Journal Cover African Journal of Emergency Medicine
  Journal Prestige (SJR): 0.344
  Citation Impact (citeScore): 6
  Number of Followers: 6  
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2211-419X
   Published by Elsevier Homepage  [3162 journals]
  • 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

    • 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
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