) can be combined to provide procedural sedation and analgesia to children. This combination is advantageous because of rapid onset of action and non‐parenteral administration, but is associated with increased vomiting. We sought to describe the associations of demographic and procedural factors with early vomiting when using this combination in children.MethodsThis was a planned secondary analysis of a randomised controlled trial comparing the effect of oral ondansetron versus placebo at a single paediatric hospital. Children aged 3 to <18 years with planned procedural sedation with IN fentanyl and N2O were randomised to receive oral ondansetron or placebo prior to N2O administration. Vomiting was defined as early if occurring during or up to 1 h after N2O delivery. We assessed the relationship between early vomiting, demographic and procedural characteristics.ResultsParticipants were recruited between October 2016 and January 2019 and 62 out of 436 (14%) had early vomiting. The risk of early vomiting was 30% higher with higher total dose of fentanyl, risk ratio = 1.3 (95% confidence interval = 1.004–1.59). There was little evidence of a relationship between the occurrence of early vomiting and sex, age, weight, type of procedure, fasting duration, time between fentanyl administration and start of procedure, and procedure duration.ConclusionWe found that higher doses of IN fentanyl were associated with higher risk of early vomiting when administered with N2O in children. Other factors did not appear to be associated with vomiting.
{"title":"Associations with early vomiting when using intranasal fentanyl and nitrous oxide for procedural sedation in children: A secondary analysis of a randomised controlled trial","authors":"Emmanuelle Fauteux‐Lamarre, Stephen Hearps, Michelle McCarthy, Nuala Quinn, Andrew Davidson, Donna Legge, Katherine J Lee, Greta M Palmer, Sandy M Hopper, Franz E Babl","doi":"10.1111/1742-6723.14497","DOIUrl":"https://doi.org/10.1111/1742-6723.14497","url":null,"abstract":"ObjectiveIntranasal (IN) fentanyl and nitrous oxide (N<jats:sub>2</jats:sub>O) can be combined to provide procedural sedation and analgesia to children. This combination is advantageous because of rapid onset of action and non‐parenteral administration, but is associated with increased vomiting. We sought to describe the associations of demographic and procedural factors with early vomiting when using this combination in children.MethodsThis was a planned secondary analysis of a randomised controlled trial comparing the effect of oral ondansetron <jats:italic>versus</jats:italic> placebo at a single paediatric hospital. Children aged 3 to <18 years with planned procedural sedation with IN fentanyl and N<jats:sub>2</jats:sub>O were randomised to receive oral ondansetron or placebo prior to N<jats:sub>2</jats:sub>O administration. Vomiting was defined as early if occurring during or up to 1 h after N<jats:sub>2</jats:sub>O delivery. We assessed the relationship between early vomiting, demographic and procedural characteristics.ResultsParticipants were recruited between October 2016 and January 2019 and 62 out of 436 (14%) had early vomiting. The risk of early vomiting was 30% higher with higher total dose of fentanyl, risk ratio = 1.3 (95% confidence interval = 1.004–1.59). There was little evidence of a relationship between the occurrence of early vomiting and sex, age, weight, type of procedure, fasting duration, time between fentanyl administration and start of procedure, and procedure duration.ConclusionWe found that higher doses of IN fentanyl were associated with higher risk of early vomiting when administered with N<jats:sub>2</jats:sub>O in children. Other factors did not appear to be associated with vomiting.","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"6 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252113","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}
ObjectivesThe aim of the present study was to examine the profile, management and outcomes of adult patients with severe burns within the Victorian State Trauma System (VSTS).MethodsData from the Victorian State Trauma Registry (VSTR) was analysed to characterise patient and injury characteristics and review pre‐hospital management and clinical outcomes of adult patients with severe burns.ResultsThere were 421 cases over 13 years of the study. Approximately 80% of cases were flame burns, and 5% were associated with other significant trauma. Approximately 75% were male; with 83% of patients under 65 years old, 40% of lower socioeconomic status, 25% having pre‐existing drug and alcohol involvement, and 36% living with associated comorbidities. All but 11 patients (of 421) were managed definitively at the burns service. Around one‐third of patients had interhospital transfer, with median (interquartile range (IQR)) time spent in the primary hospital 3.0 (1.9–4.3) h. Only five patients had multiple interhospital transfers. Nearly 75% of patients were admitted to an ICU. The median (IQR) length of definitive hospital stay was 27.2 (11.2–44.9) days. The mortality rate was 23.8%.ConclusionsSevere burns are uncommon injuries with high mortality. There is a high rate of adherence to VSTS guidelines for managing patients with severe burns, and a decrease in patients requiring transfer associated with an increase in acceptable time to a trauma‐receiving hospital. The VSTS operates to deliver almost all patients with severe burns to the definitive burns service efficiently.
{"title":"Trauma system management of adults with severe burns in Victoria, Australia","authors":"Heather Cleland, Peter Cameron, Belinda Gabbe","doi":"10.1111/1742-6723.14495","DOIUrl":"https://doi.org/10.1111/1742-6723.14495","url":null,"abstract":"ObjectivesThe aim of the present study was to examine the profile, management and outcomes of adult patients with severe burns within the Victorian State Trauma System (VSTS).MethodsData from the Victorian State Trauma Registry (VSTR) was analysed to characterise patient and injury characteristics and review pre‐hospital management and clinical outcomes of adult patients with severe burns.ResultsThere were 421 cases over 13 years of the study. Approximately 80% of cases were flame burns, and 5% were associated with other significant trauma. Approximately 75% were male; with 83% of patients under 65 years old, 40% of lower socioeconomic status, 25% having pre‐existing drug and alcohol involvement, and 36% living with associated comorbidities. All but 11 patients (of 421) were managed definitively at the burns service. Around one‐third of patients had interhospital transfer, with median (interquartile range (IQR)) time spent in the primary hospital 3.0 (1.9–4.3) h. Only five patients had multiple interhospital transfers. Nearly 75% of patients were admitted to an ICU. The median (IQR) length of definitive hospital stay was 27.2 (11.2–44.9) days. The mortality rate was 23.8%.ConclusionsSevere burns are uncommon injuries with high mortality. There is a high rate of adherence to VSTS guidelines for managing patients with severe burns, and a decrease in patients requiring transfer associated with an increase in acceptable time to a trauma‐receiving hospital. The VSTS operates to deliver almost all patients with severe burns to the definitive burns service efficiently.","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"149 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142206139","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}
Luke Phillips MBBS, BSc (BioMed) (Hons), FACEM, CCPU, GradCertClinSim, Alastair Maclean MB ChB, BSc Med Sci (Hons), Post Grad Cert CPU, MRCP (Lon), FRCEM, FACEM, Josh Monester MBBS(Hons), CCPU, GradCertClinEd, Joanne Douglas DMU, SEED, ASUM CCPU provider, Stacey Davidson ICF ACC, Zenergy Master Facilitator, Gabriela King MBBS, FACEM, Post Grad Cert CPU
Objectives
Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes the risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs.
Methods
Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab-labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by clinical leaders in ultrasound and POCUS users in Australasia.
Results
The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality.
Conclusion
These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.
{"title":"Recommendations for developing a comprehensive point-of-care ultrasound (POCUS) program in the emergency department: an Emergency Medicine Ultrasound Group advocacy statement","authors":"Luke Phillips MBBS, BSc (BioMed) (Hons), FACEM, CCPU, GradCertClinSim, Alastair Maclean MB ChB, BSc Med Sci (Hons), Post Grad Cert CPU, MRCP (Lon), FRCEM, FACEM, Josh Monester MBBS(Hons), CCPU, GradCertClinEd, Joanne Douglas DMU, SEED, ASUM CCPU provider, Stacey Davidson ICF ACC, Zenergy Master Facilitator, Gabriela King MBBS, FACEM, Post Grad Cert CPU","doi":"10.1111/1742-6723.14484","DOIUrl":"10.1111/1742-6723.14484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes the risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab-labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by clinical leaders in ultrasound and POCUS users in Australasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"956-963"},"PeriodicalIF":1.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132175","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}
Luke Phillips MBBS, BSc (BioMed) (Hons), FACEM, CCPU, MClinSim, Alastair Maclean MB ChB, BSc Med Sci (Hons), Post Grad Cert CPU, MRCP (Lon), FRCEM, FACEM, Josh Monester MBBS(Hons), CCPU, GradCertClinEd, Joanne Douglas DMU, SEED, ASUM CCPU provider, Stacey Davidson ICF ACC, Zenergy Master Facilitator, Gabriela King MBBS, FACEM, Post Grad Cert CPU
Objectives
Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs.
Methods
Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab-labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by Clinical Leads in Ultrasound and POCUS users in Australasia.
Results
The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality.
Conclusion
These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective, and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.
{"title":"Optimising POCUS programs: A summary of EMUG's recommendations for the development and maintenance of ED POCUS programs","authors":"Luke Phillips MBBS, BSc (BioMed) (Hons), FACEM, CCPU, MClinSim, Alastair Maclean MB ChB, BSc Med Sci (Hons), Post Grad Cert CPU, MRCP (Lon), FRCEM, FACEM, Josh Monester MBBS(Hons), CCPU, GradCertClinEd, Joanne Douglas DMU, SEED, ASUM CCPU provider, Stacey Davidson ICF ACC, Zenergy Master Facilitator, Gabriela King MBBS, FACEM, Post Grad Cert CPU","doi":"10.1111/1742-6723.14485","DOIUrl":"10.1111/1742-6723.14485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab-labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by Clinical Leads in Ultrasound and POCUS users in Australasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective, and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"964-967"},"PeriodicalIF":1.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132174","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}
Objectives: 'Dirty adrenaline' is the informal term used for a rapidly made peripheral dilute adrenaline infusion in the emergency treatment of shock, most commonly 1 mg adrenaline in 1 L 0.9% NaCl. It has long been part of the remote clinician's arsenal despite no supporting scientific literature. Remote clinics in Central Australia can be hours away from critical care support. The region's high prevalence of renal and cardiac disease means that access to early vasopressors and inotropes is a necessity for treating shock. To tackle this, remote clinicians often use 'dirty adrenaline'. We present a review of 'dirty adrenaline' use in this region.
Methods: Central Australian Retrieval Service's database was screened to identify cases in which a peripheral dilute adrenaline infusion was administered in a remote clinic prior to patient aeromedical retrieval. A retrospective chart review collected: patient demographics; clinical characteristics; infusion details; adverse events; hospital lengths of stay; and mortality outcomes.
Results: Fifty-seven cases were identified. Median patient age was 50 (range: 2-96). Septic shock was the most common clinical indication (40/57). Median infusion duration was 155 min. Median systolic BP from commencement until retrieval increased from 75.5 to 91 mmHg. Survival to hospital discharge was 86% (49/57). No significant adverse events associated with 'dirty adrenaline' were recorded.
Conclusion: 'Dirty adrenaline' is safe to administer and appears to considerably improve survival when used to treat fluid-resistant shock in remote nurse-led clinics guided by an off-site critical care physician.
{"title":"Pre-hospital 'dirty adrenaline': A descriptive case series of patients receiving peripheral dilute adrenaline infusions in Central Australian remote nurse-led clinics prior to aeromedical retrieval.","authors":"David Braham, Daniel W S Adams, Richard Johnson","doi":"10.1111/1742-6723.14496","DOIUrl":"https://doi.org/10.1111/1742-6723.14496","url":null,"abstract":"<p><strong>Objectives: </strong>'Dirty adrenaline' is the informal term used for a rapidly made peripheral dilute adrenaline infusion in the emergency treatment of shock, most commonly 1 mg adrenaline in 1 L 0.9% NaCl. It has long been part of the remote clinician's arsenal despite no supporting scientific literature. Remote clinics in Central Australia can be hours away from critical care support. The region's high prevalence of renal and cardiac disease means that access to early vasopressors and inotropes is a necessity for treating shock. To tackle this, remote clinicians often use 'dirty adrenaline'. We present a review of 'dirty adrenaline' use in this region.</p><p><strong>Methods: </strong>Central Australian Retrieval Service's database was screened to identify cases in which a peripheral dilute adrenaline infusion was administered in a remote clinic prior to patient aeromedical retrieval. A retrospective chart review collected: patient demographics; clinical characteristics; infusion details; adverse events; hospital lengths of stay; and mortality outcomes.</p><p><strong>Results: </strong>Fifty-seven cases were identified. Median patient age was 50 (range: 2-96). Septic shock was the most common clinical indication (40/57). Median infusion duration was 155 min. Median systolic BP from commencement until retrieval increased from 75.5 to 91 mmHg. Survival to hospital discharge was 86% (49/57). No significant adverse events associated with 'dirty adrenaline' were recorded.</p><p><strong>Conclusion: </strong>'Dirty adrenaline' is safe to administer and appears to considerably improve survival when used to treat fluid-resistant shock in remote nurse-led clinics guided by an off-site critical care physician.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125159","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}
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