In this December issue

Abstract

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. In Australia, information on primary retrieval taskings are kept by multiple service providers. A literature review found some preliminary but piecemeal insight into such retrievals. Several areas for research action and service outcome improvements can be developed with a national pre-hospital and retrieval registry. The creation of such a registry will allow analysis of the frequency and context of retrievals, comparison across services and more sophisticated data interrogation. A retrospective and hospital-based case–control study of clinical factors in all thunderstorm asthma patients who presented to one ED in November 2016 concludes that oral beta-blockers, a younger age and Asian-born heritage are risk factors for thunderstorm asthma. Evidence-based care for patients with acute traumatic spinal cord injury (TSCI) in the ED has a critical impact on long-term outcomes. Acute hypotension post-injury compromises spinal cord perfusion and extends neurological damage. Published guidelines recommend mean arterial BP maintenance between 85–90 mmHg for 7 days post-injury; the extent to which this is followed in Australia is unknown. A prospective observational study of adults with TSCI, treated at 48 hospitals across two Australian states that care given was inconsistent for hypotensive patients. Specialist care and more severe injury increased guideline compliance. Level 1 evidence is needed plus consistent guideline implementation and clinician training to improve TSCI management and outcomes. We publish a study that tries to identify out of hospital cardiac arrest (OOHCA) patients who might benefit from a future pre-hospital ECPR programme in a moderately sized city. Using data from 2014, the authors conclude that 63 patients in their study group could have derived benefit from a pre-hospital ECPR programme. Further analyses of pre-hospital ECPR logistics and economics are needed. Focussed echocardiography is a useful tool in cardiopulmonary resuscitation; it helps for prognosis, to identify reversible causes of cardiac arrest and to guide management and procedures. Many clinicians have reservations regarding its widespread adoption as it leads to prolonged interruption of cardiac compressions. Also the lack of a clear protocol for use of focussed echocardiography into the rhythm check causes confusion amongst teams not familiar with using it, as well as safety concerns for the sonographer during delivery of a shock. COACHRED is a guide for focussed echocardiography during rhythm check in a safe and timely manner. In a simulation environment it is possible to incorporate focussed echocardiography into the rhythm check while keeping the interruption to chest compressions within the timeframe prescribed by international. Are parental estimates of a child's weight reliable? We publish a study which concludes that the answer is yes, subject to one important caveat; children of Polynesian/Pacific ethnicity were less likely to have an accurate parental weight estimation. We publish a retrospective review of non-traumatic brain injury patients that presented to the EDs in two urban hospitals and received computed tomography of the brain (CTB) from January 2014–December 2016. Data from one hospital was used to develop a clinical decision rule for clinically significant CTB findings. Clinically significant CTB findings were defined as acute infarction, intracranial neoplasm, intracranial haemorrhage, acute hydrocephalus, cerebral oedema and intracranial infection. Patients from another hospital were used as a validation cohort to evaluate the clinical decision rule (CDR) and compare them to four previously derived CDRs. The CDR developed in the present study achieved the highest and a moderate specificity when compared with four other pre-existing CDRs for non-traumatic brain injury patients. The August issue of this journal published a review of a coronial inquest into the death of a woman from a tiger snake bite. During the inquest, there was considerable debate and conflict of opinions between three experts. We publish a letter from one of the experts involved. We publish some correspondence on assessment scoring in the ED.