Issue 4 (Vol. 26) of EMA Journal for 2014 was published online on 4th August.
Lifers – the loneliest doctors (#FOAMed) In the latest dispatch from the FOAM Frontier, Spiegel (@EMNerd_), Johnston (@Eleytherius), Ercleve (@Ercleve) and Nickson (@precordialthump) takes us on board the deep space transporter Odysseus where the deep space medics, jovially known as ‘Lifers’, deal with the perils of the induced mental and physiological stasis of passengers who make the centuries long voyages through deep space. The goal of appropriate sedation and ‘quenching the fires of the sleeping mind’ are not too dissimilar to management of pain, agitation and delirium in the sedated critically ill patient of the 21st century – “perhaps there really is nothing new under the suns…”
ED data sharing to reduce alcohol-related violence (Abstract) Alcohol-related patient presentations place substantial and preventable burdens on EDs. Further ED datasets substantially improve detection of injury-related assault and violence over police recorded data. This systematic review, from Droste et al, demonstrates that triangulated ED, police and ambulance data sources can be effectively used to assess the feasibility and effectiveness of community-level interventions directed to reduce alcohol-related or nightlife assaults, injury or violence. Data sharing protocols could be easily implemented, at low-cost, within modern ED triage systems
Dental and maxillofacial emergencies in the ED (#FOAMed) Presentations with oral pain and dental infections are common in EDs, even though they are not ideal settings for dental care. Furthermore, odontogenic infections, due to their proximity to airways, can be life threatening and require urgent intervention. This review, by Deangelis and colleagues, discusses the emergency assessment, triage and management principles for oral pain and odontogenic infections presentations in the ED. Assessment and treatment algorithms, along with advice on differential diagnosis and referral for specialist maxillofacial management, the use of anaesthetic blocks in pain control and the role of antibiotics are provided
Busted! Improvements needed for paediatric fracture management (#FOAMed) Upper limb fractures are common and painful paediatric presentations to ED. Appropriate analgesia and splinting have been demonstrated to reduce pain and discomfort in children with upper limb fractures and are ideally initiated before radiography. This retrospective cohort study, by Mills et al across three EDs, of 1407 paediatric patients who received upper limb x-ray, found that fractures were infrequently splinted and that moderate and severe pain was undermanaged in these children. These results highlight the need for clinician education to promote increased use of splints and timely and appropriate analgesia prior to x-ray, for children with deformed upper limb fractures
The ongoing role of mid-level providers in emergency care (Abstract) Increasing demand for ED services and insufficient numbers of emergency physicians has led to the use of mid-level providers, such as nurse practitioners (NPs) and physician assistants (PAs), as adjuncts in the provision of emergency care, particularly in the US and Canada, and more recently in Australia through trialling of Expanded Scope of Practice nursing, physiotherapy and paramedic roles (http://esoptoolkit.hwa.gov.au/). In this perspective, Tintinalli argues that these mid-level providers are important contributors to emergency care in our communities, but there a need for specific and focused training for these providers to acquire skills in safe and quality emergency medical care. As such, emergency medicine needs to develop a vision and plan to train PAs and NPs in EDs to ensure their scopes of practice and educational needs enable optimal integration with emergency physicians