Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2006
Evaluation of the impact of a paediatric procedural sedation credentialing programme on quality of care.
The aim of the present study is to describe changes in documentation, risk assessment and patient care resulting from implementation of a credentialing process for medical and nursing staff in paediatric procedural sedation (PPS) in two EDs - one an urban mixed ED and the other a specialist paediatric ED. ⋯ The implementation of a PPS credentialing programme into these two EDs resulted in significant improvements in risk assessment, monitoring and documentation of important information related to safe PPS. These improvements should result in improved quality and safety of PPS.
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Emerg Med Australas · Oct 2006
ReviewState of play: clearing the thoracolumbar spine in blunt trauma victims.
The present article reviews the clinical and imaging clearance of the thoracic and lumbar spines of blunt trauma victims and the evolution of these strategies with the use of new imaging technologies. ⋯ Thoracolumbar spine screening is best done using reformatted images acquired when scanning the chest and abdomen of high-risk multi-trauma patients. If computed tomography is not clinically indicated for investigation of other injuries then plain films are the first line investigation.
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Emerg Med Australas · Oct 2006
ReviewMultislice computed tomographic pulmonary angiography for diagnosing pulmonary embolism in the emergency department: has the 'one-stop shop' arrived?
Current diagnostic pathways for pulmonary embolism are complex and involve multiple tests. Clinicians await a single diagnostic modality that accurately rules in or out pulmonary embolism and also provides additional diagnostic and prognostic information. Multislice computed tomographic pulmonary angiography (msCTPA) might be that test. msCTPA has good outcomes using current reference standards and can be used as a stand alone test in low risk patients. ⋯ Right ventricular measurements may be calculated from msCTPA data and provide prognostic information for patients with severe PE. This may replace the need for echocardiography in the future. msCTPA provides a safe single radiological investigation for diagnosing PE for most patients, after risk stratification and D-dimer testing. A pathway is provided for msCTPA use in the management of PE in the ED.
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Emerg Med Australas · Oct 2006
Development and implementation of an education and credentialing programme to provide safe paediatric procedural sedation in emergency departments.
In the conduct of paediatric procedural sedation (PPS) within the ED the combination of powerful drugs, variable competency levels and high staff turnover carry the potential for sedation-associated adverse events. Yet, currently, there is no set programme for education and accreditation of ED staff in PPS. We set out to develop such a programme. ⋯ We present the development and implementation of a comprehensive PPS programme for emergency staff. As a result of the multicentre development process involving a community and a tertiary paediatric ED the programme will likely have broad applicability in different types of ED caring for children.