Journal Cover African Journal of Emergency Medicine
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   ISSN (Print) 2211-419X
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  • A pilot study on the management and outcomes of self-poisoning in a rural
           Ugandan Emergency Centre

    • Authors: Vinodinee Dissanayake; Erin T. Dalka; Cynthia Koh; Mark Bisanzo; Ryan S. Brandt; Timothy B. Erickson; Stacey Chamberlain
      Pages: 25 - 28
      Abstract: Publication date: March 2018
      Source:African Journal of Emergency Medicine, Volume 8, Issue 1
      Author(s): Vinodinee Dissanayake, Erin T. Dalka, Cynthia Koh, Mark Bisanzo, Ryan S. Brandt, Timothy B. Erickson, Stacey Chamberlain
      Introduction The Global Emergency Care Collaborative and Nyakibale Hospital in Rukungiri opened the first functional emergency centre in rural Uganda. We investigated decontamination, management and outcomes of poisoned patients in the emergency centre. Methods An electronic database started recording charts from 24 March 2012. A search for diagnoses concerning self-poisoning was performed from 24 March 2012 to 30 December 2013 and 192 charts were found and de-identified. Data collection included: age, sex, poison and duration, intent, vital signs, physical examination, decontamination, antidote use and follow-up status. Results From 24 March 2012 to 30 December 2013 poisoning accounted for 96 patient encounters. Of these, 33 were associated with alpha-2 agonists and 16 were associated with organophosphorous or carbamate pesticides. The post-decontamination fatality rate was 5.7%. The fatality rate of those without decontamination was 8.3%. Of those who were given atropine, 38.8% had no known indication. Of the 96 patient encounters, there were seven deaths; six were due to pesticides. Discussion In resource-limited settings where antidotes and resuscitative capabilities are scarce, decontamination needs to be studied further. Repeat atropine use without indication may lead to depletion of an essential antidote. Future directions include a public health education programme and an algorithm to help guide clinical decisions.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2017.11.002
       
  • Challenges relating to the inter-facility transport of high acuity
           paediatric cases

    • Authors: Craig Vincent-Lambert; Geraldine Wade
      Pages: 29 - 33
      Abstract: Publication date: March 2018
      Source:African Journal of Emergency Medicine, Volume 8, Issue 1
      Author(s): Craig Vincent-Lambert, Geraldine Wade
      Introduction The motivation for this study came from anecdotal reports and observations that there was a potential need for improvement to the systems that support inter-facility transfers of high acuity paediatric cases between referring and receiving facilities in Johannesburg, South Africa. In this exploratory study, we formally document and describe challenges being experienced by members of the healthcare team in facilitating the inter-facility transport of high acuity paediatric cases. Methods A qualitative, explorative design was applied, making use of interviews with purposefully-identified role players involved in paediatric transportation and care. Verbatim transcripts from audio recorded interviews underwent content analysis to allow for the identification of common categories. Results Participants described a number of challenges, which included time delays, lack of qualified ambulance personnel, poor communication between role players, and lack of appropriate equipment. Discussion There are significant challenges experienced by members of the healthcare team with regard to inter-facility transport of high acuity paediatric and neonatal cases in Johannesburg, South Africa. Whilst we acknowledge the African context and resource constrained setting, health systems managers need to explore the feasibility of establishing dedicated and suitably resourced retrieval teams who specialise in the transfer of high acuity paediatric and neonatal patients in order to improve quality of care and overall patient outcomes in this population.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2017.12.001
       
  • Emergency centre diagnosis and treatment of purulent pericarditis: A case
           report from Tanzania

    • Authors: Catherine R. Shari; Hendry R. Sawe; Kevin Davey; Brittany L. Murray
      Pages: 37 - 39
      Abstract: Publication date: March 2018
      Source:African Journal of Emergency Medicine, Volume 8, Issue 1
      Author(s): Catherine R. Shari, Hendry R. Sawe, Kevin Davey, Brittany L. Murray
      Introduction Purulent pericarditis poses diagnostic and therapeutic challenges, especially in resource-limited settings due to the unavailability of diagnostic tools, equipment, and expertise. Case report A three-year-old female presented to the emergency centre at Muhimbili National Hospital in Dar es Salaam, Tanzania with altered mental status, lethargy, intermittent fevers, worsening difficulty in breathing, and progressive lower extremity swelling over two months. The child was in shock upon arrival. Point-of-care ultrasound demonstrated cardiac tamponade secondary to purulent pericarditis. An ultrasound guided pericardiocentesis and lavage was successfully done in the emergency centre and antibiotics were started. Though definitive management (pericardiectomy) was delayed, the child survived to hospital discharge. Conclusion Pericardiocentesis, pericardial lavage, and the initiation of broad spectrum antibiotics are the mainstay of early treatment of purulent pericarditis. This treatment can be done safely in an emergency centre with little specialised equipment aside from point-of-care ultrasound.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2017.12.002
       
  • Estimated injury-associated blood loss versus availability of emergency
           blood products at a district-level public hospital in Cape Town, South
           Africa

    • Authors: Heinrich Weeber; Luke D. Hunter; Daniël J. van Hoving; Hendrick Lategan; Stevan R. Bruijns
      Abstract: Publication date: Available online 20 March 2018
      Source:African Journal of Emergency Medicine
      Author(s): Heinrich Weeber, Luke D. Hunter, Daniël J. van Hoving, Hendrick Lategan, Stevan R. Bruijns
      Introduction International guidance suggests that injury-associated haemorrhagic shock should be resuscitated using blood products. However, in low- and middle-income countries resuscitation emphasises the use of crystalloids – mainly due to poor access to blood products. This study aimed to estimate the amount of blood loss from serious injury in relation to available emergency blood products at a secondary-level, public Cape Town hospital. Methods This retrospective, cross-sectional study included all injured patients cared for in the resuscitation area of Khayelitsha Hospital’s emergency centre over a fourteen-week period. Injuries were coded using the Abbreviated Injury Scale, which was then used to estimate blood loss for each patient using an algorithm from the Trauma Audit Research Network. Descriptive statistics were used to describe blood volume lost and blood units required to replace losses greater than 15% circulating blood volume. Four units of emergency blood are stored in a dedicated blood fridge in the emergency centre. Platelets and fresh plasma are not available. Results A total of 389 injury events were enrolled of which 93 were excluded due to absent clinic data. The mean age was 29 (±10) years. We estimated a median of one unit of blood requirement per week or weekend, up to a maximum of eight or six units, respectively. Most patients (n = 275, 94%) did not have sufficient injury to warrant transfusion. Overall, one person would require a transfusion for every 15 persons with a moderate to serious injury. Conclusion The volume of available emergency blood appears inadequate for injury care, and doesn’t consider the need for other causes of acute haemorrhage (e.g. gastric, gynaecological, etc.). Furthermore, lack of other blood components (i.e. plasma and platelets) presents a challenge in this low-resourced setting. Further research is required to determine the appropriate management of injury-associated haemorrhage from a resource and budget perspective.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2018.01.004
       
  • The association between hospital arrival time, transport method,
           prehospital time intervals, and in-hospital mortality in trauma patients
           presenting to Khayelitsha Hospital, Cape Town

    • Authors: Anders Möller; Luke Hunter; Lisa Kurland; Sa'ad Lahri; Daniël J. van Hoving
      Abstract: Publication date: Available online 20 March 2018
      Source:African Journal of Emergency Medicine
      Author(s): Anders Möller, Luke Hunter, Lisa Kurland, Sa'ad Lahri, Daniël J. van Hoving
      Introduction Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa. Methods The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients’ folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher’s Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of <0.05 was deemed significant. Results The majority of patients were 19–44 year old males (n = 427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n = 343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a.m. In-hospital mortality (n = 18, 3.4%) was not significantly affected by transport method (p = 0.26), hospital arrival time (p = 0.22) or prehospital transport time intervals (all p-values >0.09). Discussion Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2018.01.001
       
  • A cross-sectional survey of child abuse management knowledge among
           emergency medicine personnel in Cape Town, South Africa

    • Authors: Bruna Dessena; Paul C. Mullan
      Abstract: Publication date: Available online 20 March 2018
      Source:African Journal of Emergency Medicine
      Author(s): Bruna Dessena, Paul C. Mullan
      Introduction Child abuse is a common condition in the emergency centres of South Africa. It is critical for both prehospital emergency care practitioners and emergency centre-based emergency medicine registrars to be competent in screening, diagnosing, treating, and documenting child abuse. Our goal was to assess the knowledge of child abuse management in a sample of prehospital emergency care practitioners and emergency medicine registrars in Cape Town, South Africa. Methods A mixed-methods approach of quantitative and qualitative data was used to survey a sample of 120 participants (30 emergency medicine registrars and 90 prehospital emergency care practitioners: 30 Basic Life Support, 30 Intermediate Life Support, and 30 Advanced Life Support). An expert panel created the survey to ensure content validity and survey questions were designed to assess the perceived and actual knowledge of participants. We hypothesised that there would be significantly higher levels of perceived and actual knowledge in emergency medicine registrars compared to emergency care practitioners. An open-ended question on how participants felt dealing with child abuse was qualitatively analysed using thematic analysis. Results There were significant differences in the levels of perceived knowledge (58% of emergency medicine registrars agreed that they felt adequately trained overall, versus 39% of emergency care practitioners; −19% difference, 95% CI −26% to −12%) and actual knowledge (83% of emergency medicine registrars with correct answers, versus 62% of emergency care practitioners; −21% difference, 95% CI −26% to −16%) among participants. Themes that emerged from qualitative analysis included personal distress, retaliation, frustration, medical system frustration, and personal competence concerns. Discussion Significant perceived and actual knowledge deficits of child abuse management exist among both emergency care practitioners and emergency medicine registrars in this setting. Future interventions should address the need for guidelines and increased training opportunities to ensure the health and safety of abused children.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2018.01.005
       
  • Paediatric weight estimation practices of advanced life support providers
           in Johannesburg, South Africa

    • Authors: Mike Wells; Laurice Barnes; Craig Vincent-Lambert
      Abstract: Publication date: Available online 20 March 2018
      Source:African Journal of Emergency Medicine
      Author(s): Mike Wells, Laurice Barnes, Craig Vincent-Lambert
      Introduction The choice of weight estimation method to use during prehospital paediatric emergency care is important because it needs to be both accurate and easy to use. Accuracy is important to ensure optimum drug dosing while ease-of-use is important to minimise user errors and the cognitive load experienced by healthcare providers. Little is known about which weight estimation systems are used in the prehospital environment anywhere in the world. This knowledge is important because if the use of inappropriate weight estimation practices is identified, it could be remedied through education and institutional policies. Methods This was a prospective questionnaire study conducted in Johannesburg, South Africa, which obtained information on the knowledge, attitude and practice of weight estimation amongst advanced life support (ALS) paramedics. Results Forty participants were enrolled, from both the public and private sectors. The participants’ preferred method of weight estimation was visual estimation (7/40; 18%), age-based formulas (16/40; 40%), parental estimation (3/40; 8%), the Broselow tape (2/40; 5%) and the PAWPER tape (11/40; 28%). No participant was familiar with or used the Mercy method. All participants were very confident in the accuracy of their selected system. Discussion The knowledge and understanding of weight estimation systems by many advanced life support paramedics was poor and the use of inappropriate weight estimation systems was common. Further education and intervention is needed in order to change the sub-optimal weight estimation practices of ALS paramedics in Johannesburg.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2018.01.003
       
  • A qualitative study exploring nurses’ attitudes, confidence, and
           perceived barriers to implementing a traumatic brain injury nursing chart
           in Uganda

    • Authors: Leslie Wynveen; Miriam Gamble; Josephine Nabulime; Tonny Luggya; Joseph K. Kalanzi; Hani Mowafi
      Abstract: Publication date: Available online 18 March 2018
      Source:African Journal of Emergency Medicine
      Author(s): Leslie Wynveen, Miriam Gamble, Josephine Nabulime, Tonny Luggya, Joseph K. Kalanzi, Hani Mowafi
      Introduction In Africa, traumatic brain injuries frequently result from road traffic injuries and assaults. Despite limited resources and the high costs of life-saving neurosurgical interventions, secondary brain injury prevention has the potential for improving outcomes. However, nurses and other medical personnel infrequently monitor vital signs, blood sugar, and pulse oximetry and only sporadically re-assess neurological status. Methods In one-on-one, semi-structured interviews, 27 nurses from Mulago Hospital’s emergency centre, a tertiary care trauma hospital in Kampala, Uganda, provided feedback regarding a traumatic brain injury-focused education session and use of a nursing chart for detecting secondary brain injury. The interviews explored the nurses’ confidence and perceived barriers to long-term chart implementation and traumatic brain injury care, as well as their ideas for improving this intervention. Interviews were audio recorded, transcribed, and coded using ATLAS.ti: Qualitative Data Analysis and Research Software (Cleverbridge, Inc., Chicago, USA) and Microsoft Word and Excel (Microsoft Office, Redmond, USA) for thematic content analysis. Results Key findings identified in the interviews included the nurses’ attitudes toward the chart and their feelings of increased confidence in assessing and caring for these patients. The main barriers to continuous implementation included inadequate staffing and resources. Conclusion Nurses were receptive to the education session and nursing chart, and felt that it increased their confidence and improved their ability to care for traumatic brain injured patients. However, lack of supplies, overwhelming numbers of patients, and inadequate staffing interfered with consistent monitoring of patients. The nurses offered various suggestions for improving traumatic brain injury care that should be further investigated. More research is needed to assess the applicability of a standardised traumatic brain injury nursing education and chart in a broader context.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2018.01.002
       
  • The accuracy of paediatric weight estimation during simulated emergencies:
           The effects of patient position, patient cooperation, and human errors

    • Authors: Mike Wells; Lara Nicole Goldstein; Alison Bentley
      Abstract: Publication date: Available online 19 January 2018
      Source:African Journal of Emergency Medicine
      Author(s): Mike Wells, Lara Nicole Goldstein, Alison Bentley
      Introduction The effect of patient position and patient cooperation on the accuracy of emergency weight estimation systems has not been evaluated previously. The objective of this study was to evaluate weight estimation accuracy of the Broselow tape, the PAWPER XL tape, the Mercy method, and a custom-designed mobile phone App in a variety of realistic simulated paediatric emergencies. Methods This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used each of the four methods to estimate the children’s weight. The accuracy of and time taken for the weight estimations were evaluated for each method. A regression analysis determined the effects of patient position and cooperation on weight estimation accuracy. Evaluation of subgroups of best-performers and worst-performers among the participants provided information on the effects of human user-error on weight estimation accuracy. Results The Broselow tape, Mercy method, App and the PAWPER XL tape achieved percentages of weight estimation within 10% of actual weight in 47.7, 57.3, 68.1, and 73.0% of estimations, respectively. Patient position and cooperation strongly impacted the accuracy of the Broselow tape, had a minimal effect on the Mercy method and the App, and had no effect on the PAWPER XL tape. The best performing participants achieved very high accuracy with all methods except the Broselow tape. Discussion The Mercy method, the App, and the PAWPER XL tape achieved exceptionally high accuracy even in uncooperative and sub-optimally positioned children when used by the best-performing participants. Human error, from inexperience and inadequate training, had the most significant impact on accuracy. The Mercy method was the most subject to human error, and the PAWPER XL tape, the least. Adequate training in using weight estimation systems is essential for paediatric patient safety.

      PubDate: 2018-03-21T10:44:44Z
      DOI: 10.1016/j.afjem.2017.12.003
       
  • Accidental similarity

    • Authors: Stevan R Bruijns; Temesgen Beyene; Aklilu Azazh; Janis P Tupesis
      Pages: 145 - 146
      Abstract: Publication date: December 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 4
      Author(s): Stevan R Bruijns, Temesgen Beyene, Aklilu Azazh, Janis P Tupesis


      PubDate: 2017-12-19T07:49:22Z
      DOI: 10.1016/j.afjem.2017.11.004
       
  • Corrigendum to Attitude of interns towards implementation and contribution
           of undergraduate Emergency Medicine training: Experience of an Ethiopian
           Medical School

    • Authors: Temesgen Beyene; Janis P. Tupesis; Aklilu Azazh
      First page: 189
      Abstract: Publication date: December 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 4
      Author(s): Temesgen Beyene, Janis P. Tupesis, Aklilu Azazh


      PubDate: 2017-12-19T07:49:22Z
      DOI: 10.1016/j.afjem.2017.11.003
       
  • Attitude of interns towards implementation and contribution of
           undergraduate Emergency Medicine training: Experience of an Ethiopian
           Medical School

    • Authors: Temesgen Beyene; Janis P. Tupesis; Aklilu Azazh
      Pages: 108 - 112
      Abstract: Publication date: September 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 3
      Author(s): Temesgen Beyene, Janis P. Tupesis, Aklilu Azazh
      Introduction Emergency Medicine is a medical specialty based on knowledge and skills required for the prevention, diagnosis and management of the acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. Addis Ababa University School of Medicine started its Emergency Medicine Residency in 2010 and Emergency Medicine training for fourth-year medical students started in 2013. This study aims to assess attitudes of fifth year medical students towards Emergency Medicine training and its contribution to their final year of medical school training. Methods Two hundred fifth year medical students participated in the study by convenience sampling. Self-administered questionnaires and Likert scales were used for data collection. Descriptive frequencies and chi-square analysis were done for categorical data. Ethical oversight was provided by the Institutional Review Board of the Addis Ababa University College of Health Sciences. Results Of the 200 participants, 150 were male and 50 were female. 80% agreed its relevance for undergraduates. Relevance was significantly associated with recommendation to other medical schools (χ 2 =8.34, Pr=0.004). 72% of respondents agreed lectures are appropriate teaching methods, 70% agreed group activity, 68.5% skill sessions, 67.5% morning discussions, 64% diagnostic session, 60% duty exposures and 45% seminars. Difficulties faced during internship are primarily attributed to lack of facilities, ranging from the setup of the emergency centre to instruments and emergency drugs. 60% of respondents agreed that Emergency Medicine training is important to future careers. 65% agreed recommending training to other medical schools. Conclusion An Emergency Medicine rotation during the final year of medical school provides opportunities to learn about undifferentiated medical emergencies and it should be included for other medical schools in the country. Participants suggest that leadership aspects of Emergency Medicine need more emphasis as the curriculum is further developed in the future.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.04.008
       
  • Quality improvement in emergency service delivery: Assessment of knowledge
           and skills amongst emergency nurses at Connaught Hospital, Sierra Leone

    • Authors: Hedda Bøe Nyhus; Michael M. Kamara
      Pages: 113 - 117
      Abstract: Publication date: September 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 3
      Author(s): Hedda Bøe Nyhus, Michael M. Kamara
      Introduction The ability to deliver quality emergency care services is reliant on a well-trained workforce. Since Sierra Leone was declared Ebola free in December 2015, the country has now moved into the post-Ebola reconstructive phase focusing on specialty training of healthcare workers. This development aligns well to the growing momentum for improved emergency medicine as a speciality in other regions of Sub-Saharan Africa. The first stage in assessing how to develop an emergency nursing speciality in Sierra Leone is to conduct an assessment of what is needed in terms of educational interventions. Concurrently enhancing emergency nursing capacity requires a comprehensive understanding of the role, function and emergency nurse educational requirements. This study was conducted to fully understand the current context, elucidate current nursing functions and gain knowledge of the educational desires and needs of nurses in the emergency centre at Connaught Hospital, the largest referral hospital in Sierra Leone. Methods This mixed-methods study comprised self-assessment, one multiple-choice questionnaire, focus group interviews and observational methods. Results Emergency nurses scored relatively low on the multiple-choice questionnaire, indicating through the self-assessment that they aspired to learn more about several topics within emergency care, and identified several themes which were considered to be barriers to delivery of care through focus group discussions and observations in the emergency centre. Conclusion This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.04.002
       
  • Characterising emergency centre encounters in Mbour, Senegal as
           emergent-emergency care, emergent-primary care or non-emergent

    • Authors: Julia M. Marsala; Farbe Faye; Rhonda BeLue; Otto Schoeck
      Pages: 124 - 129
      Abstract: Publication date: September 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 3
      Author(s): Julia M. Marsala, Farbe Faye, Rhonda BeLue, Otto Schoeck
      Introduction Emergency medicine is a relatively new specialty in Africa, with the first emergency medicine training programme only started in South Africa in 2004. Continued emergency centre development and preparedness relies on a better understanding of the quantity and category of emergency centre encounters within the various African regions. Methods This study was conducted over four, consecutive months in 2014 using a retrospective chart review, aimed to examine the types of visits made to one emergency centre at the Grande Mbour Hospital in Mbour, Senegal. The New York University Emergency Department Algorithm was used to classify emergency centre encounters. Each diagnosis included in this study was classified per the algorithm as non-emergent; emergent but primary care treatable; emergent with emergency centre care needed but avoidable/preventable; and emergent with emergency centre care needed and not avoidable/preventable. The algorithm also categorised diagnoses of injury, mental health problems, alcohol, or substance abuse. Results This study included 1268 diagnoses from the emergency centre. The most common presentations in Mbour, Senegal were injuries, with 302 cases (33%), and from the category: emergent but primary care treatable, with 303 cases (33%). In total, 174 cases (19%) were classified as: non-emergent. While only 93 cases (10%) were considered: emergency care needed/preventable or avoidable, a substantial number (n=218, 24%) were categorised as: emergent with emergency centre care needed and not avoidable/preventable. Conclusion This study provides the first description of patients presenting for care in the emergency centre of Mbour’s hospital and demonstrates the wide range of illnesses and types of trauma that the emergency centre must accommodate while contending with the limited resources available in the area. Understanding the burden of disease will help prioritise resources appropriately.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.05.010
       
  • An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in
           the immediate post-Ebola period

    • Authors: Richard Lowsby; Cecilia Kamara; Michael Kamara; Hedda Nyhus; Nathaniel Williams; Michael Bradfield; Hooi-Ling Harrison
      Pages: 51 - 55
      Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2
      Author(s): Richard Lowsby, Cecilia Kamara, Michael Kamara, Hedda Nyhus, Nathaniel Williams, Michael Bradfield, Hooi-Ling Harrison
      Introduction Nurse-led triage, using the South African Triage Scale, was introduced to the emergency centre of the tertiary referral hospital in Freetown, Sierra Leone in early 2014 prior to the Ebola epidemic. The aim of this study was to measure the effectiveness of the process now that the country has been declared free of Ebola. Methods The study was conducted over a five-day consecutive period in the adult emergency centre of the main government teaching hospital in December 2015. The times from arrival to triage and medical assessment were recorded and compared for each triage category. We also assessed the inter-rater reliability of the process. Results 111 patients were included during the study period. In terms of acuity, 6% were categorised as red, 27% were orange, 20% yellow and 47% green. Triage Early Warning Score was correctly calculated in 90% of cases and there was inter-rater agreement of colour code and triage category on 92% of occasions (k=0.877, p<0.001). Median time from triage to assessment was 15min for red patients, 20min for orange, 40min for yellow and 72min for green. Discussion The triage process is functioning effectively in the emergency centre after the Ebola epidemic and provides a reliable assessment of undifferentiated patients presenting to the hospital to ensure that they are seen in a timely manner based on acuity.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2016.10.003
       
  • Student paramedic rapid sequence intubation in Johannesburg, South Africa:
           A case series

    • Authors: Christopher Stein
      Pages: 56 - 62
      Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2
      Author(s): Christopher Stein
      Introduction Pre-hospital rapid sequence intubation was introduced within paramedic scope of practice in South Africa seven years ago. Since then, little data has been published on this high-risk intervention as practiced operationally or by students learning rapid sequence intubation in the pre-hospital environment. The objective of this study was to describe a series of pre-hospital rapid sequence intubation cases, including those that South African University paramedic students had participated in. Methods A University clinical learning database was searched for all endotracheal intubation cases involving the use of neuromuscular blockers between 1 January 2011 and 31 December 2015. Data from selected cases were extracted and analysed descriptively. Results Data indicated that most patients were young adult trauma victims with a dominant injury mechanism of vehicle-related accidents. The majority of cases utilised ketamine and suxamethonium, with a low rate of additional paralytic medication administration. 63% and 72% of patients received post-intubation sedation and analgesia, respectively. The overall intubation success rate from complete records was 99.6%, with a first pass success rate of 87.9%. Students were successful in 92.4% of attempts with a first-pass success rate of 85.2%. Five percent of patients experienced cardiac arrest between rapid sequence intubation and hospital arrival. Discussion Students demonstrated a good intubation success and first pass-success rate. However, newly qualified paramedics require strict protocols, clinical governance, and support to gain experience and perform pre-hospital rapid sequence intubation at an acceptable level in operational practice. More research is needed to understand the low rate of post-intubation paralysis, along with non-uniform administration of post-intubation sedation and analgesia, and the 5% prevalence of cardiac arrest.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.01.005
       
  • Poor adherence to Tranexamic acid guidelines for adult, injured patients
           presenting to a district, public, South African hospital

    • Authors: Jacobus G.G. Wiese; Daniël J. van Hoving; Luke Hunter; Sa'ad Lahri; Stevan R. Bruijns
      Pages: 63 - 67
      Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2
      Author(s): Jacobus G.G. Wiese, Daniël J. van Hoving, Luke Hunter, Sa'ad Lahri, Stevan R. Bruijns
      Introduction In South Africa’s high injury prevalent setting, it is imperative that injury mortality is kept to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance. Methods A retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was done. A sample of 301 patients was randomly selected from Khayelitsha’s resuscitation database and data were supplemented through chart review. The primary endpoint was compliance with local guidance: systolic blood pressure <90 or heart rate >110 or a significant risk of haemorrhage. Injury Severity Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and ISS <8 as low risk. Linear regression and Fischer’s Exact test were used to explore assumptions. Results Overall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none received a follow-up infusion. Compliance with the protocol was significantly better if an indication for TXA did not exist, compared to when one did (p<0.001). Increased TXA use was associated only with ISS >15 (p<0.001). Discussion TXA is not used in accordance with local guidelines. It was as likely not to be used when indicated than when not indicated. Reasons for this are multifactorial and likely include stock levels, lack of administration equipment, time to reach definitive care, poor documentation and hesitancy to use. Further investigation is needed to understand the barriers to administration.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.04.006
       
  • Poisoning cases and their management in emergency centres of government
           hospitals in northwest Ethiopia

    • Authors: Getnet Mequanint Adinew; Asegedech Tsegaw Woredekal; Elizabeth L. DeVos; Eshetie Melese Birru; Mohammed Birhan Abdulwahib
      Pages: 74 - 78
      Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2
      Author(s): Getnet Mequanint Adinew, Asegedech Tsegaw Woredekal, Elizabeth L. DeVos, Eshetie Melese Birru, Mohammed Birhan Abdulwahib
      Introduction With the widespread availability of a vast number of chemicals and drugs, acute poisoning is a common medical emergency worldwide. In spite of the success of interventions to prevent toxic ingestions, acute poisoning continues to be an important public health problem. Because of weak regulations and limited health care services in developing countries, adverse outcomes from poisoning are more prevalent than in the developed world. Due to the limited Ethiopian literature on this topic, the primary objective of this study was to evaluate and report poisoning cases, their management and outcome in northwest Ethiopia. Methods This is a retrospective study of all poisoning cases admitted and managed in the emergency centres of Gondar Teaching Referral Hospital and Metema and Debark district hospitals, from September 2010 to December 2014. Data was collected through retrospective chart review of patients who were admitted due to poisoning. Results There were 543 registered poisoning cases listed in the registry during the study period, of which 344 cases (63.4%) had complete data and were included in the final analysis. There were 48,619 emergency centre visits during the study period, with poisoning cases accounting for 1.1%. Females (60%) were predominant among intentional as well as unintentional poisoning cases. Patients between 15 and 24years of age accounted for 55% of the cases. Patients poisoned with organophosphate and bleaching agents accounted for 35% and 25%, respectively. Among the poisoning patients, 74% were treated with decontamination, while those exposed to organophosphate were treated with atropine 45.5% (55/121) of the time. Discussion Young females comprise a group at increased risk for suicidal poisonings. As a developing nation, pesticide and bleaching agents remain a significant cause of acute poisonings in Ethiopia. Intentional poisoning remains the most significant identified cause of poisoning overall.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.04.005
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Michael Gottlieb
      First page: 90
      Abstract: Publication date: September 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 3
      Author(s): Michael Gottlieb


      PubDate: 2017-09-14T01:08:56Z
      DOI: 10.1016/j.afjem.2016.08.007
       
  • Uchunguzi (Journal Watch/ Montre de Journal)

    • Authors: Benjamin W. Wachira
      Pages: 38 - 39
      Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2
      Author(s): Benjamin W. Wachira


      PubDate: 2017-06-02T17:43:17Z
      DOI: 10.1016/j.afjem.2017.02.001
       
  • Prospective assessment of patients with stroke in Tikur Anbessa
           Specialised Hospital, Addis Ababa, Ethiopia

    • Authors: Ayalew Zewdie; Finot Debebe; Sofia Kebede; Aklilu Azazh; Adam Laytin; Golnar Pashmforoosh; Getaw Worku Hassen
      Abstract: Publication date: Available online 16 December 2017
      Source:African Journal of Emergency Medicine
      Author(s): Ayalew Zewdie, Finot Debebe, Sofia Kebede, Aklilu Azazh, Adam Laytin, Golnar Pashmforoosh, Getaw Worku Hassen
      Introduction The burden of stroke is increasing in many low- and middle-income countries. In Ethiopia, stroke has become a major cause of morbidity, long-term disability, and mortality. Time from stroke onset to hospital presentation is a critical factor in acute stroke care. This study aimed to describe risk factors for stroke and clinical presentation of patients presenting to the emergency centre with stroke. Methods We conducted a cross sectional study conducted from August 2015 to January 2016 in an urban tertiary care centre in Addis Ababa, Ethiopia. Descriptive statistics and multivariable logistic regression models were used to evaluate associations between stroke types and stroke risk factors, and delayed presentation and clinical indicators. P-values less than .05 were considered statistically significant. Results A total of 104 patients were included. The mean age was 53 years, and 56% were male. Only 30% of patients arrived using an ambulance service. The most common presenting symptoms were altered mental status (48%), hemiparesis (47%), facial palsy (45%), hemiplegia (29%), and aphasia (25%). Hypertension was the most common risk factor (49%), followed by cardiovascular disease (20.2%) and diabetes mellitus (11%). The majority of strokes were haemorrhagic in aetiology (56%). The median arrival time to the emergency centre was 24 h after symptoms onset; only 15% presented within three hours. Patients with hypertension, or presented with loss of consciousness were significantly more likely to have haemorrhagic stroke (p < .001 and p = .01 respectively). The only risk factor robustly associated with ischaemic stroke was cardiac illness (odds ratio 3.99, p = .01). Discussion Our study identified hypertension to be the most common risk factor for stroke. The predominant aetiology type in this cohort is haemorrhagic stroke. Lastly, the median arrival time to an emergency centre was 24 h after symptom onset.

      PubDate: 2017-12-19T07:49:22Z
      DOI: 10.1016/j.afjem.2017.11.001
       
  • A one year audit of patients with venous thromboembolism presenting to a
           tertiary hospital in Johannesburg, South Africa

    • Authors: Lara Nicole Goldstein; Ming-Tung Wu
      Abstract: Publication date: Available online 22 September 2017
      Source:African Journal of Emergency Medicine
      Author(s): Lara Nicole Goldstein, Ming-Tung Wu
      Introduction Given the growing burden of venous thromboembolism (VTE) worldwide and the paucity of data from the developing world, the aim of this study was to audit the characteristics, risk factors and length of hospital stay of patients with VTE presenting to a tertiary hospital emergency centre in Johannesburg, South Africa. Methods The study was a retrospective record review of all patients who presented with VTE to a tertiary academic emergency centre in Johannesburg, South Africa from 1 April 2012 to 30 March 2013. Results Venous thromboembolism was identified in 74 patients; 56 (75.7%) with isolated deep vein thrombosis, 13 (17.6%) with pulmonary embolism and five (6.8%) who had a concurrent deep vein thrombosis with pulmonary embolism. The median age of the patients was 40years old (range 19–90). The female to male ratio was 2:1. HIV infection, tuberculosis and history of immobilisation were the most common risk factors. The median duration of hospital stay was 14days (range 4–36). A therapeutic International Normalised Ratio at discharge was only reached in 36.5% of patients. Conclusion Venous thromboembolism presentation to the emergency centre is not common, but the risks associated with the morbidity and mortality related to it makes it important despite its relative scarcity. The prevalence of HIV infection amongst patients with VTE is concerning – not only related to the frequency of the pathology but also due to HIV not being factored into the common VTE risk stratification scores.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.08.006
       
  • Emergency medical services (EMS) training in Kenya: Findings and
           recommendations from an educational assessment

    • Authors: Benjamin Nicholson; Chelsea McCollough; Benjamin Wachira; Nee-Kofi Mould-Millman
      Abstract: Publication date: Available online 8 August 2017
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin Nicholson, Chelsea McCollough, Benjamin Wachira, Nee-Kofi Mould-Millman
      Background Over the past twenty years, Kenya has been developing many important components of a prehospital emergency medical services (EMS) system. This is due to the ever-increasing demand for emergency medical care across the country. To better inform the next phase of this development, we undertook an assessment of the current state of EMS training in Kenya. Methods A group of international and Kenyan experts with relevant EMS and educational expertise conducted an observational qualitative assessment of Kenyan EMS training institutions in 2016. Three assessment techniques were utilised: semi-structured interviews, document review, and structured observations. Recommendations were reached through a consensus process amongst the assessment team. Results Key findings include: (i) No national or state-level policy exists that establishes levels of EMS providers or expected fund of knowledge and skills; (ii) Training institutions have independently created their own individual training standards; (iii) Training materials are not adapted for the local context; (iv) The foundation of basic anatomy and physiology education is weak; (v) Training does not focus on symptom- or syndrome-based complaints; (vi) Students had difficulty applying foundational classroom knowledge in simulations and clinical encounters; (vii) There is limited emphasis on complex critical thinking. Discussion Standardisation of training is needed in Kenya, including clearly defined levels of providers and expected learning outcomes. A nationally standardised EMS provider scope of practice may also help focus EMS education. Instructors must reinforce basic anatomy and physiology amongst all trainees to establish a robust foundation, then layer on field experience before trainees receive advanced training. Training graduates should be EMS providers who approach patient care with high-order symptom- or syndrome-based critical thinking. While these recommendations are specific to the Kenyan EMS environment, they may have wider applicability to other developing EMS systems in resource-limited settings.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.06.002
       
  • A quality improvement study of the emergency centre triage in a tertiary
           teaching hospital in northern Ethiopia

    • Authors: Rehab Abdelwahab; Hannah Yang; Hareya Gebremedhin Teka
      Abstract: Publication date: Available online 8 August 2017
      Source:African Journal of Emergency Medicine
      Author(s): Rehab Abdelwahab, Hannah Yang, Hareya Gebremedhin Teka
      Introduction An effective emergency triage system should prioritize both trauma and non-trauma patients according to level of acuity, while also addressing local disease burden and resource availability. In March 2012, an adapted version of the South African Triage Scale was introduced in the emergency centre (EC) of Ayder Comprehensive Specialized Hospital in northern Ethiopia. Methods This quality improvement study was conducted to evaluate the implementation of nurse-led emergency triage in a large Ethiopian teaching hospital using the Donabedian model. A 45% random sample was selected from all adult emergency patients during the study period, May 10th to May 25th 2015. Patient charts were collected and retrospectively reviewed. Presence and proper completion of the triage form were appraised. Triage level was abstracted and compared with patient outcome (dichotomized as “admitted to hospital or died” and “discharged alive from emergency centre”) to quantify over- and under-triage triage. Results From 251 randomly selected patients, 107 (42.6%) charts were retrieved. From these, only 45/107 (42.1%) contained the triage form filled within the chart. None of the triage forms were filled out completely. From 13 (28.9%) admitted or deceased patients, the under-triage rate was 30.7% and from 32 (71.1%) patients discharged alive from the EC the over-triage rate was 21.9%. Discussion The under-triage rate observed in this study exceeds the recommended threshold of 5% and is a serious patient safety concern. However, under-triage may have been magnified by irregularities in the hospital admission process. Haphazard medical record handling, poor documentation, erroneous triage decisions, and poor rapport between nurses and physicians were the main process-related challenges that must be addressed through intensive training and improved human resource management approaches to enhance the quality of triage in the emergency centre.

      PubDate: 2017-10-14T07:48:06Z
      DOI: 10.1016/j.afjem.2017.05.009
       
  • Cardiopulmonary resuscitation by Emergency Medical Services in South
           Africa: Barriers to achieving high quality performance

    • Authors: Jean-Paul Veronese; Lee Wallis; Rachel Allgaier; Ryan Botha
      Abstract: Publication date: Available online 4 October 2017
      Source:African Journal of Emergency Medicine
      Author(s): Jean-Paul Veronese, Lee Wallis, Rachel Allgaier, Ryan Botha
      Introduction Survival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting. Methods A descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills. Results Overall competency of CPR among participants (n=114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training. Conclusion Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.

      PubDate: 2017-10-11T07:37:47Z
      DOI: 10.1016/j.afjem.2017.08.005
       
  • Developing an emergency nursing short course in Tanzania

    • Authors: C. Cunningham; P. Brysiewicz; A. Sepeku; L. White; B. Murray; N. Lobue; H. Sawe
      Abstract: Publication date: Available online 22 September 2017
      Source:African Journal of Emergency Medicine
      Author(s): C. Cunningham, P. Brysiewicz, A. Sepeku, L. White, B. Murray, N. Lobue, H. Sawe
      Nurses are the largest group of healthcare workers in Africa. By adequately equipping nurses to identify, intervene and care for emergency conditions, emergency healthcare systems can be strengthened. To address this need, a nursing working group was formed within the African Federation for Emergency Medicine (AFEM). The aim of this international emergency nursing group was to develop a guiding document to help improve emergency nursing skills within Africa. Using this guiding document, a group of Tanzanian clinical nurse trainers was selected to develop a context specific short course. They used this guiding document as a foundation to improve skill development. The pilot course was well received and has since expanded to training in five regions within the United Republic of Tanzania. The clinical nurse trainers leading the course, are supported by a mentorship programme with competent educators within a global emergency nursing infrastructure. This course, a combination of local knowledge, formal mentorship programs, and international nursing support, demonstrates that investing in the improvement of emergency nursing skills can have high impact results with low-cost. This will ultimately improve emergency care on the continent.

      PubDate: 2017-09-26T01:26:20Z
      DOI: 10.1016/j.afjem.2017.08.002
       
  • Views of emergency care providers about factors that extend on-scene time
           intervals

    • Authors: Craig Vincent-Lambert; Tannith Mottershaw
      Abstract: Publication date: Available online 21 September 2017
      Source:African Journal of Emergency Medicine
      Author(s): Craig Vincent-Lambert, Tannith Mottershaw
      Introduction Rapid response, patient care and transportation remain recognised goals of the Emergency Medical Services (EMS). Spending more time on-scene may delay the initiation of definitive care interventions. This study focused on describing the perceptions of a sample of emergency care providers regarding the impact of environmental, clinical and systemic factors with respect to their on-scene time intervals. Method The study was descriptive and prospective in nature making use of a self-designed questionnaire. Basic descriptive methods were used during the analysis of the participants’ responses to 16 close-ended questions. A further review of the limited narrative elicited by two open-ended questions allowed for the reporting of additional views and opinions. Results Thirty-three (92%) participants agreed that extended time on-scene may negatively affect patient outcome. Twenty-three (64%) agreed that spending longer than 20min on-scene may be considered excessive for medical emergencies and 28 (77%) felt the same for trauma cases. Respondents felt that many of the environmental, clinical and systemic factors mentioned in the questionnaire do have the potential to extend on-scene time intervals. The factors that were seen to have the greatest effect included waiting for fire, rescue and police services, patient acuity, the use of an air ambulance, patient extrication and multi-casualty incidents. Discussion There are a number of environmental, clinical and systemic factors that emergency care providers indicate have the potential to extend on-scene time intervals. Acknowledging and attempting to address these factors is important for EMS as limiting the time spent on-scene is not only clinically desirable but may also lead to improved efficiency and availability of resources.

      PubDate: 2017-09-26T01:26:20Z
      DOI: 10.1016/j.afjem.2017.08.003
       
  • Qualitative inquiry into Registered General Nurses’ experiences in
           the emergency centre

    • Authors: Confidence Alorse Atakro; Janet Gross; Theresa Sarpong; Ernestina Armah; Cynthia Pomaa Akuoko
      Abstract: Publication date: Available online 21 September 2017
      Source:African Journal of Emergency Medicine
      Author(s): Confidence Alorse Atakro, Janet Gross, Theresa Sarpong, Ernestina Armah, Cynthia Pomaa Akuoko
      Introduction Though nurses are frontline workers in emergency care, their experiences in emergency centres are seldom researched. This study explored lived experiences of Registered General Nurses working in emergency centres. Methods This study employed an exploratory qualitative design. Purposive sampling was used in selecting hospitals and participants for study. Data were collected through semi-structured interviews with 20 Registered General Nurses who worked in emergency centres. Data analysis was performed through content analysis. Results Demographic results revealed that only one respondent used knowledge of critical care nursing to practice emergency care in an emergency centre. Four thematic categories emerged after qualitative data analysis: a) Emergency centre as a place of learning and increased confidence for nurses; b) Feelings of joy in emergency centres; c) Social and physical consequences of emergency centres on lives of emergency centre nurses; d) Clients receiving low quality care in emergency centres. Discussion Employment of specialist trained emergency staff and formal education of Registered General Nurses in the advanced role of emergency care nursing may be necessary to improve quality of care rendered to clients in emergency centres.

      PubDate: 2017-09-26T01:26:20Z
      DOI: 10.1016/j.afjem.2017.08.007
       
  • An unusual cause of recurrent laryngospasm: A case report

    • Authors: Giles N. Cattermole; Vincent Ndebwanimana; Noah Polzin-Rosenberg
      Abstract: Publication date: Available online 21 September 2017
      Source:African Journal of Emergency Medicine
      Author(s): Giles N. Cattermole, Vincent Ndebwanimana, Noah Polzin-Rosenberg
      Introduction Laryngospasm is a partial or complete closure of the vocal cords, causing stridor and then complete airway obstruction. We present an unusual case of recurrent laryngospasm following cervical spine trauma. Case report A 41-year-old pedestrian was hit by a car sustaining several spine fractures including a comminuted fracture of C1. These were initially unrecognised, and his cervical spine was not immobilised. During this time the patient experienced three episodes of laryngospasm requiring intubation. On day 11 his fractures were identified, and a Philadelphia collar was placed. He made a full recovery without any neurological sequelae. Discussion Laryngospasm is a recognised complication of anaesthesia and intubation. This case illustrates that this life-threatening complication can also follow cervical fractures, and reinforces the need for prompt and careful review of imaging to identify such fractures in trauma patients, especially those with stridor.

      PubDate: 2017-09-26T01:26:20Z
      DOI: 10.1016/j.afjem.2017.08.009
       
  • Scientific abstracts from the 2017 Rwanda Emergency Care Association
           conference

    • Abstract: Publication date: September 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 3


      PubDate: 2017-09-14T01:08:56Z
       
  • A hands-on guide to doing content analysis

    • Authors: Christen Erlingsson; Petra Brysiewicz
      Abstract: Publication date: Available online 21 August 2017
      Source:African Journal of Emergency Medicine
      Author(s): Christen Erlingsson, Petra Brysiewicz
      There is a growing recognition for the important role played by qualitative research and its usefulness in many fields, including the emergency care context in Africa. Novice qualitative researchers are often daunted by the prospect of qualitative data analysis and thus may experience much difficulty in the data analysis process. Our objective with this manuscript is to provide a practical hands-on example of qualitative content analysis to aid novice qualitative researchers in their task.

      PubDate: 2017-08-22T00:53:19Z
      DOI: 10.1016/j.afjem.2017.08.001
       
  • Competence in performing emergency skills: How good do doctors really
           think they are'

    • Authors: Nicholas Dufourq; Lara Nicole Goldstein; Martin Botha
      Abstract: Publication date: Available online 9 August 2017
      Source:African Journal of Emergency Medicine
      Author(s): Nicholas Dufourq, Lara Nicole Goldstein, Martin Botha


      PubDate: 2017-08-10T20:45:03Z
      DOI: 10.1016/j.afjem.2017.05.011
       
  • Idiopathic pulmonary vein thrombosis: An unexpected cause of respiratory
           distress and acute heart failure. A case report and review of the
           literature

    • Authors: Jamel El Ghoul; Sami Milouchi; Soued Ferjani; Omar Abid; Abdesslam Ghourabi; Ahmed Sghaier
      Abstract: Publication date: Available online 5 July 2017
      Source:African Journal of Emergency Medicine
      Author(s): Jamel El Ghoul, Sami Milouchi, Soued Ferjani, Omar Abid, Abdesslam Ghourabi, Ahmed Sghaier
      Introduction Pulmonary vein thrombosis is a potentially fatal disease. The association between pulmonary vein thrombosis and chronic heart failure has not been described in the literature. Case report Herein, we report a case involving a 73-year-old woman, with a medical history of ischemic congestive heart failure, who was hospitalised for acute decompensated heart failure with respiratory distress. A computed tomography pulmonary angiography was performed to rule out the possibility of pulmonary embolism, and it showed evidence of pulmonary vein thrombosis. No cause was determined for the pulmonary vein thrombosis; hence, it was considered idiopathic and anticoagulation therapy was initiated for the patient. However, the patient died a few days after admission to the intensive care unit. Conclusion This case of pulmonary vein thrombosis is presented to promote awareness of this disease entity. We also want to emphasize the importance of maintaining a high index of clinical suspicion for this diagnosis, particularly in patients with acute decompensated heart failure who are refractory to standard therapy.

      PubDate: 2017-07-13T20:23:19Z
      DOI: 10.1016/j.afjem.2017.05.008
       
  • In this issue…

    • Authors: Stevan Bruijns
      Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2
      Author(s): Stevan Bruijns


      PubDate: 2017-06-02T17:43:17Z
       
  • Global Research Highlights

    • Abstract: Publication date: June 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 2


      PubDate: 2017-06-02T17:43:17Z
       
  • Preventative measures taken against hypothermia in selected Durban
           hospitals’ emergency centres and operating theatres

    • Authors: Matthew James; Nel Timothy Craig Hardcastle
      Abstract: Publication date: Available online 26 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Matthew James Nel, Timothy Craig Hardcastle
      Introduction Hypothermia is common in emergency general surgical patients. It is known to be associated with major complications in multiple organ systems. It is also easily preventable with the use of safe and cost-effective equipment. However, by observation, it appears that this equipment is used too infrequently thus resulting in unnecessary harm to patients. Methods This descriptive, observational, cross-sectional study was conducted in two arms to evaluate both emergency centres and operating theatres in the major state hospitals in Durban. It was conducted as an audit as well as a questionnaire-based study, to ascertain the availability of equipment used to prevent hypothermia and also how appropriately the equipment was being used. Results There was good availability of equipment in both the operating theatres and the emergency centres. However it was being used very poorly, particularly in emergency centres (41% of responses deemed not beneficial to patients versus 29% from operating theatres; 39% of answers beneficial versus 54% from operating theatres). Institutions with hypothermia-prevention protocols scored significantly better than those without a protocol (59% versus 25% beneficial; p=0.01). Conclusion In the field of hypothermia prevention, there was sufficient equipment to result in optimal patient care. However there appears to be a lack of knowledge amongst health care providers, resulting in suboptimal use of this equipment. Protocolised management may provide a solution to this problem and improve patient outcomes.

      PubDate: 2017-05-28T17:11:03Z
       
  • Assessing the impact of an emergency trauma course for senior medical
           students in Kenya

    • Authors: Grace Wanjiku; Hannah Janeway; John Foggle; Robert Partridge; Yvonne Wang; Alexis Kearney; Adam C. Levine; Jane Carter; John S. Tabu
      Abstract: Publication date: Available online 25 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Grace Wanjiku, Hannah Janeway, John Foggle, Robert Partridge, Yvonne Wang, Alexis Kearney, Adam C. Levine, Jane Carter, John S. Tabu
      Introduction Ninety percent of all injury-related deaths occur in low- and middle-income countries. The WHO recommends short, resource-specific trauma courses for healthcare providers. Studies show that teaching trauma courses to medical students in developed countries leads to significant increases in knowledge and skill. High costs hinder widespread and sustained teaching of these courses in low-income countries. Methods A two-day trauma course was designed for students at Moi College of Health Sciences in Eldoret, Kenya. Participants underwent pre- and post-course written and simulation testing and rated their confidence in 21 clinical scenarios and 15 procedures pre- and post-course using a five point Likert scale. A subset of the students was re-evaluated nine months post-course. Using the paired t-test, mean written, simulation and confidence scores were compared pre-course, immediately post-course and nine months post-course. Results Twenty-two students were enrolled. Written test score means were 61.5% pre-course and 76.9% post-course, mean difference 15.5% (p<0.001). Simulation test score means were 36.7% pre-course and 82.2% post-course, mean difference 45.5% (p<0.001). Aggregate confidence scores were 3.21 pre-course and 4.72 post-course (scale 1–5). Ten out of 22 (45.5%) students were re-evaluated nine months post-course. Results showed written test score mean of 75%, simulation score mean of 61.7%, and aggregate confidence score of 4.59 (scale 1–5). Mean differences between immediate post- and nine months post-course were 1.6% (p=0.75) and 8.7% (p=0.10) for the written and simulation tests, respectively. Conclusion Senior Kenyan medical students demonstrated statistically significant increases in knowledge, skills and confidence after participating in a novel student trauma course. Nine months post-course, improvements in knowledge skills and confidence were sustained.

      PubDate: 2017-05-28T17:11:03Z
      DOI: 10.1016/j.afjem.2017.04.013
       
  • Barriers and facilitators to Electronic Medical Records usage in the
           Emergency Centre at Komfo Anokye Teaching Hospital, Kumasi-Ghana

    • Authors: Adwoa Gyamfi; Kofi A. Mensah; George Oduro; Peter Donkor; Charles N. Mock
      Abstract: Publication date: Available online 25 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Adwoa Gyamfi, Kofi A. Mensah, George Oduro, Peter Donkor, Charles N. Mock
      Introduction The use of paper for record keeping (or a manual system) has been the order of the day in almost all health care facilities in resource poor countries. This system has presented numerous challenges, which the use of Electronic Medical Records (EMR) seeks to address. The objectives of the study were to identify the facilitators and barriers to EMR implementation in Komfo Anokye Teaching Hospital’s (KATH) Emergency Centre (EC) and to identify lessons learned. These will help in implementation of EMR in ECs in similar settings. Methods This was a non-interventional, descriptive cross-sectional and purely qualitative study using a semi-structured interview guide for a study population of 24. The interviews were manually recorded and analysed thematically. EMR implementation was piloted in the EC. Some of the EC staff doubled as EMR personnel. An open source EMR was freely downloaded and customised to meet the needs of the EC. The EMR database created was a hybrid one comprising of digital bio-data of patients and scanned copies of their paper EC records. Results The facilitators for utilising the system included providing training to staff, the availability of some logistics, and the commitment of staff. The project barriers were funding, full-time information technology expertise, and automatic data and power backups. It was observed that with the provision of adequate human and financial resources, the challenges were overcome and the adoption of the EMR improved. Discussion The EMR has been a partial success. The facilitators identified in this study, namely training, provision of logistics, and staff commitment represent foundations to work from. The barriers identified could be addressed with additional funding, provision of information technology expertise, and data and power back up. It is acknowledged that lack of funding could substantially limit EMR implementation.

      PubDate: 2017-05-28T17:11:03Z
      DOI: 10.1016/j.afjem.2017.05.002
       
  • A comparison of direct laryngoscopy to video laryngoscopy by paramedic
           students in manikin-simulated airway management scenarios

    • Authors: Tyron Maartens; Benjamin de Waal
      Abstract: Publication date: Available online 25 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Tyron Maartens, Benjamin de Waal
      Introduction We compare the effectiveness of direct laryngoscopy (DL) to video laryngoscopy (VL) in simulated, difficult airway scenarios in a cohort of novice, prehospital, emergency care providers. Methods Forty-five (45) students were randomised to DL or VL groups and then tasked to perform intubation on a manikin in three simulated airway scenarios. The scenarios included an uncomplicated intubation, intubation with manual in-line neck stabilisation (MILNS), and a simulated motor vehicle entrapment, with C-Spine held from behind, using a face-to-face intubation technique. The primary outcome was time taken to intubate, with secondary outcomes including first pass success rate, number of intubation attempts, Cormack-Lehane (CL) view grade obtained, adverse event rate, and self-reported laryngoscopist comfort. Results Twenty-seven participants (VL n=15, DL n=12) completed the study. Mean time to intubate was not statistically different between VL and DL groups in any scenario. VL was associated with an increased frequency of intubation attempts (p=0.043) and failed intubations (RR 6.4, 95% CI 0.92–44.33, p=0.0175) in the face-to-face intubation scenario, VL was associated with a reduced incidence of poor CL view (RR 0.06, 95% CI 0.004–0.997, p=0.0497) in the face-to-face intubation scenario, and a reduction in the frequency of dental damage (RR 0.13, 95% CI 0.02–0.96, p=0.0165) in the supine MILNS scenario. Discussion In our small sample, we found DL to be superior to VL in relation to a reduced risk of failed intubation and frequency of intubation attempts despite VL being superior in obtaining a good view of the vocal cords in a face-to-face intubation scenario. We found no statistically significant difference in the time taken to intubate in any scenarios. A larger study is required to inform practice and education around prehospital use of VL.

      PubDate: 2017-05-28T17:11:03Z
      DOI: 10.1016/j.afjem.2017.05.003
       
  • Epidemiology, clinical characteristics and outcomes of head injured
           patients in an Ethiopian emergency centre

    • Authors: Megan Landes; Raghu Venugopal; Sara Berman; Spencer Heffernan; James Maskalyk; Aklilu Azazh
      Abstract: Publication date: Available online 24 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Megan Landes, Raghu Venugopal, Sara Berman, Spencer Heffernan, James Maskalyk, Aklilu Azazh
      Introduction Head injury is a leading cause of mortality in Africa. We characterise the epidemiology and outcomes of head injury at an Ethiopian emergency centre. Methods We conducted a prospective cohort study of all head injured patients presenting to the Emergency Centre of Tikur Anbessa Specialised Hospital, Addis Ababa. Data was collected via a standardised form from the patient’s chart, radiology reports and operative reports. Patients were followed until discharge, facility transfer, death, or 7days in hospital. Consent was obtained from the patient or substitute decision maker. Results Among 204 head injured patients enrolled, the majority were<30years old (51.0%) and male (86.8%). Forty-one percent of injuries occurred from road traffic accidents (RTAs). A significant number of patients had at least one indicator of severe injury on presentation: 51 (25.0%) had a GCS<9, 53 (26.0%) had multi-system trauma, 95 (46.6%) had≥1 abnormal vital sign and of the 133 patients with data available, 37 (27.8%) had a Revised Trauma Score (RTS)<6. Patients injured by RTA were more likely to have indicators of severe injury than other mechanisms, including multi-system trauma (OR 3.2, 95% CI 1.7–6.2, p=0.00), GCS<9 (OR 3.7, 95% CI 1.8–7.4, p=0.00),≥1 abnormal vital sign (OR 2.5, 95% CI 1.4–4.6, p=0.00) or an RTS score<6 (OR 3.6, 95% CI 1.6–8.1, p=0.00). Overall, 149 (73.0%) patients were discharged from hospital, 34 (16.7%) were transferred to another hospital, and 21 patients died (10.3%). In multivariable analysis, death was significantly associated with age over 60years (aOR 68.8, 95% CI 2.0–2329.0, p=0.02), GCS<9 (aOR 14.8, 95% CI 2.2–99.5, p=0.01), fixed bilateral pupils (aOR 39.1, 95% CI 4.2–362.8, p<0.01) and hypoxia (oxygen saturation<90%; aOR 14.2%, 95% CI 2.6–123.9, p=0.01). Conclusion Head injury represents a significant risk for morbidity and mortality in Ethiopia, of which RTA’s increase injury severity. Targeted approaches to improving care of the injured may improve outcomes.

      PubDate: 2017-05-28T17:11:03Z
      DOI: 10.1016/j.afjem.2017.04.001
       
  • Evaluation of a point-of-care ultrasound scan list in a resource-limited
           emergency department in Addis Ababa Ethiopia

    • Authors: Maja Stachura; Megan Landes; Fasika Aklilu; Raghu Venugopal; Cheryl Hunchak; Sara Berman; James Maskalyk; Josee Sarrazin; Tesfaye Kebede; Aklilu Azazh
      Abstract: Publication date: Available online 17 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Maja Stachura, Megan Landes, Fasika Aklilu, Raghu Venugopal, Cheryl Hunchak, Sara Berman, James Maskalyk, Josee Sarrazin, Tesfaye Kebede, Aklilu Azazh
      Introduction Emergency centres (EC) 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 35years 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 dyspnea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia’s first emergency medicine residency program.

      PubDate: 2017-05-19T03:45:02Z
      DOI: 10.1016/j.afjem.2017.04.011
       
  • Libyan healthcare system during the armed conflict: Challenges and
           restoration

    • Authors: Mohamed A. Daw
      Abstract: Publication date: Available online 9 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Mohamed A. Daw


      PubDate: 2017-05-14T03:28:45Z
      DOI: 10.1016/j.afjem.2017.04.010
       
  • What intracranial pathologies are most likely to receive intervention? A
           preliminary study on referrals from an emergency centre with no on-site
           neurosurgical capabilities

    • Authors: Lara Nicole Goldstein; Craig Beringer; Lumé Morrow
      Abstract: Publication date: Available online 6 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Lara Nicole Goldstein, Craig Beringer, Lumé Morrow
      Introduction Access to neurosurgical facilities remains limited in resource-restricted medical environments worldwide, including Africa. Many hospitals refer patients to off-site facilities if they require intervention. Unnecessary referrals, however, can be detrimental to the patient and/or costly to the healthcare system itself. The aim of this study was to determine the frequency and associated intracranial pathology of patients who did and did not receive active neurosurgical intervention after having presented to an academic emergency centre at a hospital without on-site neurosurgical capabilities. Methods A one-year, retrospective record review of all patients who presented with potential neurosurgical pathology to a tertiary academic emergency centre in Johannesburg, South Africa was conducted. Results A total of 983 patients received a computed tomography brain scan for suspected neurosurgical pathology. There were 395 positive scans; 67.8% with traumatic brain injury (TBI) and 32.3% non-traumatic brain injury (non-TBI). Only 14.4% of patients received neurosurgical intervention, mostly non-TBI-related. The main intervention was a craniotomy for both TBI and non-TBI patients. The main TBI haemorrhages that received an intervention were subdural (SDH) (16.5%) and extradural (10.4%) haemorrhages. More than half the patients with non-TBI SDHs as well as those with aneurysms and subarachnoid haemorrhages received an intervention. Discussion Based on this study’s findings, in a resource-restricted setting, the patients who should receive preference for neurosurgical referral and intervention are (1) those with intracranial haemorrhages (2) those with non-traumatic SDH more than traumatic SDH and (3) those patients with non-traumatic subarachnoid haemorrhages caused by aneurysms.

      PubDate: 2017-05-08T23:28:13Z
      DOI: 10.1016/j.afjem.2017.04.012
       
  • Traumatic chylothorax in a young child: Case report and management

    • Authors: Haiko K. Jahn; Jodie H. Frost; A.B. (Sebastian) van As
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Haiko K. Jahn, Jodie H. Frost, A.B. (Sebastian) van As
      Introduction A chylothorax is an uncommon feature of paediatric chest trauma. Case report We report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20ml per 12h and she made a full recovery. Discussion Initial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.007
       
  • A survey of emergency medicine and orthopaedic physicians’ knowledge,
           attitude, and practice towards the use of peripheral nerve blocks

    • Authors: Ayalew Zewdie; Finot Debebe; Aklilu Azazh; Margaret Salmon; Christian Salmon
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Ayalew Zewdie, Finot Debebe, Aklilu Azazh, Margaret Salmon, Christian Salmon
      Introduction Peripheral nerve blocks (also known as regional anaesthesia) are currently used by many anaesthesiologists and emergency physicians for perioperative and procedural pain management. Methods This is a cross sectional descriptive study conducted to evaluate knowledge, attitudes, and current practice towards use of peripheral nerve blocks for lower extremity injuries at Black Lion Hospital, a tertiary trauma centre in Addis Ababa. Results A standardised survey was conducted with 64 participants working in emergency medicine [30/64 (46.9%)] and orthopaedics [34/64 (53.1%)]. Twenty-three of 64 (35.9%) respondents had received formal training. Knowledge was acquired from didactic/workshop format for 15/23 (65.2%), followed by peer training 6/23 (39.1%). The majority, 62/64 (96.9%), believed that knowledge of general anatomy and nerve blocks are very important. Thirty-one of 64 (48%) of the respondents did not routinely perform peripheral nerve blocks. A majority, 27/31 (87.1%) stated they lacked the required skills. Ultrasound guidance of the femoral nerve 16/33 (48.5%) was the most commonly performed peripheral nerve block, followed by ankle block using anatomic landmarks 15/33 (45.5%). Almost all (15/16) ultrasound-guided nerve blocks were done by emergency medicine providers, while all anatomic land mark guided blocks were done by orthopaedic teams. A majority of the respondents (93.8%) (n=60) were optimistic that their practice on peripheral nerve blocks would increase in future. A highly significant association was found between previous training on peripheral nerve blocks and the number of peripheral nerve blocks performed in a month; p value – 0.006. Discussion This study indicates peripheral nerve blocks are likely underutilised due to lack of training. There was a positive attitude towards peripheral nerve blocks but gaps on knowledge and practice.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.003
       
  • Describing the categories of people that contribute to an Emergency Centre
           crowd at Khayelitsha hospital, Western Cape, South Africa

    • Authors: Emmanuel Ahiable; Sa'ad Lahri; Stevan Bruijns
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Emmanuel Ahiable, Sa'ad Lahri, Stevan Bruijns
      Introduction Emergency Centre (EC) crowding has globally been recognised to adversely affect patients, staff and visitors. Anecdotally, local ECs are perceived to be fairly crowded, however, not much is known about the size of this crowd and what constitutes it. Although more reliable, resource restrictions render more detailed flow studies less achievable. This study describes the EC crowd at Khayelitsha hospital in Cape Town, South Africa as the number and different categories of people, at predefined times during the day over a four-week period. Methods A prospective, cross-sectional design was used. Headcounts were made by predefined groups at 09h00, 14h00, and 21h00 every day for four weeks. Predefined groups included doctors, nurses, visitors, patients, and other allied health staff. Summary statistics were used to describe the data. Precision was described using the 95% confidence interval. Results A total of 16,353 people were counted during the study period. On average, 6370 (39%) of the groups were staff, 5231 (32%) were patients and 4752 (29%) were visitors. Of the staff, 586 (3.6%) were EC doctors, 733 (4.4%) were non-EC doctors, 1488 (9%) were EC nurses, and 445 (3%) were non-EC nurses. Although patient numbers in the EC remained constant, visitors and non-EC staff varied significantly with visitors peaking in the afternoon and non-EC staff drastically reducing in the evening. The EC was consistently crowded – average occupancy: 130%. Conclusion Staff levels fluctuated predictably, reducing at night and over weekends, while patient levels remained constant. Non-EC doctors more than doubled during the day on week shifts, in significantly more numbers than EC doctors, suggesting that many of the patients in the EC were likely to be admissions boarding in the EC. Visitor numbers were substantial during visiting hours and further aggravated crowding. Resource-light studies involving flow are important to explore crowding in low- and middle income settings.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.004
       
  • Percutaneous coronary intervention still not accessible for many South
           Africans

    • Authors: Willem Stassen; Lee Wallis; Craig Lambert; Maaret Castren; Lisa Kurland
      Abstract: Publication date: Available online 19 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Willem Stassen, Lee Wallis, Craig Lambert, Maaret Castren, Lisa Kurland
      Introduction The incidence of myocardial infarction is rising in Sub-Saharan Africa. In order to reduce mortality, timely reperfusion by percutaneous coronary intervention (PCI) or thrombolysis followed by PCI is required. South Africa has historically been characterised by inequities in healthcare access based on geographic and socioeconomic status. We aimed to determine the coverage of PCI-facilities in South Africa and relate this to access based on population and socio-economic status. Methods This cross-sectional study obtained data from literature, directories, organisational databases and correspondence with Departments of Health and hospital groups. Data was analysed descriptively while Spearman’s Rho sought correlations between PCI-facility resources, population, poverty and medical insurance status. Results South Africa has 62 PCI-facilities. Gauteng has the most PCI-facilities (n=28) while the Northern Cape has none. Most PCI-facilities (n=48; 77%) are owned by the private sector. A disparity exists between the number of private and state-owned PCI-facilities when compared to the poverty (r=0.01; p=0.17) and insurance status of individuals (r=−0.4; p=0.27). Conclusion For many South Africans, access to PCI-facilities and primary PCI is still impossible given their socio-economic status or geographical locale. Research is needed to determine the specific PCI-facility needs based on geographic and epidemiological aspects, and to develop a contextualised solution for South Africans suffering a myocardial infarction.

      PubDate: 2017-04-19T20:18:48Z
      DOI: 10.1016/j.afjem.2017.04.009
       
  • In this issue…

    • Abstract: Publication date: March 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 1


      PubDate: 2017-03-08T08:14:05Z
       
  • Cervical collars and immobilisation: A South African best practice
           recommendation

    • Authors: D. Stanton; T. Hardcastle; D. Muhlbauer; D. van Zyl
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): D. Stanton, T. Hardcastle, D. Muhlbauer, D. van Zyl
      Introduction The consequences of spinal injury as a result of trauma can be devastating. Spinal immobilisation using hard trauma boards and rigid cervical collars has traditionally been the standard response to suspected spinal injury patients even though the risk may be extremely low. Recently, adverse events due to the method of immobilisation have challenged the need for motion restriction in all trauma patients. International guidelines have been published for protection of the spine during transport and this article brings those guidelines into the South African context. Recommendations Trauma patients need to be properly assessed using both an approved list of high and low risk factors, as well as a thorough examination. They should then be managed accordingly. Internationally validated assessment strategies have been developed, and should be used as part of the patient assessment. The method of motion restriction should be selected to suit the situation. The use of a vacuum mattress is the preferable technique, with the use of a trauma board being the least desirable. Conclusion The need for motion restriction in suspected spinal injury should be properly evaluated and appropriate action taken. Not all trauma patients require spinal motion restriction.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.007
       
 
 
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