Here are the highlights from this month’s issue…
Ophthalmoscopy in the Emergency Department
Ophthalmoscopy is a difficult but essential skill in the Emergency Department environment. In this short report, the panOptic ophthalmoscope was compared to traditional direct ophthalmoscopy in conditions comparable to those found in most EDs. While the newer instrument was preferred, the actual clinical utility of doctors using both was worryingly poor. See the performance of trainee emergency physicians for yourselves.
Perfect World or Dark World
Emergency Department crowding is a problem just about everywhere. In this paper, a discrete event simulation created models of the Emergency Unit to explore the effect of various changes to physical capacity and human resources. The relationship (in the model) between the physical resource requirements and the number of clinical decision makers is particularly noteworthy.
Emergency Departments abound with clinical risk: high numbers of new, undifferentiated and unwell patients, multi-professional and multi-specialty staff in unfamiliar teams, time constraints and a high turnover to name but a few. Anything designed to reduce avoidable risk is to be welcomed. Our colleagues from Imperial College, London describe the development and implementation of a tool for ED shift handover that clearly works for them. The papers are worthy of close study.
Buscopan and/or Paracetamol in moderate abdominal pain
We all have hobby horses (or fixations!) and I have to admit that one of mine is a profound desire not to give patients with abdominal pain a dry mouth, blurred vision and a raised chance of urinary retention in addition to their presenting problems. I was delighted, therefore, to see the paper that randomised patients with acute abdominal pain into groups that received either oral paracetamol or intravenous hyoscine butylbromide alone or a combination of the two. To see what they found and to find out whether my fixation was justified or whether I need to eat my hat you’ll have to read the paper!
To CRP or not to CRP, that is the question
Santos and colleagues from Sao Paulo report on a problem that faces us all—the uncontrolled rise of the easily requested, expensive yet ultimately clinically unhelpful test, juts like this well known, non-specific marker of inflammation. Their initial assessment of the problem involved an audit of current practise together with a review of the evidence of clinical utility. The most interesting story they have to tell is, however, in terms of the intervention they designed to combat the problem. It is well worth getting this paper out and studying it, as the lessons are generalisable to many situations and settings.
They think it’s all over
It wasn’t just the athletes and the gamesmaker volunteers who had to prepare for the London 2012 Olympics—there was a considerable, hidden public health agenda too. Part of this was the development of an Emergency Department syndromic surveillance system to help monitor the nation’s health. As Elliot and collaborators report in their paper describing the early part of this work, such a system is both feasible and useful.
In a short report Reed and others from Edinburgh, Scotland report on a possible role for troponin assay in patients with syncope. Well worth a read.