Pediatric ENT Complaints: An Update

Weller, M.A. et al. (2017) Emergency Medicine. 49(1) pp. 8-17

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This review highlights the diagnosis and management of the three most common causes of pediatric otolaryngologic complaints seen in the ED.

Among all of the causes of ear, nose, and throat (ENT) complaints, acute otitis media (AOM), bacterial sinusitis, and streptococcal pharyngitis (SP) are the most common infections prompting pediatric presentation to the ED. Through a series of case scenarios, along with key questions to help guide the clinician’s work-up, this review covers the proper evaluation and management of pediatric ENT complaints.

Read the full review here

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Steep rise in A&E psychiatric patients

There has been a steep rise in the number of people arriving at A&E departments in England with mental health problems, figures show.

Experts say a lack of early support means patients are reaching crisis. Data compiled for the BBC by NHS Digital showed that between 2011-12 and 2015-16 the number of patients attending A&E units with psychiatric problems rose by nearly 50% to 165,000. For the under 18s alone the numbers almost doubled to nearly 22,000.

These figures represent a small minority of overall A&E attendances – just over 1% in total.

But the Royal College of Emergency Medicine said that was likely to be the “tip of the iceberg” as these figures just included cases where the primary diagnosis was a psychiatric condition.

Read more at BBC News

A & E performance: The view of NHS Providers

Following recent media coverage of NHS accident and emergency department performance, NHS Providers has published NHS Providers view on NHS A&E performance and linked media coverage

This briefing sets out facts about current A&E performance without underplaying the real pressures facing providers.

The briefing hihghlights the following:

  • Very few trusts are performing well, as measured by meeting the seeing 95% of A&E patients within the four-hour standard. We expect overall NHS performance for last week against the standard to be between 70 and 80%.
  • The vast majority of trusts are coping with the demand, in terms of avoiding persistently long trolley and 12-hour waits but some are struggling to do so.
  • There is a small number of trusts who are failing to cope with the demand and who have seen persistently large trolley and 12-hour waits. These tend to have lasted for short periods as corrective management action kicks in. Clearly, any incident of unavoidable harm is unacceptable and trusts are doing all they can to avoid them.

Read the full briefing here

Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons

Nagurney, J. M. et al. Annals of Emergency Medicine. Published online: January 6 2017

Study objective: Among older persons, disability and functional decline are associated with increased mortality, institutionalization, and costs. The aim of the study was to determine whether illnesses and injuries leading to an emergency department (ED) visit but not hospitalization are associated with functional decline among community-living older persons.

 

Conclusion: Although not as debilitating as an acute hospitalization, illnesses and injuries leading to an ED visit without hospitalization were associated with a clinically meaningful decline in functional status during the following 6 months, suggesting that the period after an ED visit represents a vulnerable time for community-living older persons.

Read the full abstract here

Validity of the Manchester Triage System in patients with sepsis presenting at the ED

Gräff, I. et al. Emergency Medicine Journal. Published Online: 19 December 2016

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Background: The Manchester Triage System (MTS) does not have a specific presentational flow chart for sepsis. The goal of this investigation was to determine adequacy of acuity assignment for patients with sepsis presenting at the ED and triaged using the MTS.

 

Conclusions: The MTS has some weaknesses regarding priority levels in emergency patients with septic illness. Overall, target key symptoms (discriminators) which aim at identifying systemic infection and ascertaining vital parameters are insufficiently considered.

Read the full abstract here

Palliative Care in the Emergency Department

Cooper, E. et al. (2016) Emergency Medicine Journal 33:919-920

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Objectives & Background: Emergency departments (EDs) receive a variety of patients: those with unexpected injuries or trauma, chronic disease exacerbation or progression and existing advanced disease or terminal illness. Thus expectations of attendees can vary greatly. However the primary focus of EDs is acute management.The provision of tailored palliative care (PC), that meets the unique needs of people with advanced disease, is often difficult in the ED. The main objective of this qualitative synthesis was to increase understanding of the ED experience of people with advanced disease, their relatives and healthcare professionals.

 

Conclusion: This synthesis has provided a greater breadth of insight to enable recurring themes regarding the potential conflicts between emergency care and PC to be identified with a view to overcoming the challenges faced. Significantly recognising the need for educating ED physicians in the scope and components of PC, improving interdisciplinary working and enabling better understanding of patients and carers about their likely disease progression and the opportunities open to them. Further research should focus on the best ways to provide such education, the specific reasons for shortfalls in communication and how these could be overcome.

Read the full abstract here

Educating Emergency Department Registered Nurses in Screening, Brief Intervention and Referral to Treatment

Mitchel, A.M. et al. International Emergency Nursing. Published online: December 17 2016

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Highlights

  • SBIRT has been shown to be effective in reducing risky alcohol consumption.
  • Patients trust nurses, underscoring nurses’ ability to have a positive impact.
  • EDRNs can increase their knowledge and attitudes to routinely screen patients for risky substance use.
  • SBIRT training and educational reinforcement is key for continued implementation.

Read the full abstract here