Asha and colleagues from the University of New South Wales report on a large cohort study comparing radiation exposure to trauma patients before and after the introduction of a CT pan-scan diagnostic algorithm, finding that pan-scan increased the proportion of trauma patients receiving a radiation dose >20mSv. This increased risk occurred regardless of age or injury severity.
- Cowan et al, in their research letter, also argue that in major trauma the clinical impact of any abnormal findings should be considered in order to address the true risk–benefit balance of CT pan-scan.
- Stengel’s editorial on this CT pan-scan topic argues that the therapeutic index for pan-scan could be improved by developing more accurate decision criteria so that only those patients who really need this imaging are scheduled for the procedure.
A growing interest in palliative care in EM reflects common experiences with patients who have chronic life-limiting illness who present to EDs without being offered palliative care services that could ease symptoms and address their need to subsequently attend ED.
- The perspective by Lukin et al discusses instigating palliative care through the ED, including engaging palliative care colleagues to increase clinical support for these vulnerable patients.
- Todd’s editorial on this topic explores the likely barriers to ED-based palliative care and argues for Emergency Medicine to play an important role in calling for improvements in end-of-life care planning.
Resuscitation targets to facilitate early detection and appropriate management of circulatory shock are considered in a two-part review series. In part 1, Holley at al explore global haemodynamic end-points for guiding resuscitation and their potential limitations. Part 2 of this series will be published in the next issue.
Paix and Griggs of MedSTAR SA, two experienced Australian medical specialists with backgrounds in Anaesthesia and Aeromedical Retrieval, report on their experience of emergency surgical airway cases, leading to their adopting a simple ‘scalpel–finger–tube’ method for cricothyrotomy. They suggest this technique is useful for trauma patients and other occasions where emergency surgical airway access is required.
FitzGerald and colleagues from the Queensland University of Technology report demand for public ED care has grown by 37% over the past decade. This increase in demand exceeds population growth, and variability between states in utilisation rates and overall trends cannot be readily explained. However, population ageing, rather than overuse by lower-acuity patients or ‘inappropriate use’ based on retrospective clinical judgement, is likely to be a significant factor.