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Journal Cover African Journal of Emergency Medicine
   [3 followers]  Follow    
  This is an Open Access Journal Open Access journal
     ISSN (Print) 2211-419X
     Published by Elsevier Homepage  [2563 journals]   [SJR: 0.145]   [H-I: 2]
  • UJUZI (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 1 June 2014
      Source:African Journal of Emergency Medicine
      Author(s): M. Osei-Ampofo , C. Oppong , M. Ntow , P.K. Forson



      PubDate: 2014-06-06T14:39:13Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: Available online 24 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2014-04-26T16:32:11Z
       
  • Hypoparathyroidism presenting with seizures and intracranial
           calcifications in a child

    • Abstract: Publication date: Available online 24 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): Harika Tirumani , Prashanth Saddala
      Introduction The most common potentially treatable cause of basal ganglia calcification is hypoparathyroidism. Case report We present a case of incidentally detected basal ganglia calcification due to hypoparathyroidism in a child presenting with seizures and discuss the clinical features, imaging findings, and management of hypoparathyroidism. Conclusion Prompt detection and treatment of hypoparathyroidism can prevent intracranial calcification and the risk of intracerebral haemorrhages in patients with intracranial calcification.


      PubDate: 2014-04-26T16:32:11Z
       
  • Headache in the Emergency Centre, intra-cranial haemorrhage from
           arteriovenous malformation

    • Abstract: Publication date: Available online 24 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): P.G. Cloete , H.-C. Huang
      Introduction Headaches are a common cause for presentation to Emergency Centres (ECs). Emergency physicians need to be aware of the red flags on history and examination that point towards serious underlying causes. Case report We present the case of a young woman who presented to the EC with a severe headache. The diagnosis of subarachnoid haemorrhage was suspected on history and strengthened on the lumbar puncture results. A high-grade arteriovenous malformation was subsequently diagnosed on computed tomography (CT). Conclusion In emergency medicine, all new onset of severe headaches should be evaluated with potential disabling or life threatening diagnoses in mind, even if symptoms should resolve with time and analgesia. CT imaging and LP as investigations in the workup of headache in Africa should be utilised appropriately as access to CT may be limited.


      PubDate: 2014-04-26T16:32:11Z
       
  • A novel and fatal method of copper sulphate poisoning

    • Abstract: Publication date: Available online 24 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): Keneilwe Motlhatlhedi , Jacqueline A. Firth , Vincent Setlhare , Jackson K. Kaguamba , Mmapula Mmolaatshepe
      Introduction Copper sulphate is widely used around the world as a pesticide and seed fungicide. Many cases of accidental intoxication with this substance have been reported among farm workers who have absorbed large amounts of the substance through the skin. It has also been used for self-harm, generally by oral ingestion. Toxic levels of the substance can lead to methaemoglobinaemia and death. Case report The case of a 29year old woman who diluted and inserted copper sulphate vaginally in order to terminate an unwanted pregnancy is reported. Conclusion A review of the presentation, diagnosis, and treatment of copper-sulphate-induced methaemoglobinaemia, including the challenges of treating this condition in clinical settings that are unprepared for this complication.


      PubDate: 2014-04-26T16:32:11Z
       
  • In this issue…

    • Abstract: Publication date: Available online 18 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): Stevan R. Bruijns



      PubDate: 2014-04-21T16:27:46Z
       
  • Providing blood transfusion in the resource limited setting

    • Abstract: Publication date: Available online 18 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): Mark Bisanzo



      PubDate: 2014-04-21T16:27:46Z
       
  • AFEM Consensus Conference, 2013. AFEM Out-of-Hospital Emergency Care
           Workgroup Consensus Paper: Advancing Out-of-Hospital Emergency Care in
           Africa: Advocacy and Development

    • Abstract: Publication date: Available online 13 April 2014
      Source:African Journal of Emergency Medicine
      Author(s): N.K. Mould-Millman , R. Naidoo , S. de Vries , C. Stein , L.A. Wallis
      Emergency care occurs on a continuum. Developing prehospital emergency care systems that are integrated with in-hospital emergency care systems can be a sustainable and effective way to help address the large morbidity and mortality of acute disease in Africa. Unfortunately, development of such prehospital systems across Africa has been slow to progress for many reasons, including feared cost implications, no agreed optimal system structure and function, and poor advocacy. In November 2013, the African Federation for Emergency Medicine (AFEM) convened a second expert and stakeholder meeting in Cape Town, South Africa, with the objective of reaching consensus on a few position statements to facilitate advocacy and to guide the development of emergency care in Africa. The objective of this paper is to report the outputs and position statements emerging from the AFEM Out-of-Hospital Emergency Care Workgroup consensus process. The term “Out-of-Hospital Emergency Care” was agreed by consensus and defined by the Workgroup as a suitable umbrella term for use in Africa that refers to the full spectrum of emergency care that occurs outside healthcare facilities. Critical components of this system were defined, including first responder care (tier-one) systems, and prehospital care and emergency medical services (tier-two) systems. The Workgroup provided a practical, adaptable and flexible set of guidelines and expert recommendations to facilitate advocacy and development of out-of-hospital emergency care systems in needy African settings. Future directions of the AFEM Out-of-Hospital Emergency Care Workgroup include creating an online Toolkit. This will serve as a repository of template documents to guide implementation and development of clinical care, education, transportation, public access, policy and governance.


      PubDate: 2014-04-16T21:13:38Z
       
  • Luxatio Erecta – “Hands-up” shoulder dislocation

    • Abstract: Publication date: Available online 26 March 2014
      Source:African Journal of Emergency Medicine
      Author(s): Richard Lynch , Yvonne McCague , Michelle Barlow
      Introduction Inferior shoulder dislocation, also known as luxatio erecta or “hands up dislocation”, is a rare and unusual type of shoulder dislocation. It is more commonly associated with neurovascular damage than other types of shoulder dislocation. Case report We describe a case of a 44year-old male who presented to our emergency centre with an inferior shoulder dislocation. X-ray of his left shoulder was performed which revealed the classical appearance. The injury was subsequently relocated by closed reduction technique. Conclusion The typical mechanism of injury is a sudden application of pressure from above onto an abducted and externally rotated shoulder joint with the elbow flexed. To reduce, first traction–counter traction is applied in line with the abducted humerus followed by steady adduction of the arm.


      PubDate: 2014-03-31T16:35:09Z
       
  • Epidemiology of injuries, outcomes, and hospital resource utilisation at a
           tertiary teaching hospital in Lusaka, Zambia

    • Abstract: Publication date: Available online 25 March 2014
      Source:African Journal of Emergency Medicine
      Author(s): Philip Seidenberg , Kathryn Cerwensky , Rae Oranmore Brown , Emily Hammond , Yona Mofu , James Lungu , Yakub Mulla , Godfrey Biemba , Hani Mowafi
      Introduction Injuries represent a global public health threat and that threat is disproportionally felt especially in low and middle income countries (LMICs) that experience 90% of global mortality from injury. Few LMICs have robust datasets describing patient injuries and injury care. Objective: To develop a hospital-based trauma registry in an urban hospital in Lusaka, Zambia to assess patterns of injury, transport methods and duration, injury severity, outcomes and hospital resource utilisation. Methods From September 2011 to February 2012, all injured patients presenting to the Surgical Casualty Department at University Teaching Hospital (UTH) were prospectively enrolled in an observational study to describe the epidemiology and the circumstances of injury of patients presenting to UTH, a 1400 bed urban hospital which is the primary trauma centre for Lusaka. Data on injured patients were collected by trained staff 24h/day including: circumstances of trauma, transport method and time, injury type and location, vital signs on arrival, and disposition. Additional data regarding length of stay, HIV testing, operative procedures, use of blood products, and 30-day vital status were recorded for admitted patients. Results A total of 3498 patients were enrolled in the trauma registry. Patients were primarily male (71.8%), young (median age 24years), and the majority arrived by private vehicle (51.8%) or public transport (37.1%). The most common reported mechanisms of injury were falls (26.3%), road traffic accidents (25.6%) and assault (20.0%). Hospital resource utilisation data were available for 863 of the 1769 (48.7%) admitted patients. Of these, 661 (76.6%) had X-rays, 468 (57.5%) had a surgical procedure performed, 390 (45.2%) underwent HIV testing, and 50 (5.8%) received blood products. The case fatality rate was 3%. Conclusion Limited dataset trauma registries can capture important epidemiologic data that can characterise injury care, identify patterns of injury, and inform hospital-based intervention strategies in Zambia.


      PubDate: 2014-03-26T04:09:49Z
       
  • Epidemiology of patients presenting to the emergency centre of Princess
           Marina Hospital in Gaborone, Botswana

    • Abstract: Publication date: Available online 21 March 2014
      Source:African Journal of Emergency Medicine
      Author(s): Amit Chandra , Paul Mullan , Ari Ho-Foster , Antanoid Langeveldt , Ngaire Caruso , Joseph Motsumi , Andrew Kestler
      Introduction Emergency medicine is a newly recognized specialty in Botswana and the country launched an emergency medicine residency in January 2011. Data regarding the practice of emergency medicine in Botswana are limited. This study reviewed 1year of patient presentations to the emergency centre of the Princess Marina Hospital, the country’s main referral hospital located in the capital city, Gaborone. Methods Epidemiologic data of all patients presenting to the emergency centre between May 2010 and April 2011 were extracted into a database. The diagnoses of a random sample of patient presentations were coded using the categories outlined by the Clinical Classifications Software (CCS) for ICD-10. For ease of analysis, several CCS categories were grouped together for subsequent analysis. Results 24,905 patient encounters were recorded during the study period. A large proportion of patients were aged between 25 and 50years old. 20% of patients presented with a traumatic injury. The most common diagnoses across all ages included trauma, pregnancy complications, gastrointestinal disorders, and pneumonia. Conclusion These results can inform the development of emergency medicine education and acute care systems in Botswana.


      PubDate: 2014-03-26T04:09:49Z
       
  • Methamphetamine and MDMA: ‘Safe’ drugs of abuse

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): Allana M. Krolikowski , Alex Koyfman
      Methamphetamine and MDMA have been called safe drugs of abuse. Worldwide there is an increased consumption of these drugs, which has become a focus of research in South Africa. As the number of methamphetamine users has increased in many African countries, it is essential that emergency care practitioners are able to diagnose and manage intoxication with methamphetamine, MDMA, and other derivatives. The most common presentations include restlessness, agitation, hypertension, tachycardia, and headache while hyperthermia, hyponatraemia, and rhabdomyolysis are among the most common serious complications. Most deaths are secondary to hyperthermia complicated by multiple organ failure. A number of laboratory analyses should be obtained if locally available. We provide a review of the current recommended general and specific management approaches. Benzodiazepines are the first line therapy for hyperthermia, agitation, critical hypertension, and seizures. Patients with serious complications are best managed in an intensive care unit if available. Emergency centres should create protocols and/or further train staff in the recognition and management of intoxication with these ‘not so safe’ drugs.


      PubDate: 2014-03-01T01:53:04Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): P.K. Forson , M. Osei-Ampofo , L. Ofori-Boadu , A.P. Safo , R. Oteng , G. Oduro , P. Donkor



      PubDate: 2014-03-01T01:53:04Z
       
  • Advanced practice registered nurses: Addressing emerging needs in
           emergency care

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): Rachel L. DiFazio , Judith Vessey
      An advanced practice registered nurse (APRN) is a registered nurse with advanced specialized clinical knowledge and skills to provide healthcare to diverse populations. The role of the APRN is emerging worldwide to improve access to, quality, and cost-effective healthcare services. APRNs with expanded capabilities are now working in a variety of healthcare settings including emergency centres. This paper will provide a brief overview of APRN roles in the United States followed by a discussion of how APRNs can meet the healthcare needs of patients seeking emergency care. An example from a paediatric specialty practice will demonstrate how the APRN role can be implemented in the emergency centre. Finally, implications for initiating APRNs in emergency care across Africa will be addressed.


      PubDate: 2014-03-01T01:53:04Z
       
  • Ambulance or taxi' High acuity prehospital transports in the Ashanti
           region of Ghana

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): C. Nee-Kofi Mould-Millman , Sarah Rominski , Rockefeller Oteng
      Introduction African emergency medical services (EMS) systems are inadequate, thereby necessitating its selective use. This study aims to investigate differences in mode of arrival to the Emergency Centre (EC) at Komfo Anokye Teaching Hospital in Kumasi, Ghana by acuity, injury and referral status. Methods A cross-sectional survey was conducted in the EC at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, in 2011. A survey was administered to all patients triaged to the EC. Patients were excluded if they were under 18years of age, unable to communicate in English, Twi, or Fante, had altered mental status, or were deceased. Data were inputted into an excel spread sheet and uploaded to SPSS. Descriptive statistics were computed. Inferential statistics were performed testing for differences and associations between modes of arrival and acuity level, referral and injury status. Results Of the 1004 patients enrolled, 411 (41%) had an injury-related complaint, and 458 (45.6%) were inter-facility transfers (“referrals”). 148 (14.8%) arrived by ambulance, and 778 (77.6%) non-ambulance (38% private cars, 38% taxis). 67 (6.7%) were triaged as Red, 276 (27.5%) as Orange, and 637 (63.4%) as Yellow (highest to lowest acuity). Ambulance arrival was positively associated with a higher triage score (OR: 1.53). Patients referred from other facilities were almost twice as likely (OR 1.92) to arrive at the KATH EC via ambulance than those not referred. Patients with injuries and higher acuities patients were more likely to be transported to KATH by ambulance (OR 1.86 and 1.87 respectively). All results are highly statistically significant. Conclusion Although a minority of patients were transported by ambulance, they represented the most acute patients arriving at the KATH EC. Given the limited availability of EMS resources and ambulances in Ashanti, selective ambulance use appears warranted and should inform prehospital care planning.


      PubDate: 2014-03-01T01:53:04Z
       
  • Assessment of knowledge and skills of triage amongst nurses working in the
           emergency centres in Dar es Salaam, Tanzania

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): Robert Aloyce , Sebalda Leshabari , Petra Brysiewicz
      Introduction The triage nurse in the emergency centre (EC) is the first person that a patient encounters and the triage nurses’ knowledge has been cited as an influential factor in triage decision-making. The purpose was to assess the triaging knowledge and skills of nurses working in the ECs in Dar es Salaam, Tanzania. Methods Both descriptive cross-sectional and observational study designs were used and data was collected using a structured questionnaire, an observation checklist and a triage equipment audit record. The study population was all nurses (enrolled and registered) working within the EC of the national hospital and three municipal district hospitals in Dar es Salaam. Descriptive statistical data analysis was carried out using SPSS 13.0. Results Thirty three percent (20/60) of the respondents were not knowledgeable about triage. Thirteen percent of the respondents reported that although they had attended workshops, there had been a lack of information on how to triage patients. More than half (52%) of the respondents were not able to allocate the patient to the appropriate triage category. Fifty eight percent (35/60) of the respondents had no knowledge on waiting time limits for the triaged categories. Among the four hospitals observed, only one had nurses specifically allocated for patients’ triage. The respiratory rate of patients was not assessed by 84% of the triage nurses observed. No pain assessment was done by any of the triage nurses observed. Only one out of four ECs assessed had triage guidelines and triage assessment forms. Discussion Nurses who participated in this study demonstrated significant deficits in knowledge and skills regarding patients’ triaging in the EC. To correct these deficits, immediate in-service training/education workshops should be carried out, followed by continuous professional development on a regular basis, including refresher training, supportive supervision and clinical skills sessions.


      PubDate: 2014-03-01T01:53:04Z
       
  • Descriptive study of an emergency centre in Western Kenya: Challenges and
           opportunities

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): Darlene R. House , Saratiel L. Nyabera , Kurt Yusi , Daniel E. Rusyniak
      Introduction With the highest global burden of disease and injury, there is an urgent need for Emergency Centres (EC) and physicians in Africa. Essential to this is the need for information on demographics, complaints, and acuity of patients presenting for acute care in Sub-Saharan Africa. The goal of this study was to determine the characteristics of EC patients in Eldoret, Kenya. Methods Between January 1, 2011 and December 31, 2011, patient demographics, chief complaints, diagnoses, and dispositions were recorded for all patients presenting to an EC in Eldoret, Kenya. Patient volumes were averaged by month, week, and time of day. EC provider diagnoses were categorized according to the World Health Organization (WHO) ICD-10 Classifications. Dispositions were categorized into the following categories: admitted, observed, discharged, died, or unknown. Results 20,666 patients were seen with 17,336 (83.9%) having complete visit information. The average age was 35.6years and 52.6% of patients were female. The majority of patients (70%) presented between the hours of 8am and 5pm. Deaths were highest in the early morning. The most common diagnoses were related to injury (20.2%) followed by infectious diseases (11.7%) and mental health disorders (11.3%). Patient acuity was high as 58.6% of patients required observation or admission. Conclusions The most common presentation for acute care in western Kenya was injury related. However, the severity of illness, lack of pre-hospital transportation, and lack of community mental health services provide significant challenges and opportunities for developing ECs in sub-Saharan Africa.


      PubDate: 2014-03-01T01:53:04Z
       
  • A rare cause of acute renal failure: Coturnism

    • Abstract: Publication date: March 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 1
      Author(s): S. Gokhan , M.A. Cetiner , A. Ozhasenekler
      Introduction Rhabdomyolysis, which is defined as the degradation and disintegration of striated muscle, is an acute and possibly fatal clinical syndrome. Migratory quail consumption (Coturnism) is an unusual reported cause of acute rhabdomyolysis. Acute renal failure occurring only a few hours after migratory quail ingestion is presented in our case. Case history A 58-year-old male applied to the emergency centre with weakness, muscle pain, nausea, vomiting, decreased and darkened urine that started approximately 12h prior to his admittance. While no other possible cause for rhabdomyolysis was present, migratory quail meat ingestion 4h prior to the symptoms was reported in the history. Laboratory results revealed abnormal kidney function tests and raised liver enzymes. Prominent myoglobinuria and proteinuria were observed in the urine sample. Considering the patient’s history, clinical findings and laboratory abnormalities, poisoning and acute rhabdomyolysis due to consumption of quail were diagnosed. The patient was hospitalised and treated symptomatically in the following days. The treatment resulted in the complete resolution of symptoms and signs. Abnormal blood values gradually decreased to normal levels and the patient was successfully discharged. Discussion One of the important complications of rhabdomyolysis is acute renal failure. Acute renal failure following rhabdomyolysis is seen in around 10–40% of cases. Given that Coturnism is a rare cause of acute rhabdomyolysis, renal failure due to Coturnism has only been reported on a few occasions. A diet of hemlock seeds by the birds, in addition to a hereditary enzyme deficiency is suspected to be the pathological basis for the disease. In severe cases rhabdomyolysis can result in shock or acute renal failure which may necessitate dialysis. Supportive treatment with appropriate volume replacement, urinary alkalinisation and aggressive diuresis is usually sufficient and recovery occurs quickly.


      PubDate: 2014-03-01T01:53:04Z
       
  • Lactate clearance predicts outcome after major trauma

    • Abstract: Publication date: Available online 10 February 2014
      Source:African Journal of Emergency Medicine
      Author(s): Essi Heinonen , Timothy Craig Hardcastle , Hans Barle , David James Jackson Muckart
      Introduction To determine a correlation between lactate clearance within 48h and survival in trauma patients at a Level I trauma centre in a developing country and compare to previous international lactate clearance studies. Methods We conducted a retrospective study of a prospectively collected database at a Level I trauma centre from March 2007 to November 2010. Patients of all ages were included. Metabolic parameters from initial arterial blood gas were measured in all patients, an abnormal lactate being defined as >2.5mmol/L. A subgroup analysis of blunt versus penetrating injury was performed. Results Of the 657 patients in the database, 493 had complete lactate data. The survival rate of patients with lactate values <2.5mmol/L was 88%. Of the patients with high lactate levels that cleared within 24 and 48h the survival rates were 81% and 71%, respectively. The survival rate amongst patients not achieving a normal lactate within 48h was 46% but was higher in those with penetrating as opposed to blunt injury (67% versus 38%). The overall survival was 81%. Conclusion The present results confirm previous studies showing that prolonged lactate clearance predicts increased mortality in severely injured trauma patients. Thus, the measurements of arterial serum lactate trends are simple and effective predictors of outcome.


      PubDate: 2014-02-14T02:07:14Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: Available online 1 February 2014
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2014-02-04T17:15:30Z
       
  • Issue highlights

    • Abstract: Publication date: Available online 30 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Stevan R. Bruijns



      PubDate: 2014-02-04T17:15:30Z
       
  • UJUZI (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 29 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Martin J. Botha , Mike Wells



      PubDate: 2014-02-04T17:15:30Z
       
  • Yesterday, today and tomorrow in Targeted Temperature Management

    • Abstract: Publication date: Available online 1 February 2014
      Source:African Journal of Emergency Medicine
      Author(s): Roger Dickerson , Mike Wells , Lara N. Goldstein



      PubDate: 2014-02-04T17:15:30Z
       
  • Emergency nurses – A resource-tiered approach

    • Abstract: Publication date: Available online 29 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): B.M. Terry



      PubDate: 2014-01-30T12:17:14Z
       
  • A descriptive analysis of Emergency Department overcrowding in a selected
           hospital in Kigali, Rwanda

    • Abstract: Publication date: Available online 25 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Kagobora Pascasie , Ntombifikile Gloria Mtshali
      Introduction Emergency Centre (EC) overcrowding is a global concern. It limits timeous access to emergency care, prolongs patient suffering, compromises quality of clinical care, increases staff frustration and chances of exposing staff to patient violence and is linked to unnecessary preventable fatalities. The literature shows that a better understanding of this phenomenon may contribute significantly in coming up with solutions, hence the need to conduct this study in Rwanda. Methods A quantitative descriptive design, guided by the positivist paradigm, was adopted in this study. Self-administered questionnaires were distributed to 40 nurses working in the EC. Only 38 returned questionnaires, thus making the response rate 95%. Results The findings revealed that EC overcrowding in Rwanda is characterised by what is considered as reasonable waiting time for a patient to be seen by a physician, full occupancy of beds in the EC, time spent by patients placed in the hallways waiting, and time spent by patients in waiting room before they are attended. Triggers of EC overcrowding were classified into three areas: (a) those associated with community level services; (b) those associated with the emergency centre; (c) those associated with inpatient and emergency centre support services. Discussion A number of recommendations were made, including the Ministry of Health in Rwanda adopting a collaborative approach in addressing EC overcrowding with emergency trained nurses and doctors playing an active role in coming up with resolutions to this phenomenon; conducting research that will lead to an African region definition of EC overcrowding and solutions best suited for the African context; and increasing the pool of nurses with emergency care training.


      PubDate: 2014-01-30T12:17:14Z
       
  • UJUZI (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 29 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Patrick D’Andrea , Hendrik J. Lategan , Sa’ad Lahri



      PubDate: 2014-01-30T12:17:14Z
       
  • Emergency pericardiocentesis under dynamic ultrasound guidance in the
           resource limited setting

    • Abstract: Publication date: Available online 23 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Will Loughborough
      Introduction Pericardial effusions are common causes of heart failure in populations of high HIV prevalence and, if left untreated, mortality rates approach 85%. 1 Cardiac tamponade is a life threatening complication of pericardial effusion and must be treated immediately with emergency pericardiocentesis. Often emergency care clinicians serving populations of high HIV prevalence have limited resources at their disposal. Case report This case report describes how cardiac tamponade can be diagnosed and treated effectively with limited resources: a portable ultrasound machine and a central venous catheterisation kit. Conclusion Initial ultrasound findings, equipment if resources are limited, types of ultrasound guidance and approaches to pericardium are discussed.


      PubDate: 2014-01-25T12:25:34Z
       
  • The sick LADy who cried wolf: A case of Wellens’ syndrome presenting
           in the shadow of chronic sickle cell pain

    • Abstract: Publication date: Available online 21 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Tinashe Gede , Lilian Hodzi
      Introduction Chest pain is a common presenting complaint in the EC, with a very wide differential diagnosis. Evaluation of patients with chest pain in the EC is geared toward rapidly identifying and treating the subset of patients with potentially life-threatening causes, including acute coronary syndromes. ECG and cardiac biomarkers are indispensable tools in this endeavor. Case report A 47year old African woman presented to the EC with chest pain; her ECG revealed findings typical of Wellens’ syndrome. Subsequent coronary angiography revealed near-total proximal LAD occlusion. Discussion Wellens’ syndrome refers to a pre-infarction stage of acute coronary syndrome with distinct ECG T-wave changes that strongly predict the presence of critical LAD coronary artery stenosis; it is a harbinger of impending extensive anterior myocardial infarction. Emergency physicians must be able to recognize its ECG features and institute appropriate intervention.


      PubDate: 2014-01-25T12:25:34Z
       
  • Upper extremity injury management by non-physician emergency practitioners
           in rural Uganda: A pilot study

    • Abstract: Publication date: Available online 17 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Daniel S. Frank , Katie Dunleavy , Rashidah Nambaziira , Irene Nayebare , Bradley Dreifuss , Mark Bisanzo
      Introduction Improper management of and resultant poor outcomes from upper extremity injuries can be economically devastating to patients who rely on manual labour for survival. This is a pilot study using the Quick DASH Survey (disabilities of arm, shoulder and hand), a validated outcome measurement tool. Our objective was to assess functional outcomes of patients with acute upper extremity injuries who were cared for by non-physician clinicians as part of a task-shifting programme. Methods This pilot study was performed at the Karoli Lwanga Hospital Emergency Centre (EC) in Uganda. Patients were identified retrospectively by querying the EC quality assurance database. An initial list of all patients who sustained traumatic injury (road traffic accident, assault) between March 2012 and February 2013 was narrowed to patients with upper extremity trauma, those 18 years and older, and those with cellular phone access. This subset of patients was called and administered the Quick DASH. The results were subsequently analysed using the standardized DASH metrics. These outcome measures were further analysed based upon injury type (simple laceration, complex laceration, fracture and subluxation). Results There were a total of 25 initial candidates, of which only 17 were able to complete the survey. Using the Quick DASH Outcome Measure, our 17 patients had a mean score of 28.86 (range 5.0–56.8). Conclusions When compared to the standardized Quick DASH outcomes (no work limitation at 27.5 vs. work limited by injury at 52.6) the non-physician clinicians appear to be performing upper extremity repairs with good outcomes. The key variable to successful repair was the initial injury type. Although accommodations needed to be made to the standard Quick DASH protocol, the tool appears to be usable in non-traditional settings.


      PubDate: 2014-01-21T12:35:11Z
       
  • The state of emergency care in the Republic of the Sudan

    • Abstract: Publication date: Available online 17 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Nada Rahman , Gabrielle A. Jacquet
      Sudan is one of the largest African countries, covering an area of 1.9millionkm2—approximately one fifth of the geographic area of the United States. The population is 30million people, the majority of whom (68%) live in rural areas, as compared with the sub-Saharan African average of approximately 62%. Sudan is considered a lower-middle income country—with 47% of the population living below the poverty line and a gross domestic product (GDP) of US $62billion in 2010. In addition to excessive burden of communicable diseases such as malaria, tuberculosis, and schistosomiasis, Sudan is particularly susceptible to both natural and manmade disasters. Drought and flood are quite common due to Sudan’s proximity to and dependency on the Nile, and throughout history Sudan has also been plagued with internal conflicts and outbreaks of violence, which bring about a burden of traumatic disease and demand high quality emergency care. The purpose of this paper is to describe the state of emergency care and Emergency Medicine education, and their context within the Sudanese health care system. As is the case in most African countries, emergency care is delivered by junior staff: new graduates from medical schools and unsupervised medical officers who handle all types of case presentations. In 2001, increased mortality and morbidity among unsorted patients prompted the Ministry of Health to introduce a new triage-based emergency care system. In late 2005, twenty-one Emergency physicians delivered these new Emergency Services. In 2011, following a curriculum workshop in November 2010, the Emergency Medicine residency program was started in Khartoum. Currently there are 27 rotating registrars, the first class of whom is expected to graduate in 2015.


      PubDate: 2014-01-21T12:35:11Z
       
  • The implementation of the South African Triage Score (SATS) in an urban
           teaching hospital, Ghana

    • Abstract: Publication date: Available online 17 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Sarah Rominski , Sue Anne Bell , George Oduro , Patience Ampong , Rockefeller Oteng , Peter Donkor
      Introduction Triage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH. Methods This cross-sectional study was conducted in the EC at KATH in Kumasi, Ghana. Patients 12years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41–50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached. Results 52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories. Conclusion Under-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses.


      PubDate: 2014-01-21T12:35:11Z
       
  • Acute management of ST-elevation myocardial infarction in a tertiary
           hospital in Kenya: Are we complying with practice guidelines' Phase
           active de prise en charge des infarctus du myocarde avec
           élévation du segment ST dans un hôpital tertiaire au Kenya.
           Les directives pratiques sont-elles respectées'

    • Abstract: Publication date: Available online 18 January 2014
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira , Andrew O. Owuor , Harun A. Otieno
      Introduction Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya. Methods This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013. Results Data were collected for 45 patient presentations. There were 37 male patients (82%). The mean age was 59.7±3.8 years. Of the 45 patients, 23 were Asian (51%), 18 were Black (40%) and four were Caucasian (9%). Thirty-five patients (78%) presented within 12h of symptom onset. Within 10min of arrival to the hospital, 40 patients (89%) had electrocardiographs performed and 39 patients (87%) were reviewed by a doctor. Medications given on presentation were aspirin (98%), clopidogrel (91%) and anticoagulants (73%). All patients received reperfusion therapy. Twenty-eight patients (62%) received fibrinolytic therapy and 17 patients (38%) had primary percutaneous coronary intervention. Door-to-needle time of <30min was achieved in 43% of the cases. Door-to- balloon time was <90min in 29% of the cases. All the patients survived to hospital discharge. The average length of stay was 5.3±1.0 days. In-hospital complications occurred in six patients (13.3%). These included bleeding (three patients), stroke (one patient) and cardiogenic shock requiring intra- aortic balloon pump support (two patients). Conclusion Whereas the majority of STEMI patients are evaluated within 10min of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve acute care systems to target early reperfusion of STEMI patients.


      PubDate: 2014-01-21T12:35:11Z
       
  • Peri-mortem laparotomy in a patient with a ruptured intra-abdominal
           pregnancy

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): A.E. Laher , L.N. Goldstein , M.D. Wells , Z. Mahomed , R. Gihwala , P. Moodley
      Introduction Intra-abdominal pregnancies can present at an advanced stage of pregnancy and can have the potential for life-threatening rupture and haemorrhage. The purpose of this case report was to discuss the early recognition and prompt management options of a patient with a life threatening ruptured intra-abdominal pregnancy. Case report We report what we believe to be the first case of a patient who presented with an intra-abdominal pregnancy who underwent a peri-mortem laparotomy in the Emergency Centre following a cardiac arrest, and who exhibited a return to spontaneous circulation (ROSC). Conclusion Peri-mortem laparotomy/thoracotomy coupled with high quality CPR and resuscitation may be lifesaving in a patient with a life threatening ruptured intra-abdominal pregnancy.


      PubDate: 2013-10-04T11:23:16Z
       
  • Barriers to utilization of pre-hospital emergency medical services among
           residents in Libreville, Gabon: A qualitative study Obstacles à
           l’utilisation des services d’urgence médicale
           préhospitaliers parmi les habitants de Libreville, Gabon : une
           étude qualitative

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Nichole Bosson , Michael A. Redlener , George L. Foltin , Maria C. Raven , Mark P Foran , Stephen P. Wall
      Introduction In 2002, the West-African nation of Gabon established an emergency medical system (EMS), Service d’Aide Médicale Urgente (SAMU), in Libreville, yet few people access it. Our objective was to describe Libreville residents’ knowledge and attitudes toward the SAMU in an effort to understand why this service is underutilized. Methods Qualitative interviews consisting of nine open-ended questions were conducted on a convenience sample of twenty patients, three visitors and two patient/visitor dyads at the Jeanne Ebori Hospital Emergency Centre in October 2009. Eligible subjects arrived in vehicles other than the SAMU and were ill enough to require hospital admission. Exclusion criteria were: under 21years old, unable to speak French, or medically unstable. A bilingual team member audio-recorded the interviews in French and transcribed them into English. Investigators organized text into codes, then into themes and theoretical constructs. Intercoder agreement was excellent. Data were collected until theoretical saturation was achieved. Results Analysis of data revealed no difference in response between patients and visitors. People underused SAMU because of financial costs, lack of awareness of the program, use of traditional modes of transportation, infrastructure flaws, perceived response times and other misconceptions. Conclusion We identified remediable barriers to EMS (SAMU) access in Libreville, Gabon: lack of awareness, misperceptions, established alternatives, and cost. Interventions and future investigations designed to increase EMS utilization in Gabon should target these four areas.


      PubDate: 2013-10-04T11:23:16Z
       
  • Knowing and doing; negotiating resource constraints through research

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Lee A. Wallis



      PubDate: 2013-10-04T11:23:16Z
       
  • Acute care in Tanzania: Epidemiology of acute care in a small community
           medical centre Les soins aigus en Tanzanie: Épidémiologie des
           soins aigus dans un petit centre médical communautaire

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Rachel M. Little , Michael D. Kelso , Frances S. Shofer , Meredith H. Arasaratnam , Sean Wentworth , Ian B.K. Martin
      Introduction Without uniform recognition of Emergency Medicine as a specialty in developing sub-Saharan African countries, data are limited on the epidemiology of emergency care needs. The purposes of this study were to quantify the burden of disease presenting as medical or surgical emergencies and describe the patient population at a small community medical centre in the Republic of Tanzania. Methods An observational study was conducted from March to June 2011 at the University of Arusha (UOA) Medical Centre in Arusha, Tanzania. All consenting patients presenting with acute illness or injury were eligible for inclusion in the study. A standardized form was used to record demographic information, chief complaint, diagnosis/diagnoses, procedure(s), treatment(s), and disposition. Results Data were collected on 719 patients, with a mean age of 21.8 years (range neonate to 83 years). Fever (19.5%), respiratory (17.5%), and gastrointestinal complaints (15.0%) were the top three chief complaints; 94.9% of chief complaints were atraumatic. The top three diagnoses included respiratory infection (22.1%); malaria (21.4%); and skin or soft tissue infection (7.9%). Forty-three percent of patients required no procedures or tests, and 42% required only one procedure or test. Of treatments administered, 67.6% were analgesics, 51.3% were cough medications, and 47.6% were antipyretics. Ninety-seven percent of patients were discharged home after their visits. Discussion Respiratory infections, malaria, and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha, Tanzania, highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma, burns, and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis, most treatments administered were inexpensive, and most patients were discharged home, suggesting that providing acute care in this setting could be accomplished with limited resources.


      PubDate: 2013-10-04T11:23:16Z
       
  • Undergraduate emergency medicine in an African medical school –
           Experiences from Botswana

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Megan Cox , Amit Chandra
      Introduction In August 2011, the first cohort of students at the University of Botswana School of Medicine (UBSOM) began their third year of undergraduate medical training. As part of their 2011–2012 curriculum they each completed a 10week rotation in Emergency Medicine (EM), involving problem based learning (PBL) sessions, maintenance of log books, case presentations, and clinical time at the Emergency Centre (EC) of the main tertiary referral hospital in Gaborone, Princess Marina Hospital. Methods Since EM rotations are often undertaken in the final year of medical training, students were given an anonymous voluntary survey to study the effect of an EM experience in their first clinical year of training. A 5-point Likert scale was used to evaluate learning opportunities and the overall EM experience. Students described which procedures they had observed or performed in their rotation. The survey concluded with open-ended questions seeking additional feedback. Results These were very encouraging for both early exposure to EM and the PBL approach. More than 90% of students agreed or strongly agreed that they felt more confident in clinical settings, improved their clinical decision making process, and found the PBL model to be effective over the rotation. 22 different procedures were observed in the EC with 100% observing venesection and plaster applications. 14 different procedures were performed with 83% students performing venesection and over 65% performing chest compressions and venous cannulation. Discussion It is hoped that this study will provide valuable practical information about undergraduate EM learning in a PBL based Medical School within Sub Saharan Africa that can be replicated across other medical education institutions throughout the region.


      PubDate: 2013-10-04T11:23:16Z
       
  • The first East Africa Regional Meeting on Acute and Emergency Care

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Teri A. Reynolds , Hendry Sawe , Juma Mfinanga , Joseph Kalanzi



      PubDate: 2013-10-04T11:23:16Z
       
  • The smartphone: How it is transforming medical education, patient care,
           and professional collaboration

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Nikita Joshi , Michelle Lin



      PubDate: 2013-10-04T11:23:16Z
       
  • Asthma essentials Les points essentiels de l’asthme

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Timothy Greene , Maryam Amour , Alex Koyfman , Mark Foran
      Asthma is a chronic, reversible obstructive disease that when in exacerbation can present to the emergency department in a spectrum of severity. Prompt recognition of the potentially severely ill asthmatic requires a careful history and physical exam while considering alternative diagnoses for the presenting symptoms. Early administration of salbutamol and corticosteroids is indicated in almost all patients with other medications such as ipratropium and magnesium and supportive modalities like BiPAP reserved for sicker patients. The global impact of asthma is increasing, especially amongst children. While the benign clinical presentation is most common and mortality has decreased in recent decades due to improved recognition and care, the ubiquity of the condition and frequent lack of regular outpatient management contribute to the disease claiming 250,000 lives worldwide annually. The emergency physician must be prepared to assess and appropriately manage both the young child with a mild wheeze and the adult in respiratory failure.


      PubDate: 2013-10-04T11:23:16Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4
      Author(s): Benjamin W. Wachira



      PubDate: 2013-10-04T11:23:16Z
       
  • State of the art: Rescue intubation through supraglottic airways

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): R. Hofmeyr
      The use of supraglottic airways as rescue devices in failed intubation and resuscitation has become well accepted in emergency practice. Many offer or advertise the possibility of intubation through the device, but techniques and success rates vary greatly. Intubation can be achieved blindly, with the use a bougie or introducer, or with fiberoptic guidance. In this review, I examine the evidence behind different devices with various techniques, present the data from our on-going research, suggest further research directions and propose practical guidelines for clinical use in emergencies.


      PubDate: 2013-09-26T16:26:41Z
       
  • Epidemiology of traumatic brain injury patients at Kilimanjaro Christian
           medical centre, Moshi, Tanzania

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): G. Kiwango , D. Msilanga , M. Hocker , C. Gerardo , R. Lester , M. Mvungi , M. Ntabaye , C.A. Lynch
      Introduction Traumatic brain injury (TBI) affects 10 million people annually. Clinical epidemiology can inform prevention initiatives to curb this burden. Kilimanjaro Christian Medical Centre (KCMC) is a referral hospital for 11million people with neurosurgical capacity located in Moshi, Tanzania. Methods Secondary analysis of a prospective observational TBI Acute Care Registry at the KCMC Casualty Department (CD) included all patients presenting between May 5 and July 27th, 2013. Means with standard deviations (SD), Fisher’s exact or Chi-squared with a binomial logistic regression reporting Odds Ratios (OR) with 95% confidence intervals (CI) was calculated using Stata IC (College Station, TX). Results 171 total patients were enrolled in the TBI Registry. The mean age was 32.1 years (range 1–99, SD 16.6), with 71% between 15 and 45years of age. 82% were male and 28% cases involved alcohol. Causes of TBI were road traffic injuries (RTI) (74%), assaults (13%) or falls (8%). 52% of RTI’s involved motorcycle users. The mean Glasgow Coma Score (GCS) was 12.6 (range 3-15, SD 4.04) with 19% of patients having severe TBI (GCS of <9). The overall mortality rate was 13% for all CD patients, 14% for admitted patients and 80% for patients admitted to the ICU. Death was associated with hypoxia (OR 16.0 (95% CI 5.4, 47.5), hypotension (OR 7.3 (95% CI 1.4, 38.4) and low GCS (GCS <9, OR 29.7 (95% CI 9.6, 92.0). Severe TBI had a 53% mortality rate, while moderate and mild TBI 12% and 3% fatality rates respectively. Of severe TBI patients, 63.6% suffered disability from their injury compared to 27% of moderate and 3% of mild TBI. Conclusion Most TBI patients were young males involved in road traffic collisions, predominantly involving motorcycles. Over a quarter of them involve alcohol. Our data support that TBI causes significant death and disability.


      PubDate: 2013-09-26T16:26:41Z
       
  • An analysis of inter-healthcare facility transfer of neonates within the
           eThekwini health district of KwaZulu-Natal

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): P. Ashokcoomar , R. Naidoo
      Objectives To assess the time frames for the inter-healthcare facility transfer of neonates and investigate the factors that may have led to delays in the transfer; and investigate any adverse events encountered during the transfer of the neonate. Methods A prospective study was conducted from December 2011 to January 2012. A quantitative, non-experimental design was used to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two questionnaires. Results All the transfers were undertaken by road ambulances of which 83 (62.2%) by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Twenty nine (24.2%) were specialised transfers. The mean time ± standard deviation (SD) to complete an inter-healthcare facility transfer was 3h 49min±1h 57min with the minimum time of 5min and the maximum time of 10h 34min. Equipment required for neonatal transport was a major problem due to poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The study identified 10 (8.3%) physiological related adverse events which included 1 (0.8%) death and 18 (15.0%) equipment related adverse events. Conclusions The EMRS eThekwini Health District is involved in the transportation of a significant number of intensive care and non-intensive care neonates between healthcare facilities. This study has identified numerous factors affecting the efficiency of inter-facility transfer of neonates highlighting various areas requiring improvement.


      PubDate: 2013-09-26T16:26:41Z
       
  • Text messages improve pain management post-discharge from the paediatric
           emergency department

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): J. Boyd , C. Harper , P. Thomas
      Introduction Recognition and alleviation of pain should be a priority when treating ill and injured children in the Emergency Department (ED). Optimising analgesia in paediatric patients post-discharge remains a challenge. The increasing accessibility of mobile phone technology worldwide offers new opportunities to communicate with families post-discharge. This study investigates whether text message reminders improve pain management in children post-discharge from the ED. Method This was a prospective study of 50 children (aged 1–16years) with fractures, discharged from the ED. An online automated service was used to send text messages to parents at 6h and 30h post-discharge. These served as reminders to administer analgesia. 25 parents received text message reminders and 25 parents received no messages. All parents were telephoned 48 hours post-discharge to ascertain the number of analgesia doses administered and the frequency of reported pain. Results The mean number of analgesia doses administered to the text message group was 7.6 vs. 4.9 in the control group, p =<0.05. In the text message group 0 children complained of pain frequently or constantly vs. 5 in the control group. 100% of parents in the text message group felt text messages were an effective reminder. Conclusion This study demonstrates that sending text message reminders post-discharge significantly increases the number of analgesia doses administered, reduces the frequency of patients reporting pain and is an effective method of communicating with parents. With increasing accessibility of mobile phones worldwide this is a viable, cost-effective and reproducible method of optimising analgesia post-discharge from the Paediatric ED.


      PubDate: 2013-09-26T16:26:41Z
       
  • Internal medicine outreach in area 2 of KwaZulu-Natal with the Red Cross
           Air Mercy Servi 2007-mid-2013

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): R.I. Caldwell
      Introduction This study updates the Outreach Programme for Internal Medicine in Area 2 of KwaZulu-Natal (KZN) over the past six-and-a-half years. Methods AMS, via a formal agreement with the KZN Department of Health (DOH) for 16years, has provided a safe, reliable, independent transport system, by air and by road. The DOH has provided posts in the major disciplines for the co-ordination of Area 2 outreach. The aim is that each district hospital should receive a visit from a specialist in each major discipline on a monthly basis. Internal Medicine is fortunate to have a fulltime coordinator with the retention of the retired coordinator on a sessional basis. A typical visit comprises a teaching session, a ward-round, and an outpatient session. Protocols and referral criteria are discussed, and the medical manager may be consulted regarding needs and problems. Results 90% of the 20 district hospitals in Area 2 of KZN have received regular visits. The sessional outreach physician visits seven hospitals per month, and has now made 432 visits, 172 of them by air and 260 by road. The current coordinator and other specialists have achieved a further 167 visits, giving a tally of 599. A total of 3509 medical personnel have been involved, and 5525 patients have been seen. An additional achievement has been regular visits by Neurology, Nephrology, Cardiology and Endocrinology to Madadeni Hospital, furthering the plan of subspecialty outreach to regional hospitals and general specialty outreach to district hospitals. Conclusion This Outreach Programme functions on a comprehensive footing, thanks to the AMS and the KZN DOH. Other health areas could be encouraged to follow this example.


      PubDate: 2013-09-26T16:26:41Z
       
  • Multi-disciplinary training improves pain management in the paediatric
           emergency department

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): C. Harper , T. Waterfield , P. Thomas
      Introduction Recognition and alleviation of pain should be a priority when treating ill and injured children. We determine whether pain assessment and management in a UK paediatric emergency department follows national standards and improves following multi-disciplinary training. Methods We retrospectively analysed notes of 100 randomly-selected cases (1month–15years) presenting to a paediatric emergency department over one month. We studied initial assessment of pain, time to prescription, appropriateness of analgesia and re-assessment of pain. These outcomes were compared to national standards. Following multi-disciplinary training sessions we re-evaluated these outcomes by analysing a further 100 cases. Results Prior to training, 48% cases had pain scores documented and 31% cases had appropriate analgesia prescribed. No cases were assessed as having severe pain. Pain was not re-assessed in any patients. Following training, 74% cases had pain scores documented; 6% cases scored ‘severe pain’; 74% had appropriate analgesia prescribed and 12% cases were re-assessed. Conclusions Our study highlights that pain in children is commonly under-recognised, under-treated and treatment delayed. Prior to training, pain scoring was performed less in younger children and time to prescribe analgesia was longer; perhaps due to unfamiliarity with pre-verbal pain assessment methods. Training covered various pain assessment tools, which improved pain scoring at triage for all ages and enabled identification of patients in severe pain. Raising awareness of the paediatric ‘analgesic ladder’ improved prescribing of appropriate analgesia. With the pressures of a busy emergency department good documentation of pain scoring and re-assessment is often neglected. Assessment and management of pain in children improved with multi-disciplinary training. This is a simple and cost-effective strategy, which should be provided in all emergency departments worldwide to ensure quality of care.


      PubDate: 2013-09-26T16:26:41Z
       
  • Point-of-care ultrasound use over six-month training period in Rwandan
           district hospitals

    • Abstract: Publication date: December 2013
      Source:African Journal of Emergency Medicine, Volume 3, Issue 4, Supplement
      Author(s): P.C. Henwood , J.S. Rempell , A.S. Liteplo , A.F. Murray , D.C. Mackenzie , M.M. Leo , S. Vaillancourt , E.R. Douglass , D. Dukundane , S. Rulisa , A.J. Dean , V.E. Noble
      Introduction Point-of-care ultrasound (POCUS) is an effective diagnostic technology in resource-limited settings. There is increasing interest in introducing ultrasound training in such environments, but few reports describing long-term follow-up and impact of a POCUS program in a resource-limited setting. We introduced a POCUS program in Rwanda, and sought to determine the number and type of ultrasounds performed, the impact of a remote quality assurance (QA) program, and the effect of POCUS on patient management. Methods Seventeen Rwandan physicians underwent a ten-day training course in POCUS in Kigali, Rwanda. Post-course, participants tracked the ultrasounds they performed using a cloud-based storage system, recorded clinical impressions, and received periodic QA with on-site proctoring over a six-month follow-up. Remote QA to evaluate image quality was performed by five emergency ultrasound fellowship-trained clinicians. Images were graded on a scale of 0–4. (0=no meaningful image, 2=adequate, 4=outstanding). Trainees also documented how POCUS changed clinical management. Results Over six months, 1158 ultrasounds were performed and logged by fifteen participants at eleven regional hospitals. 590 (50.9%) had matched images and interpretations available for review. Abdominal ultrasound was the most frequently performed application (19.7%), followed by liver (14.6%), obstetrics (14.5%), renal (12.4%), and spleen (11%). Across all applications, the mean score was 2.5 (SD±0.11, 95% confidence interval, 2.39–2.54). Ultrasound resulted in a management change in 84% of cases. Major changes in management related to medication choice (42.4%), admission (30%), transfer to a higher level of care (28.1%), and performance of procedures (23.3%). Conclusions During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51% of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting.


      PubDate: 2013-09-26T16:26:41Z
       
  • Opportunity and innovation in African health care

    • Abstract: Publication date: Available online 22 August 2013
      Source:African Journal of Emergency Medicine
      Author(s): Julian B. Fleming



      PubDate: 2013-08-23T06:17:30Z
       
  • Healing is a matter of time, but it is sometimes also a matter of
           opportunity

    • Abstract: Publication date: Available online 12 August 2013
      Source:African Journal of Emergency Medicine
      Author(s): Melanie Stander



      PubDate: 2013-08-14T16:15:07Z
       
 
 
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