International journal of emergency medicine
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Burns occur disproportionately within low-socioeconomic populations. The Western Cape Province of South Africa represents a middle-income setting with a high rate of burns, few specialists and few burn centres, yet a well-developed pre-hospital system. This paper describes the burn cases from a viewpoint of operational factors important to pre-hospital emergency medical services. ⋯ Burns make up a small portion of the EMS caseload. More burns occurred in areas far from urban hospitals and burn centres. The majority of burn cases met the burn centre referral criteria.
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Mass Cardio-Pulmonary Resuscitation (CPR) training using less expensive and easily portable manikins is one way to increase the number of trained laypeople in a short time. The easy-to-carry, low-cost CPR training model called Push Heart (PH) is widely used in Japan. The aim of this study was to examine if PH can achieve chest compression quality that is similar to that using more conventional Little Anne (LA) manikins for training laypersons. ⋯ The PH can be an alternative mass CPR training model. Both models achieved satisfactory chest compression rates, but the majority of participants, especially the elderly, had difficulty achieving adequate depth.
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The safe and effective administration of fluids and medications during the management of medical emergencies in children depends on an appropriately determined dose, based on body weight. Weight can often not be measured in these circumstances and a convenient, quick and accurate method of weight estimation is required. Most methods in current use are not accurate enough, but the newer length-based, habitus-modified (two-dimensional) systems have shown significantly higher accuracy. ⋯ A benchmark for minimum accuracy is recommended for weight estimation studies and a PW10 > 70% with PW20 > 95% is suggested. The Mercy method, the PAWPER tape and parental estimates were the most accurate weight estimation systems followed by length-based and age-based systems. The use of age-based formulas should be abandoned because of their poor accuracy.
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Adequate pain control through sedation and anesthesia for emergency procedures is a crucial aspect of pediatric emergency care. Resources for administering such anesthesia are extremely limited in many low-income settings. ⋯ The ESM-Ketamine package, through the use of a simplified protocol and checklist, allows for safe analgesia and anesthesia in children by non-anesthetists in a resource-limited setting for selected emergent and urgent procedures. This package addresses a significant gap in the availability of anesthesia services in low-income settings that would otherwise result in significant delays to procedures or proceeding with painful procedures with inadequate analgesia.
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Emergency medicine is one of the youngest recognized specialties in Nepal, and its growth in clinical practice and academic development has been challenging. In this paper, we reviewed the current state of emergency medicine in Nepal based on review of the literature, personal observations and experience, and interviews with many Nepali and foreign emergency physicians. Most hospitals in Nepal have adopted a multi-specialist approach, where emergency room physicians are primarily general practitioners/family physicians or house officers. ⋯ As a result, the scope of practice for emergency physicians and the quality of care vary greatly among hospitals. Difficult working conditions, physician recruitment, compensation, and academic enrichment remain major challenges in the development of emergency medicine. For the sustainable development of this specialty, more international guidance and local leadership is needed to standardize the training curriculum, to provide adequate funding opportunities for academic development and to promote the overall development of the emergency care system.