Editor’s note: Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine world-wide, as described in the WAME statement at http://www.wame.org/about/policy-statements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals, and are not peer reviewed or edited by Hong Kong Journal of Emergency Medicine.
African journal of emergency medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria and the Rwanda Emergency Care Association.
Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia
Stachura M, Landes M, Aklilu F, Venugopal R, Hunchak C, Berman S, Maskalyk J, Sarrazin J, Kebede T, Azazh A. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia. Afr J Emerg Med 2017; 7(3): 118–123.
Introduction: Emergency centres (ECs) in low- and middle-income countries often have limited diagnostic imaging capabilities. Point-of-care ultrasound (POCUS) is used in high-income countries to diagnose and guide treatment of life-threatening conditions. This study aims to identify high-impact POCUS scans most relevant to practice in an Ethiopian EC.
Methods: A prospective observational study where patients presenting to Tikur Anbessa Specialized Hospital EC in Addis Ababa were eligible for inclusion. Physicians referred patients with a clinical indication for POCUS from a pre-determined 15-scan list. Scans were performed and interpreted, at the bedside, by qualified emergency physicians with POCUS training.
Results: A convenience sample of 118 patients with clinical indications for POCUS was enrolled. The mean age was 35 years and 42% were female. In total, 338 scans were performed for 145 indications in 118 patients. The most common scans performed were pericardial (n = 78; 23%), abdominal free fluid (n = 73; 22%), pleural effusion/haemothorax (n = 51; 15%), inferior vena cava (n = 43; 13%), pneumothorax (n = 38; 11%) and global cardiac activity (n = 25; 7%). One hundred and twelve (95%) POCUS scans provided clinically useful information. In 53 (45%) patients, ultrasound findings changed patient management plans by altering the working diagnosis (n = 32; 27%), resulting in a new treatment intervention (n = 28; 24%), resulting in a procedure/surgical intervention (n = 17; 14%) leading to consultation with a specialist (n = 16; 14%) and/or changing a disposition decision (n = 9; 8%).
Discussion: In this urban, low-resource, academic EC in Ethiopia, POCUS provided clinically relevant information for patient management, particularly for polytrauma, undifferentiated shock and undifferentiated dyspnoea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia’s first emergency medicine residency programme.
Annals of Emergency Medicine
Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care
Richard C Dart, Lewis R Goldfrank, Brian L Erstad, David T Huang, Knox H Todd, Jeffrey Weitz, Vikhyat S Bebarta, E Martin Caravati, Fred M Henretig, Theodore R Delbridge, William Banner, Sandra M Schneider and Victoria E Anderson
We provide recommendations for stocking of antidotes used in emergency departments (EDs). An expert panel representing diverse perspectives (clinical pharmacology, medical toxicology, critical care medicine, haematology/oncology, hospital pharmacy, emergency medicine, emergency medical services, paediatric emergency medicine, paediatric critical care medicine, poison centres, hospital administration and public health) was formed to create recommendations for antidote stocking. Using a standardised summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel. The panel used a formal iterative process to reach their recommendation for both the quantity of antidote that should be stocked and the acceptable timeframe for its delivery. The panel recommended consideration of 45 antidotes; 44 were recommended for stocking, of which 23 should be immediately available. In most hospitals, this timeframe requires that the antidote be stocked in a location that allows immediate availability. Another 14 antidotes were recommended for availability within 1 h of the decision to administer, allowing the antidote to be stocked in the hospital pharmacy if the hospital has a mechanism for prompt delivery of antidotes. The panel recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine its specific need for antidote stocking. Antidote administration is an important part of emergency care. These expert recommendations provide a tool for hospitals that offer emergency care to provide appropriate care of poisoned patients.
How to cite this article:
Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med 2018. http://dx.doi.org/10.1016/j.annemergmed.2017.05.021
Managing the discharge of diabetic patients from the emergency department: a consensus paper
Rafael Cuervo Pinto, Esther Álvarez-Rodríguez, Noemí González Pérez de Villar, Sara Artola-Menéndez, Juan Girbés Borrás, Manel Mata-Cases, Mercedes Galindo Rubio, Juan Puig Larrosa, Ricardo Muñoz Albert and José Ángel Díaz Pérez
http://emergencias.portalsemes.org/descargar/documento-de-consenso-sobre-el-manejo-al-alta-desde-urgencias-del-paciente-diabtico/
Cited: Cuervo Pinto R, Álvarez-Rodríguez E, González Pérez de Villar N, Artola-Menéndez S, Girbés Borrás J, Mata-Cases M, et al. Managing the discharge of diabetic patients from the emergency department: a consensus paper. Emergencias 2007; 29: 343–351.
About 80%–90% of patients attended in emergency departments are discharged to home. Emergency department physicians are, therefore, responsible for specifying how these patients are treated afterwards. An estimated 30%–40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is, therefore, necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus article presents the consensus of experts from three medical associations, whose members are directly involved with treating patients with diabetes. The aim of the article is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.
A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?
Colin Rouse, Jefferson Hayre, James French, Jacqueline Fraser, Ian Watson, Susan Benjamin, Allison Chisholm, Beth Sealy, Mete Erdogan, Robert S Green, George Stoica and Paul Atkinson
Published Online First: 4 November 2017. doi: 10.1136/emermed-2016-206329
Background: Two distinct emergency medical services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an advanced emergency medical system (AEMS) and New Brunswick operates a basic emergency medical system (BEMS). We sought to determine whether survival rates differed between the two systems.
Methods: This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common injury severity score (ISS) collected by both registries was ISS ≥ 13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher’s exact test and the Student’s t-test.
Results: About 101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR, 1.98; 95% CI, 0.66 to 5.99; p = 0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS > 24), there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR, 1.96; 95% CI, 0.40 to 9.63; p = 0.50).
Conclusion: Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded. This prioritisation process has established a list of research questions, which will inform multicentre PEM [prehospital emergency medicine] research in Australia and New Zealand. It has also emphasised the importance of the translation of new knowledge.
