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Medical issues in disasters

Essentials 1 The incidence of globally reported disasters from natural and technological hazards increased exponentially from 1960 to 2000 and has fallen slightly in the period 2006 to 2015 after a peak in 2005. 2 Deaths due to natural hazards has steadily declined over the past five decades—largely due to improvements in multisectoral emergency risk management—but numbers of affected populations continue to rise, encompassing 25% of…

Retrieval

Essentials 1 Mature retrieval systems act as a single point of entry for the referrer, preferably providing services by initiation of a single call to a systemwide phone number. 2 Retrieved patients are often unstable, at the margin of physiological compensation, and in need of specialized investigation and intervention. They are often at that phase of an emergency presentation where diagnosis is incomplete, treatment is problem-focused…

Pre-hospital emergency medicine

Essentials 1 Ambulance call taking and dispatch is increasingly becoming computerized, which allows for the medical determination of the most appropriate response speed and skill set as well as telephone instructions for cardiopulmonary resuscitation and first aid. 2 Ambulance care of the critically ill or injured patient is similar to initial evaluation and management by an emergency physician, with emphasis on basic life-support measures. 3 The…

Ethics in emergency medicine

Essentials 1 Ethics is about doing the right thing for the patient. 2 The morality of the doctor and the morality of the patient will influence decision making. 3 The two most common ethical dilemmas in emergency medicine concern treating patients who do not consent and stopping resuscitation. 4 When these dilemmas are being addressed, the application of pragmatic tools assists ethical decision making. 5 The…

Privacy and confidentiality

Essentials 1 Privacy and confidentiality issues can be related to the physical environment in which care is given or to the personal health information involved in the patient’s care. 2 Breaching confidentiality of personal health information now breaks Australian and New Zealand legislation. Introduction An individual’s right to privacy and confidentiality has gained increasing recognition over the past decade. In an emergency setting, where patients are…

Consent and competence—the Australian, NZ and UK perspectives

Essentials 1 Informed consent is an essential process for medical treatment that has ethical, legal and administrative elements. Complexities of the practical situation may result in deviation from the theoretical ideal. 2 Consent may be implied, verbal or written, and should always be clearly documented. 3 Consent must be informed, specific and freely given, and must cover that which is actually done. 4 The patient must…

The coroner: the Australian, NZ and UK perspectives

Essentials 1 The Coroners Court is a specialist court established to investigate certain types of deaths and fires. The purpose of these investigations is to consider ways that similar events may be prevented in the future. 2 Preparation for a coronial investigation should start as soon as someone dies in reportable circumstances. 3 A coronial inquest is generally a public inquiry into a death to which…

Mental health and the law: the Australian, NZ and UK perspectives

Essentials 1 The emergency department is frequently the point of access to the mental health system. 2 Emergency physicians need to be able to distinguish between patients with physical and those with psychiatric illness. 3 Patients should only be committed involuntarily to an approved hospital if they have a mental illness requiring immediate treatment for their own health or safety or the protection of others and…

Postgraduate emergency medicine teaching and simulation

Essentials 1 Emergency medicine training programs need explicit curricular objectives, effective learning and teaching strategies, and valid and reliable assessment methods. 2 Technology, social media and online collaboration are affecting the way emergency medicine trainees and their supervisors learn and access information, and demand new skills in information retrieval and critique. 3 Simulation offers learning opportunities in clinical and procedural skills, teamwork and communication, and requires…

Teaching medical students emergency medicine

Essentials 1 Emergency medicine as an academic discipline has achieved maturity, with medical student teaching a core business of every emergency department in the country, with structured terms in emergency medicine now considered an essential part of any medical curriculum. 2 The specialty of emergency medicine has a unique and practical body of knowledge that can contribute much to the entire medical curriculum and it is…

Principles of medical education

Essentials 1 The emergency department (ED) provides a rich learning environment despite the constraints of service provision and time pressure. 2 Understanding individual learners by exploring their prior experience and learning goals, then tailoring teaching to address these goals will maximize learning in the ED. 3 Setting clear learning objectives at the beginning and summarizing the learning experience at its conclusion enhances any form of teaching.…

Writing for publication

Essentials 1 Check and follow the journal’s suggested format and length. Pay particular attention to the abstract, text and references. 2 Make sure that the objectives, methods, results and conclusions are logically consistent. 3 Be clear and concise. Introduction Sharing of research findings through publication is an important way of improving clinical practice. Publication may be by an original research manuscript, systematic or narrative review, brief…

Research methodology

Essentials 1. Research projects should be designed and undertaken in a structured, predetermined fashion. 2. During the study design phase, assistance from a statistician is highly recommended. 3. The study protocol should be written in advance of data collection and adhered to throughout the project. 4. Most research mistakes relate to inadequate sample size calculations and selection bias in subject recruitment. 5. Research ethics issues are…

Marine injury, envenomation and poisoning

Essentials 1 The majority of marine-related presentations can be effectively managed with attention to basic life support (BLS) and the provision of supportive therapy. This includes aggressive analgesia and meticulous wound management. 2 Pain associated with barbed fish stings can sometimes be attenuated by immersion of the effected limb in warm water (up to 45°C). 3 Tropical jellyfish envenoming may be life threatening and require early…

Spider bite

Essentials 1 Australasia has a number of venomous spiders, but the majority of bites cause only minor problems. 2 Redback spider (a widow spider) bite is the most common cause of medically significant human envenoming in Australia. It can cause severe and persistent pain and, less often, systemic effects, but it is not life-threatening. 3 Australia appears to have the highest rate of widow spider envenoming…

Exotic snakebite

Essentials 1 Exotic snakebite is a growing issue worldwide, especially with the growth in illegally held snakes. 2 Symptoms and signs may be different to those seen in Australian snakebites. 3 As many non-Australian snakes, especially the vipers, cause local tissue destruction and damage, pressure bandage immobilization is not recommended. 4 Expert advice is available and recommended in managing these cases and helping locate antivenom. 5…

Snakebite

Essentials 1 Australia has a number of medically important venomous snakes. All are elapids (front-fanged). New Zealand has no snakes of medical importance. 2 All patients giving a history of possible snakebite should be assessed and observed for at least 12 hours to rule out envenoming. 3 Most fatalities occur within hours of the bite from initial cardiac arrest and multiorgan failure. Delayed deaths are now…

Oral anticoagulants

Essentials 1 In overdose, any of the oral anticoagulants will elevate the international normalized ratio (INR), although not always in a direct dose-dependent manner. 2 Activated charcoal decreases the absorption following the ingestion of apixaban and is probably also effective following the ingestion of warfarin, dabigatran and rivaroxaban. 3 There are clear guidelines for the management of warfarin anticoagulation and these should continue to be followed.…

Opioids

Essentials 1 Opioid toxicity is characterized by respiratory depression, decreased level of consciousness and miosis. 2 The mainstay of treatment of opioid toxicity is naloxone and good supportive care. 3 Many opioid agents can have other toxic effects; for example, tramadol may cause seizures, methadone causes QT prolongation and dextropropoxyphene causes QRS widening. 4 Opioid exposure in children can result in significant morbidity and mortality. Introduction…

Chloroquine

Essentials 1 In overdose, chloroquine is a highly toxic drug with a high mortality rate. 2 Cardiac toxicity occurs early and may manifest before arrival at hospital. 3 Good supportive care and the use of adrenaline are the principles of management. 4 Expert advice on management from a toxicologist should be sought at an early stage. 5 All deliberate self-poisonings require hospital admission and cardiac monitoring…