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Journal Cover African Journal of Emergency Medicine
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  This is an Open Access Journal Open Access journal
     ISSN (Print) 2211-419X
     Published by Elsevier Homepage  [2570 journals]   [SJR: 0.145]   [H-I: 2]
  • Domestic donkey (Equus africanus asinus) bites: An unusual aetiology of
           severe scalp injuries in Morocco

    • Abstract: Publication date: Available online 1 October 2014
      Source:African Journal of Emergency Medicine
      Author(s): Hatim Droussi , D. Elamrani , M. Dlimi , K. Elatiqi , S. Boukind , Aristomenis K. Exadaktylos , S. Ettalbi
      Introduction The African donkey (Equus africanus asinus) is employed for manual work in many African countries. Donkey bites are an uncommon cause of injury in children, but when they occur, can cause severe injuries to particularly the scalp. Case report Three cases of injury to the scalp in children caused by donkey bites are described, one of which involved the skull. Discussion The bite of a donkey is rare aetiology of scalp injuries. Special features of these injuries, including a literature review, are discussed focusing on the care of these patients in the emergency centre, describing the surgical procedures required and antibiotic choice. Recommendations for the management of donkey bite scalp injuries are provided.


      PubDate: 2014-10-06T19:42:38Z
       
  • Emphysematous pyelonephritis masquerading as hollow viscus perforation

    • Abstract: Publication date: Available online 29 September 2014
      Source:African Journal of Emergency Medicine
      Author(s): P. Adithya Malolan , B.S. Shivaswamy , G. Rajashekara Babu , C.S. Santhosh
      Introduction Emphysematous pyelonephritis (EPN) may be defined as a severe infection of the kidney that leads to necrosis and the presence of gas in the renal parenchyma, surrounding tissue, and the pelvi-calyceal system. EPN occurs almost exclusively in diabetics, but may occasionally complicate obstructive uropathy in non-diabetic patients. Case Report We present the case of a 45year old male with uncontrolled diabetes mellitus who presented with acute abdominal pain and free intraperitoneal air on abdominal radiograph, initially suggestive of hollow viscus perforation. He was found to have EPN that had ruptured into the peritoneal cavity. Conclusion Acute abdominal emergencies presenting with a pneumoperitoneum are not an uncommon occurrence in emergency centres throughout the world. However, rarely, patients present with the source of the pneumoperitoneum being an organ other than bowel. These patients need to be identified as soon as possible to prevent further morbidity and mortality arising from a delay in diagnosis.


      PubDate: 2014-10-01T19:26:58Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 29 September 2014
      Source:African Journal of Emergency Medicine
      Author(s): Ekremet Kwame , Osei-Ampofo Maxwell , Nkansah Reginald Sefah , Offei Owusu Kwasi , Antwi-Donkor Kwabena , Ekremet Asiedu Peggy



      PubDate: 2014-10-01T19:26:58Z
       
  • Emergency pericardiocentesis under dynamic ultrasound guidance in the
           resource limited setting

    • Abstract: Publication date: September 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 3
      Author(s): Will Loughborough
      Introduction Pericardial effusions are common causes of heart failure in populations of high HIV prevalence and, if left untreated, mortality rates approach 85%. 1 Cardiac tamponade is a life threatening complication of pericardial effusion and must be treated immediately with emergency pericardiocentesis. Often emergency care clinicians serving populations of high HIV prevalence have limited resources at their disposal. Case report This case report describes how cardiac tamponade can be diagnosed and treated effectively with limited resources: a portable ultrasound machine and a central venous catheterisation kit. Conclusion Initial ultrasound findings, equipment if resources are limited, types of ultrasound guidance and approaches to pericardium are discussed.


      PubDate: 2014-09-17T18:34:06Z
       
  • Acute management of ST-elevation myocardial infarction in a tertiary
           hospital in Kenya: Are we complying with practice guidelines' Phase
           active de prise en charge des infarctus du myocarde avec
           élévation du segment ST dans un hôpital tertiaire au Kenya.
           Les directives pratiques sont-elles respectées'

    • Abstract: Publication date: September 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 3
      Author(s): Benjamin W. Wachira , Andrew O. Owuor , Harun A. Otieno
      Introduction Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya. Methods This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013. Results Data were collected for 45 patient presentations. There were 37 male patients (82%). The mean age was 59.7±3.8 years. Of the 45 patients, 23 were Asian (51%), 18 were Black (40%) and four were Caucasian (9%). Thirty-five patients (78%) presented within 12h of symptom onset. Within 10min of arrival to the hospital, 40 patients (89%) had electrocardiographs performed and 39 patients (87%) were reviewed by a doctor. Medications given on presentation were aspirin (98%), clopidogrel (91%) and anticoagulants (73%). All patients received reperfusion therapy. Twenty-eight patients (62%) received fibrinolytic therapy and 17 patients (38%) had primary percutaneous coronary intervention. Door-to-needle time of <30min was achieved in 43% of the cases. Door-to- balloon time was <90min in 29% of the cases. All the patients survived to hospital discharge. The average length of stay was 5.3±1.0 days. In-hospital complications occurred in six patients (13.3%). These included bleeding (three patients), stroke (one patient) and cardiogenic shock requiring intra- aortic balloon pump support (two patients). Conclusion Whereas the majority of STEMI patients are evaluated within 10min of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve acute care systems to target early reperfusion of STEMI patients.


      PubDate: 2014-09-17T18:34:06Z
       
  • The sick LADy who cried wolf: A case of Wellens’ syndrome presenting
           in the shadow of chronic sickle cell pain

    • Abstract: Publication date: September 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 3
      Author(s): Tinashe Gede , Lilian Hodzi
      Introduction Chest pain is a common presenting complaint in the emergency centre (EC), with a very wide differential diagnosis. Evaluation of patients with chest pain in the EC is geared toward rapidly identifying and treating the subset of patients with potentially life-threatening causes, including acute coronary syndromes. ECG and cardiac biomarkers are indispensable tools in this endeavor. Case report A 47year old African woman presented to the EC with chest pain; her ECG revealed findings typical of Wellens’ syndrome. Subsequent coronary angiography revealed near-total proximal LAD occlusion. Discussion Wellens’ syndrome refers to a pre-infarction stage of acute coronary syndrome with distinct ECG T-wave changes that strongly predict the presence of critical LAD coronary artery stenosis; it is a harbinger of impending extensive anterior myocardial infarction. Emergency physicians must be able to recognize its ECG features and institute appropriate intervention.


      PubDate: 2014-09-17T18:34:06Z
       
  • Chronic obstructive pulmonary disease: Emergency care in acute
           exacerbation

    • Abstract: Publication date: Available online 20 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Tedd J. Welniak , Amy Panzenbeck , Alex Koyfman , Mark Foran
      Chronic obstructive pulmonary disease (COPD) is a preventable condition affecting more than 230 million people globally, and is expected to become the world’s third largest cause of mortality by 2030. Despite this fact, it is thought to be widely underdiagnosed and underreported across the African continent. This presents a challenge to emergency medicine (EM) providers in the region, who are faced with treating large numbers of patients presenting with exacerbation of previously undiagnosed COPD. This is complicated by other factors, including lack of public awareness, high prevalence of other chronic respiratory illnesses, and difficulties in access to healthcare. The purpose of this paper is to outline the current state of research and international guidelines surrounding the management of acute exacerbation of COPD in the emergency centre. Strict adherence to international guidelines for management of acute exacerbation of COPD may be difficult for many African providers given factors affecting diagnosis, treatment, and access to care for many Africans suffering from COPD. Research looking into the role of the African EM practitioner in providing more cost-effective means of diagnosis and treatment of COPD is limited.


      PubDate: 2014-09-02T17:54:38Z
       
  • Frequency of utilisation of ultrasound in the diagnosis of ectopic
           pregnancy in Sub-Saharan Africa countries: A systematic review

    • Abstract: Publication date: Available online 20 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Adrian H. Flores , Sherin Kassamali , Gloria Y. Won , John C. Stein , Teri Reynolds
      Introduction Ectopic pregnancy (EP) is a common diagnosis, frequently misdiagnosed early in its presentation and a leading cause of first trimester mortality. Ultrasound (US) is a key component of evidence-based diagnostic algorithms. We present a systematic review on the frequency of the use of US in the diagnosis of EP in Sub-Saharan Africa. Methods A librarian-assisted search of PUBMED, EMBASE, Cochrane, Web of Science, and POPLINE databases was performed. Inclusion criteria were original research studies that reported the proportion of patients receiving US as part of a workup for EP in a Sub-Saharan African country. s were reviewed and those potentially meeting criteria had a formal survey of the manuscript. Results The initial search revealed 784 original publications. Manual review of abstracts narrowed this to 91 papers with potential relevance, and 12 studies were included in the final analysis. A total of 6055 patients diagnosed with EP were included. 8.7% received a pregnancy test. 92.3% were ruptured at the time of presentation. 42.9% were in shock and 75.8% received red blood cell transfusion. 73.7% were unaware of the pregnancy and 24.9% were aware from a healthcare worker prior to presentation. 1.1% of patients died. Overall, 12.6% received US to aid in the diagnosis. Conclusion In this study, overall utilisation of US in the diagnosis of EP was found to be low. In this population, patients presented late and critically ill, obviating the need for US in many cases. However, studies in Sub-Saharan Africa in populations of patients with similar rates of late presentations have shown a substantial increase in the diagnosis of unruptured EP with the routine use of US.


      PubDate: 2014-09-02T17:54:38Z
       
  • ECG lead misplacement: A brief review of limb lead misplacement

    • Abstract: Publication date: Available online 23 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Richard Lynch
      Introduction The electrocardiogram (ECG) is essential for the diagnosis of some potentially life-threatening and time sensitive conditions, such as ST-elevation in myocardial infarction (MI). It is therefore imperative that healthcare professionals responsible for performing and interpreting ECGs are alert to the features of lead misplacement, as these can alter the ECG appearance dramatically, resulting in unnecessary investigations, admission to hospital, and treatment. ECG lead misplacement can result in significant harm to the patient if essential treatment is withheld or if the incorrect treatment is delivered solely on the basis of ECG findings. Case report An unusual and previously unreported case of misplacement of all 12 ECG leads is presented, which would have resulted in significant harm to the patient had it not been identified so early. Conclusion The ECG is one of the most important and most frequently requested investigations in the management of the acutely ill patient. A review of ECG lead misplacement is presented.


      PubDate: 2014-09-02T17:54:38Z
       
  • Setting the agenda in emergency medicine in the southern African region:
           Conference assumptions and recommendations, Emergency Medicine Conference
           2014: Gaborone, Botswana

    • Abstract: Publication date: Available online 13 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Lloyd D. Christopher , Navindhra Naidoo , Ben de Waal , Tiroyaone S. Mampane , Kelebogile Kgosibodiba , Koziba Chepete
      The first international emergency medicine (EM) conference in Botswana was held on 15th and 16th May 2014 at the Gaborone International Convention Centre. The support from key stakeholders positioned the conference, from its conception, to deliver expert guidance on emergency medicine relevance, education and systems implementation. The conference theme was aptly: “Setting the Agenda in Emergency Medicine in the Southern African Region.” Over 300 local, regional and international delegates convened to participate in this landmark event. Country representation included Botswana, South Africa, Zambia, Namibia, Zimbabwe, Swaziland, Lesotho, Nigeria and the United States of America. Conference assumptions intersected emergency care, African burden of injury and illness and the role of the state; the public protection ethic of emergency care, and the developmental, economic and health interest in promoting EM. The recommendations addressed emergency care relevance; health systems research as an imperative for emergency systems development in southern Africa; community agency as a requisite for emergency care resilience; emergency care workers as pivotal to the emergency medical system, and support of EM system implementation. The conference recommendations – by way of setting an agenda, augur well for emergency care development and implementation in the southern African region and are likely to prove useful to the southern African countries seeking to address health service quality, EM advocacy support and implementation guidance. Emergency medicine is the only discipline with ‘universality’ and ‘responsivity’ at the point of need. This implies the widespread potential for facilitation of access to health care: a public health goal nuanced by the African development agenda.


      PubDate: 2014-08-16T17:35:59Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 12 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): P.K. Forson , M. Osei-Ampofo , E.K. Acheampong , R. Oteng , P. Donkor , G. Oduro



      PubDate: 2014-08-12T17:33:25Z
       
  • UJUZI (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 12 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): M. Osei-Ampofo , P.K. Forson , K.O. Offei , D. Osei-Kwame



      PubDate: 2014-08-12T17:33:25Z
       
  • UJUZI (Practical Pearl/Perle Pratique)

    • Abstract: Publication date: Available online 12 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): P.K. Forson , M. Osei-Ampofo , Momade Eszter , J. Sylverken , R. Oteng , P. Donkor , G. Oduro



      PubDate: 2014-08-12T17:33:25Z
       
  • AFEM consensus conference 2013 summary: Emergency care in Africa –
           Where are we now'

    • Abstract: Publication date: Available online 4 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Teri A. Reynolds , Emilie J.B. Calvello , Morgan C. Broccoli , Hendry R. Sawe , N.K. Mould-Millman , Sisay Teklu , Lee A. Wallis
      Emergencies span all social and specialty boundaries, making an integrated and cross-cutting approach to the management of acutely ill and injured patients essential. Most low income countries lack emergency care systems, and thus suffer the highest rates of morbidity and mortality from acute disease. The second African Federation for Emergency Medicine Consensus Conference was held in November, 2013, in Cape Town, South Africa. Workgroups included: Out of Hospital Care, Emergency Care Integration into Current Health Systems, and Documenting the Regional Burden of Acute Disease. One hundred thirty-five leaders in acute and emergency care representing 32 different countries attended the meeting. Workgroups were tasked with the generation of candidate frameworks to facilitate advocacy, scientific development, and future interventions in these three key areas.


      PubDate: 2014-08-08T17:31:35Z
       
  • The frontline of emergency cardiac care in Africa

    • Abstract: Publication date: Available online 30 July 2014
      Source:African Journal of Emergency Medicine
      Author(s): Mark Bisanzom



      PubDate: 2014-08-04T17:30:21Z
       
  • “Be still my beating heart”: Ventricular standstill occurring
           in different age groups

    • Abstract: Publication date: Available online 1 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Richard M. Lynch , Louise Ballesty , Rawle Maicoo
      Introduction Ventricular standstill is an uncommon yet potentially fatal arrhythmia, which requires urgent recognition and treatment. As the name suggests, the ventricles come to a standstill with an almost immediate cessation of cardiac output. If this persists for more than a few seconds the patient will lose consciousness and no pulse will be palpable. Recommended treatment includes prompt initiation of cardiopulmonary resuscitation, and if return of circulation is achieved, pacemaker insertion is usually required. Case report Four case reports are presented which highlight the ECG features of ventricular standstill and that this arrhythmia can occur across a wide range of ages. Conclusion Ventricular standstill can occur at any age. It can be difficult to diagnose with many cases only evident on pre-hospital ECG recordings. It may present as recurring episodes of loss of consciousness yet the patient may be well in the intervening period. During episodes of ventricular standstill failure to palpate the pulse and/or over reliance on cardiac monitoring and automated ECG analysis programmes to determine the heart rate, may result in dramatic overestimation of the heart rate and may lead to delays in initiation of cardiopulmonary resuscitation and pacing if required.


      PubDate: 2014-08-04T17:30:21Z
       
  • Essentials for emergency care: Lessons from an inventory assessment of an
           emergency centre in Sub-Saharan Africa

    • Abstract: Publication date: Available online 1 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Kofi Marfo Osei , Baker Hamilton , Felicia Birch Freeman , Nii Nunoo , Susan B. Torrey , Sari Soghoian
      Introduction The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra, Ghana, to determine quality improvement needs. Methods A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006. Results Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control, advanced airway management, and ophthalmologic or gynaecological examinations. Several additional items, such as glucometers and pulse oximeters, were available and often used for patient care. Conclusion Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and ‘ready-to-hand’. Consequently, key factors in determining readiness to provide quality emergency care include supply-chain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.


      PubDate: 2014-08-04T17:30:21Z
       
  • Sepsis, severe sepsis, and septic shock: A review of the literature

    • Abstract: Publication date: Available online 1 August 2014
      Source:African Journal of Emergency Medicine
      Author(s): Keegan Tupchong , Alex Koyfman , Mark Foran
      Sepsis represents a continuum of illness due to systemic inflammation caused by an infection that requires prompt recognition and treatment. While sepsis is a significant cause of death worldwide, its mortality is believed to be disproportionately high in low- and middle-income countries (LMICs). Since 1992, its definition has become standardized, and beginning in 2002, an international collaboration has produced a set of consensus guidelines on the optimal management of septic patients. Based on new evidence, significant updates have been made since then. It is known that application of a bundled approach to patient care with the use of specific resuscitation endpoints to guide therapy leads to significant reductions in mortality from sepsis. However, it is also recognized that the implementation of such interventions in LMICs is extremely challenging. Consequently, a body of literature on practical guidelines for sepsis in developing countries has emerged. This article provides a review of the evidence for the best practice of sepsis management, with recommendations for resource-limited settings.


      PubDate: 2014-08-04T17:30:21Z
       
  • In this issue…

    • Abstract: Publication date: Available online 27 July 2014
      Source:African Journal of Emergency Medicine
      Author(s): Stevan R. Bruijns



      PubDate: 2014-07-29T17:28:48Z
       
  • An intraosseous blood transfusion in a critically ill child

    • Abstract: Publication date: June 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 2
      Author(s): E. Chansa , K. Hansen , B. Gustafsson
      Introduction An intraosseous infusion (IO) is a safe and simple method to administer fluid in an emergency situation and can be used to gain rapid vascular access in a critically ill child. Fluids and drugs can be infused as well as blood boluses, but very few cases describe the infusion of blood products. Case Report In this case study we report of a successful transfusion of fluid and blood by IO to a 31 months old child, who had suffered severe epistaxis for 12 hours. The child was unconscious at time of admission and the hemoglobin (Hb) level was measured to 3.6g/dl. Through an IO in the proximal tibia, 300ml of fluid was first infused, followed by 200ml of blood. Discussion We conclude that IO should be placed without delay when venous access is not rapidly obtained.


      PubDate: 2014-07-26T17:08:33Z
       
  • Resource tiered reviews – A provisional reporting checklist

    • Abstract: Publication date: Available online 21 July 2014
      Source:African Journal of Emergency Medicine
      Author(s): Daniël J. van Hoving , Jennifer Chipps , Gabrielle Jacquet



      PubDate: 2014-07-26T17:08:33Z
       
  • Uchunguzi (Journal Watch/Montre de journal)

    • Abstract: Publication date: Available online 21 July 2014
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira



      PubDate: 2014-07-26T17:08:33Z
       
  • Prehospital emergency care and injury prevention in Sudan

    • Abstract: Publication date: Available online 8 July 2014
      Source:African Journal of Emergency Medicine
      Author(s): Khalid Elbashir , Robert J. Gore , Tariq Abuaaraki , Patricia Roblin , Martin Botha , Mohammed Yousif , Grigory Ostrovskiys , Christina Bloem , Stephen A. James
      Introduction Emerging opportunities exist to improve prehospital emergency care and injury prevention in Sudan. This article aims to provide a description of the status of prehospital emergency care and injury prevention in Sudan, identify opportunities for improvement, create awareness, and initiate discussion around the development of EMS in Sudan. Sudan lags behind neighbouring Tanzania in terms of EMS development. Violent conflict and natural disaster place an enormous burden on the already fragile emergency care infrastructure. The need for an effective emergency prehospital care system in this setting is critical. Methods Qualitative descriptive data were collected in collaboration between Sudanese and United States based physicians from September 2008 to February 2014 from Sudan’s Ministry of Health paper registries, internet, interviews, and empirical observations. Results In the capital Khartoum, the government operates 67 ambulances, with a further 30 ambulances in Darfur, making a total of 97 state operated ambulances in the entirety of Sudan. Ambulance crews comprise two emergency care assistants without certification. Ambulance transport costs are covered mostly by out-of-pocket cash payment and via insurance for the privileged few. The existing 24h a day – 7days a week ambulance service in Khartoum is coordinated from a central dispatch centre reached by dialling “333”. Conclusion Due to an absence of published literature in Sudan, much of the data have been recorded from paper records and empirical observations. Prehospital care and injury prevention in the Sudan is a recent initiative, but it is developing into a promising model with many opportunities for improvement. This momentum should be nurtured and requires a purposive, collective collaboration to draw a blueprint for a locally relevant, effective and efficient prehospital system in Sudan. It is hoped that this article will highlight and encourage further progress.


      PubDate: 2014-07-26T17:08:33Z
       
  • Care for the Carers

    • Abstract: Publication date: Available online 11 June 2014
      Source:African Journal of Emergency Medicine
      Author(s): Lindy-Lee Folscher



      PubDate: 2014-07-26T17:08:33Z
       
  • The diagnosis of and emergent care for the patient with subarachnoid
           haemorrhage in resource-limited settings

    • Abstract: Publication date: Available online 11 June 2014
      Source:African Journal of Emergency Medicine
      Author(s): Katharine L. Modisett , Alex Koyfman , Michael S. Runyon
      Non-traumatic subarachnoid haemorrhage (SAH) is a neurosurgical emergency that may present similarly to a benign headache, yet poses high morbidity and mortality in what often times are young and otherwise healthy patients. While the diagnosis may be made via several different modalities, not all of these are available to every emergency physician. A high suspicion for SAH along with a good history and physical examination may best serve patients in these resource-limited settings. Adequate resuscitative and supportive care, combined with prompt transfer to a facility with neurosurgical capabilities is integral to optimizing patient outcomes.


      PubDate: 2014-07-26T17:08:33Z
       
  • Hypertonic saline (HTS) versus standard (isotonic) fluid therapy for
           traumatic brain injuries: a systematic review

    • Abstract: Publication date: Available online 9 June 2014
      Source:African Journal of Emergency Medicine
      Author(s): Andrit Lourens , Johanna Catharina Botha
      Traumatic Brain Injury (TBI) is one of the foremost causes of mortality secondary to trauma. Poorer outcomes are associated with secondary insults, after the initial brain injury occurred. The management goal of TBI is to prevent or minimise the effects of secondary brain injuries. The primary objective of this systematic review/meta-analysis was to assess the effects of Hypertonic Saline (HTS) compared to Standard Fluid Therapy (SFT) in the treatment and resuscitation of TBI patients. We searched CENTRAL, MEDLINE (from 1966), EBSCOhost, Scopus, ScienceDirect, Proquest Medical Library and EMBASE (from 1980) in May 2010 and updated searches in February 2011. Data were assessed and extracted by two independent authors. Risk ratios (RR) with a 95% confidence interval (CI) were used as the effect measure. The review included three RCTs (1184 participants) of which two were of high to moderate quality (1005 participants). HTS was not found to be associated with a reduction in mortality (3 RCTs, 1184 participants, RR 0.91, 95%CI 0.76 to 1.09) and morbidity in TBI patients. No significant improvement in haemodynamical stability was found whereas insufficient data were available to indicate a reduction in the intracranial pressure (ICP). In the HTS group, cerebral perfusion pressure (CPP) (MD 3.83mmHg, 95%CI 1.08 to 6.57) and serum sodium level (MD 8mEq/L, 95%CI 7.47 to 8.53) were higher. Existing studies show no indication that HTS, in comparison to SFT, reduces mortality or morbidity after the occurrence of TBI. Against this backdrop, some uncertainties still exist in terms of the use of different concentrations and volumes of HTS, the timing of administration as well as the benefit in specific injury profiles. As a result, formulating conclusive recommendations is complex.


      PubDate: 2014-07-26T17:08:33Z
       
  • Blood transfusion and oxygen extraction ratio in patients admitted to the
           general intensive care unit: A quasi experimental study

    • Abstract: Publication date: June 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 2
      Author(s): Vitalis Mung’ayi , Thikra Sharif , David Samuel Odaba
      Introduction Blood transfusion is commonly undertaken in critically ill patients; and studies have suggested the use of oxygen extraction ratio (O2ER) as an additional transfusion trigger in critically ill patients. The aim of this study was to establish the relationship between blood transfusion and oxygen extraction ratio in adult patients admitted to the general intensive care unit, using central venous oxygen saturation instead of mixed venous oxygen saturation. Methods Arterial and central venous blood samples were drawn and a blood gas analysis immediately before commencement of blood transfusion was undertaken. At least 15min after completion of the transfusion, similar samples were drawn and the blood gas analysis was repeated. The O2ER before and after transfusion was then calculated. Using paired student’s t-test, we checked whether the mean difference between the two O2ERs was statistically significant. Results We enrolled 58 patients in the study, the mean (±SD) haemoglobin concentration before transfusion was 7.38g/dl (±1.71). The mean change in haemoglobin concentration following blood transfusion was 2.29g/dl (±1.18), after transfusing an average of 1.95 (±0.83) units of packed cells. Mean O2ER was 0.27 (±0.11) before, and 0.25 (±0.12) after RBC transfusion. The mean change in O2ER was −0.018 SD±0.10 (95% CI, −0.043–0.007; P =0.15). Linear regression analysis showed no statistically significant relationship between change in haemoglobin concentration and change in O2ER; p-value=0.12. Discussion The change in oxygen extraction ratio was not statistically significant following blood transfusion in adult patients admitted to the general ICU at a tertiary teaching hospital. Further studies are required especially in patients with increased pre transfusion O2ER to evaluate the usefulness of this measurement as a possible transfusion trigger.


      PubDate: 2014-07-26T17:08:33Z
       
  • CT before lumbar puncture in suspected meningitis in Botswana: How
           established guidelines may not apply

    • Abstract: Publication date: June 2014
      Source:African Journal of Emergency Medicine, Volume 4, Issue 2
      Author(s): Andrew Kestler , Ngaire Caruso , Amit Chandra , David Goldfarb , Michelle Haas
      Introduction According to established guidelines from high-income countries, computed tomography of the head (CT) is indicated before lumbar puncture (LP) in the evaluation of suspected meningitis in HIV patients. In Botswana, meningitis in HIV-infected patients is common but CT is not widely available. Objective Develop a rational, evidence-based approach to CT use in the emergency evaluation of suspected meningitis in a population with high HIV prevalence. Methods Emergency center (EC) staff at Princess Marina Hospital in Gaborone, Botswana, reviewed indications for CT and LP in suspected meningitis. The authors considered existing evidence for CT before LP (mostly from high-income countries) and considered the epidemiology of central nervous system infections in Southern Africa. Draft guidelines were circulated to emergency center doctors and nurses, and to specialists in other hospital departments for review and comment before finalization. Result Available literature seems to indicate that in Botswana it would be possible to significantly limit the use of head CT before LP in HIV positive patients without increasing the incidence or risk of herniation. The guideline includes scenarios where an LP might be indicated in the presence of focal neurological findings and in the absence of a CT, in contradiction to established guidelines. Discussion The applicability of established guidelines for CT use in suspected meningitis is dependent on local epidemiology and resources.


      PubDate: 2014-07-26T17:08:33Z
       
  • UJUZI (Practical Pearl/Perle Pratique)

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



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

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



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

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


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

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


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

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


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

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



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

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



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

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


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

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


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

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


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

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


      PubDate: 2014-03-26T04:09:49Z
       
  • Ambulance or taxi' High acuity prehospital transports in the Ashanti
           region of Ghana

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


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

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


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

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


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

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


      PubDate: 2014-02-14T02:07:14Z
       
  • Issue highlights

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



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

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



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

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



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

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



      PubDate: 2014-01-30T12:17:14Z
       
  • Upper extremity injury management by non-physician emergency practitioners
           in rural Uganda: A pilot study

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


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

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


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

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


      PubDate: 2014-01-21T12:35:11Z
       
 
 
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