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Paediatric advanced life support

Essentials 1 In the absence of signs of life, pulse check should be limited to 10 seconds and cardiopulmonary resuscitation (CPR) commenced immediately if no detectable pulse or heart rate <60 beats per minute (bpm). It has been established that diagnosis of cardiac arrest using palpation alone results in delays to initiation of resuscitation even amongst healthcare personnel. 2 The major causes of cardiopulmonary arrest in…

Paediatric basic life support

Essentials 1 Paediatric life support differs from adult life support in several aspects, but the basic principles remain the same: Ensure both the patient and rescuer are safe Call for help Initiate basic life support (BLS) measures at the earliest possible moment 2 DRSABC is a mnemonic used to remind the rescuer of the appropriate sequence of events that should be followed when encountering any collapsed…

Paediatric cardiopulmonary arrest

Essentials 1 Cardiopulmonary arrest (CPA) can occur either as in-hospital cardiac arrest (IHCA) or as an out-of-hospital cardiac arrest (OHCA), but prevention of both is the key to decreasing paediatric deaths. 2 CPA in children usually results from the development of progressive hypoxia and/or shock, which may be due to a myriad of causes. 3 Paediatric patients who sustain OHCA have survival to hospital discharge rates…

Common chronic paediatric conditions

Essentials 1 Children with chronic medical conditions make up 10–20% of paediatric emergency department (ED) presentations. 2 These patients have a longer ED stay and have increased rates of hospital and intensive care unit admission. 3 Liaise with the medical teams who know these patients well. 4 Trust the parents/caregivers: if they are worried, you should be worried. 5 Minimise pain and anxiety associated with procedures.…

Approach to the paediatric patient

Essentials 1 Gaining rapport with the child and the confidence of the parents is the key to assessing children. Never underestimate the power of distraction and entertainment. 2 A child needs to be approached according to chronological and developmental age. 3 Observation is a vital diagnostic tool, which is vastly more important in children than in adult patients. 4 The need for investigations is a balance…

Wellness, resilience and performance in emergency medicine

Essentials 1 Wellness is integral to performance and the ability to provide high-quality patient care. 2 Emergency physicians are at high risk of poor physical and mental health, including compassion fatigue and burnout. 3 Work-related distress is common. There is a need to move towards open discussion and encouragement of physicians to seek help when necessary. 4 Wellness interventions should include both individual and organizational strategies.…

Patient safety

Essentials 1 Approximately 1 in 10 hospital patients experiences an adverse event, of which half may be attributed to clinical error and one-third results in significant harm or death. 2 Emergency medicine faces particular challenges to safe patient care due to the undifferentiated and potentially unstable patient case mix, high staff turnover, staff inexperience and fatigue and distractions, noise and overcrowding in the clinical care environment.…

Complaints

Essentials 1 Complaints occur in every emergency department. They can be considered useful feedback. 2 Good complaints management involves being open to complaints and seeing them as an opportunity for improvement. 3 The majority of complaints are at least partly justified when properly investigated. 4 An acknowledgement, apology, commitment to investigate and truthful response are expected. 5 Resolution is by conveying the facts, any corrective actions…

Specialist training and recognition in emergency medicine in the United Kingdom

Essentials 1 Postgraduate medical training in the United Kingdom has become increasingly regulated and controlled by the General Medical Council (GMC). 2 Changes to immigration rules have occurred in response to insufficient training opportunities for UK and European graduates. This is one of the contributory factors in the deficit in the number of doctors in training in emergency medicine (EM). Nevertheless it is relatively easy for…

Accreditation, specialist training and recognition in Australia

Essentials 1 Specialist training in emergency medicine (EM) in Australia and New Zealand is the responsibility of the Australasian College for Emergency Medicine (ACEM). 2 Specialist international medical graduates require recognition from either the Australian Medical Council or the Medical Council of New Zealand. 3 Specialist training in EM under the ACEM is a 5-year program. Trainees must complete certain training requirements, including workplace-based assessment, the…

Business planning

Essentials 1 Organizational business planning describes the strategies an organization will take to achieve the goals of the strategic plan. 2 The emergency department (ED) business plan is an important multipurpose document and informs the organization about the agreed performance dimensions of revenue and expenditure, activity, efficiency and quality of services proposed for the next financial year. 3 Once the business plan is approved by the…

Quality assurance and quality improvement

Essentials 1 Quality improvement offers the tools to translate knowledge into improved patient care. 2 The six key aims for improvement are safety, effectiveness, patient-centeredness, timeliness, efficiency and equitable care. 3 The commonly used quality cycle known as ‘plan, do, study, act’ involves planning a test, carrying out a change, observing the consequences and putting in place modifications. 4 Standards provide a consistent and uniform set…

Emergency department layout

Essentials 1 The layout of the emergency department should functionally promote efficacy of care, safety and efficient patient flow by maximizing access to every space with the minimum of cross-traffic. 2 The triage location should enable staff directly to observe and gain access to both the ambulance entry and the patient waiting areas. 3 The acute treatment area should be open, with all spaces directly observable…

Emergency department staffing

Essentials 1 An emergency department staff structure that is appropriate in numbers and skill mix is required to provide high-quality and timely clinical care, while maintaining sustainable working conditions for staff. 2 Senior medical and nursing staff have clinical roles that include direct patient care, as well as supervision and teaching of junior staff, coordination of patient flow and liaison with other clinicians. 3 The senior…

Public health and emergency medicine

Essentials 1 Public health is a key component of a sustainable health system. 2 Emergency medicine has a mandate to advocate for public health initiatives. 3 Acute health care has limited opportunity to affect health care outcomes compared to public health. 4 Screening, brief intervention and referral for treatment are the cornerstone of emergency department (ED) prevention. 5 Disease and injury surveillance is an important function…

Rapid response systems and the emergency department

Essentials 1 Serious adverse events (SAEs), including cardiac arrest were previously common in hospitalized ward patients. 2 SAEs were often preceded by signs of physiological derangement for up to 24 hours prior to the event. 3 Rapid response systems (RRSs) are designed to enable early recognition of, and response to, clinical deterioration. 4 Three systematic reviews show that RRSs reduce in-hospital cardiac arrests, and one demonstrates…

Overcrowding

Essentials 1 Overcrowding is the situation where emergency department (ED) function is impeded primarily by the excessive number of patients needing or receiving care. 2 Access block is excessive delay in accessing appropriate inpatient beds and, in Australasia, is defined as the proportion of patients with longer than 8 hours total ED time. 3 Access block is the principal cause of overcrowding but overall demand is…

Emergency department short stay units

Essentials 1 Emergency department short stay units play a key role in modern emergency departments. 2 Staffing is ideally by emergency department staff with defined admission criteria and a plan for disposition within 24 hours. 3 They offer time-limited intensive treatment with clear treatment and follow-up guidelines. 4 They have an increasing role in improving patient flow while maintaining quality of care and safety in the…

Emergency care in a humanitarian crisis

Essentials 1 The worldwide problem of refugees, internally displaced and stateless persons is significant and likely to increase. 2 Overall responsibility for internally displaced persons (IDPs) lies with the governments of the country in which they reside. The international community, including many of the United Nations (UN) agencies, can assist through collaboration and diplomacy ( ). Refugees, on the other hand, have crossed an international…

Triage

Essentials 1 Triage is the ongoing process of sorting patients on the basis of the urgency of their need for medical care. 2 Urgency is distinct from both severity and complexity. 3 Triage categorization has been found to relate strongly to both resource use and patient outcome in the near term. 4 The five-level Australasian Triage Scale (ATS) forms the basis of emergency department triage in…