Evaluation of the use of intraosseous access on adult patients presenting to the emergency department in urban South Africa.

Background: Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access.

Total body weight estimation by 3D camera systems: Potential high-tech solutions for emergency medicine applications? A scoping review.

Background: Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often not possible. Inaccurate estimations may lead to inaccurate drug dosing, which may cause patient harm. High-tech 3D camera systems driven by artificial intelligence might be the solution to this problem.

Alcohol use is associated with intracranial hemorrhage in older emergency department head trauma patients.

Objectives: Falls are common in adults aged 65 years and older and are the leading cause of traumatic brain injuries in this age group. Alcohol use may increase the risk of falls as well as the severity of resultant injuries. The aim of this study was to examine the association between self-reported alcohol use and the prevalence of intracranial hemorrhage (ICH) in this patient group.

The Florida Geriatric Head Trauma CT Clinical Decision Rule.

Background: Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65 years or older. We aimed to derive and validate a head injury clinical decision rule for older adults.

Methods: We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients >65 years old with blunt head trauma.

Educational concepts: A longitudinal interleaved curriculum for emergency medicine residency training.

Traditionally, emergency medicine (EM) residency programs teach non-adult emergency department activities (such as pediatric EM, point-of-care ultrasound [PoCUS], emergency medical services, and others) in a block format. In this way, a resident may have a 1-month pediatric EM rotation and then not have any further pediatric EM exposure until their next pediatric rotation 6‒9 months later. Furthermore, some rotations are only allotted for 1-month during the entire residency.

'It's a difficult situation to be an asylum seeker in the UK. It's not easy at all': An exploration of the social and psychological impact of seeking asylum in Wales.

Wales has been committed to receiving asylum seekers and resettling refugees in towns and cities, and these numbers are increasing on a yearly basis. However, many people seeking asylum feel disempowered by the disabling policies of the Home Office, leading to social and economic hardship for this population. This qualitative study aimed to capture the voices of this under-served group through in-depth, semi structured interviews to gain contextual understanding of the social and psychological challenges experienced by people seeking asylum in Wales.

The accuracy of total body weight estimation in adults - A systematic review and meta-analysis.

Background: Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often impossible. Inaccurate estimations may lead to inaccurate drug doses, which may cause patient harm. Little is known about the relative accuracy of different methods of weight estimation that could be used during resuscitative care.

Is there evidence that length-based tapes with precalculated drug doses increase the accuracy of drug dose calculations in children? A systematic review.

Objective: The use of pediatric length-based weight estimation tapes with precalculated drug doses is advocated by major Advanced Life Support organizations, but concerns have been raised on the accuracy of these systems. The objective of this systematic review was to collect, review, evaluate, and create a synthesis of the current literature to establish whether there is high-quality evidence for use of length-based tapes in accurate drug dose administration. A further objective was to compare these tapes with other dosing aids.

Weight Estimation for Drug Dose Calculations in the Prehospital Setting - A Systematic Review.

Background: Weight estimation is required to enable dose calculations for weight-based drugs administered during emergency care. The accuracy of the estimation will determine the accuracy of the administered dose. This is an important matter of patient safety.

Estimating Lean Body Weight in Adults With the PAWPER XL-MAC Tape Using Actual Measured Weight as an Input Variable.

Introduction Accurate drug dose calculation in obese patients requires an estimation of lean body weight (LBW) for dosing hydrophilic medications. Inaccurate weight estimates during the management of critically ill obese adults may contribute to inaccurate drug doses and consequential poor outcomes. Existing methods of LBW estimation or measurement may be very difficult or impossible to use during emergency care.

Development and Validation of a Length- and Habitus-Based Method of Ideal and Lean Body Weight Estimation for Adults Requiring Urgent Weight-Based Medical Intervention.

Background And Objective: Accurate drug dosing in obese patients requires an estimation of ideal body weight (IBW) or lean body weight (LBW) for dosing hydrophilic medications. Erroneous weight estimates during the management of adults requiring weight-based treatment may contribute to poor outcomes. Existing methods of IBW and LBW estimation or measurement are very difficult to use during emergency care.

Development and validation of a length- and habitus-based method of total body weight estimation in adults.

Background: Erroneous weight estimation during the management of emergency presentations in adults may contribute to patient harm and poor outcomes. Patients can often not be weighed during emergencies and a weight estimation is required to facilitate weight-based therapies. Many existing methods of weight estimation are either unacceptably inaccurate or very difficult to use during the provision of emergency care.

Comparison of adult weight estimation methods for use during emergency medical care.

Objective: Many emergency drug and fluid doses are weight dependent in adults, but in resuscitation and low-resource settings it can be impractical or impossible to weigh a patient. It is especially important to obtain accurate weight estimation for dose calculations for emergency drugs with narrow therapeutic ranges. Several weight estimation methods have been proposed for use in adults, but none is widely established.

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa.

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers.

Human Factor Errors in the use of the PAWPER Tape Systems: An Analysis of Inter-Rater Reliability.

Background International guidelines have promoted the use of length-based tapes for emergency weight estimation in children. This is primarily because of a perception that more modern methods might require more training than can practically be achieved. This study aimed to evaluate the inter-rater reliability of novice users of the PAWPER XL (paediatric advanced weight-prediction in the emergency room) tape as an indicator of the ability to use the device effectively with limited training.

Pediatric weight estimation: validation of the PAWPER XL tape and the PAWPER XL tape mid-arm circumference method in a South African hospital.

Objective: The primary aim of this study was to prospectively compare the performance of the Broselow tape, Mercy method, pediatric advanced weight prediction in the emergency room extra-long (PAWPER XL) tape, and PAWPER XL mid-arm circumference (MAC) method in estimating the weight of children from a low-income setting. The secondary aim was to analyze the time taken to perform each method.

Methods: This analyzed a convenience study sample of 300 children aged 0 to 18 years at the Baragwanath Hospital in South Africa.

Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus.

Erratum to "Paediatric weight estimation practices of advanced life support providers in Johannesburg, South Africa" [Afr Am J Emerg Med 8 (2018) 51-54].

[This corrects the article DOI: 10.1016/j.afjem.

The utility of pediatric age-based weight estimation formulas for emergency drug dose calculations in obese children.

Objectives: In obese children, when drug therapy is required during emergency care, an estimation of ideal body weight is required for certain drug dose calculations. Some experts have previously speculated that age-based weight estimation formulas could be used to predict ideal body weight. The objectives of this study were to evaluate how accurately age-based formulas could predict ideal body weight and total body weight in obese children.

Drug dosing errors in simulated paediatric emergencies - Comprehensive dosing guides outperform length-based tapes with precalculated drug doses.

Background: The accuracy of drug dosing calculations during medical emergencies in children has not been evaluated extensively. The objectives of this study were to evaluate the accuracy of drug dose calculations using the Broselow tape, the PAWPER XL tape plus its companion drug-dosing guide, a custom-designed mobile phone app and no drug-dosing aid (control group).

Methods: This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models.