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Journal Cover African Journal of Emergency Medicine
  [SJR: 0.344]   [H-I: 6]   [5 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2211-419X
   Published by Elsevier Homepage  [3044 journals]
  • 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
       
  • Uchunguzi (Journal Watch/ Montre de Journal)

    • Authors: Benjamin W. Wachira
      Pages: 38 - 39
      Abstract: Publication date: March 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 1
      Author(s): Benjamin W. Wachira


      PubDate: 2017-03-08T08:14:05Z
      DOI: 10.1016/j.afjem.2017.02.001
       
  • 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
       
  • Mawasiliano (Correspondence/Correspondance)

    • Authors: T.B. Kortz; B. Murray; H.R. Sawe; T. Reynolds
      Abstract: Publication date: Available online 10 August 2017
      Source:African Journal of Emergency Medicine
      Author(s): T.B. Kortz, B. Murray, H.R. Sawe, T. Reynolds


      PubDate: 2017-08-10T20:45:03Z
      DOI: 10.1016/j.afjem.2017.06.003
       
  • 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
       
  • Global research highlights

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


      PubDate: 2017-03-08T08:14:05Z
       
  • Stability of warmed and cooled intravenous fluids used in Emergency Room

    • Authors: Doudou Nzaumvila; Indiran Govender
      Abstract: Publication date: Available online 14 February 2017
      Source:African Journal of Emergency Medicine
      Author(s): Doudou Nzaumvila, Indiran Govender


      PubDate: 2017-02-16T10:39:50Z
      DOI: 10.1016/j.afjem.2017.01.008
       
  • African emergency care providers’ attitudes and practices towards
           research

    • Authors: D.J. van Hoving; P. Brysiewicz
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): D.J. van Hoving, P. Brysiewicz
      Introduction Emergency care research in Africa is not on par with other world regions. The study aimed to assess the perceptions and practices towards research among current emergency care providers in Africa. Methods A survey was sent to all individual members of the African Federation of Emergency Medicine. The survey was available in English and French. Results One hundred and sixty-eight responses were analysed (invited n=540, responded n=188, 34.8%, excluded n=20). Responders’ mean age was 36.3years (SD=9.1); 122 (72.6%) were male, 104 (61.9%) were doctors, and 127 (75.6%) were African trained. Thirty-seven (22%) have never been involved in research; 33 (19.6%) have been involved in ⩾5 research projects. African related projects were mostly relevant to African audiences (n=106, 63.1%). Ninety-four (56%) participants have never published. Forty-one (24.4%) were not willing to publish in open access journals requesting a publication fee; 65 (38.7%) will consider open access journals if fees are sponsored. Eighty responders (47.6%) frequently experienced access block to original articles due to subscription charges. Lack of research funding (n=108, 64.3%), lack of research training (n=86, 51.2%), and lack of allocated research time (n=76, 45.2%) were the main barriers to research involvement. Improvement of research skills (n=118, 70.2%) and having research published (n=117, 69.6%) were the top motivational factors selected. Responders agreed that research promotes critical thinking (n=137, 81.5%) and serve as an important educational tool (n=134, 80.4%). However, 134 (79.8%) feel that emergency care workers need to be shown how to use research to improve clinical practice. Most agreed that insufficient emergency care research is being conducted in Africa (n=113, 67.3%). Discussion There is scope to increase research involvement in emergency care in Africa, but solutions need to be find to address lack of research-related funding, training and time.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.003
       
  • Case mix of patients managed in the resuscitation area of a district-level
           public hospital in Cape Town

    • Authors: L.D. Hunter; S. Lahri; D.J. van Hoving
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): L.D. Hunter, S. Lahri, D.J. van Hoving


      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.001
       
  • 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
       
  • A description of pharmacological analgesia administration by public sector
           advanced life support paramedics in the City of Cape Town

    • Authors: Ryan Matthews; Michael McCaul; Wayne Smith
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): Ryan Matthews, Michael McCaul, Wayne Smith
      Introduction Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. Methods A retrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results A total of 530 patient care records were included (n=530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). Discussion Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.002
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Michael Gottlieb
      Abstract: Publication date: Available online 3 September 2016
      Source:African Journal of Emergency Medicine
      Author(s): Michael Gottlieb


      PubDate: 2016-09-03T11:51:18Z
      DOI: 10.1016/j.afjem.2016.08.007
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Emmanuel Kwasi Acheampong
      Abstract: Publication date: Available online 16 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Emmanuel Kwasi Acheampong


      PubDate: 2016-08-20T10:39:13Z
      DOI: 10.1016/j.afjem.2016.08.001
       
 
 
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