Tag Archives: Emergency medicine

MCRI experts developed the first guidelines on pediatric head injuries in Australia and New Zealand | Instant News

Australia and New Zealand’s first set of clinical guidelines for pediatric head injuries have been developed by a network of specialists based at the Murdoch Children’s Research Institute (MCRI).

The manual, developed by the Pediatric Research in Emergency Departments International Collaborative (PREDICT) and published in Australasia Emergency Medicine, will enable emergency physicians to diagnose and treat children’s head injuries while reducing unnecessary ones radiation exposure from a CT scan. They also treat head injuries in children with underlying problems, such as bleeding disorders.

Matthew Salter took his son Jakob, 15, to the emergency department of a large hospital late last year after he hit his head after a BMX accident.

Jakob tries to do a bike trick on one of our local BMX tracks but he missteps landing and crashes first. When my wife and I arrived at the scene, we found her helmet shield had been destroyed, she was depressed and I was worried she might have a concussion. When we arrived at the hospital he vomited several times so to confirm a head injury he received a CT scan and was observed overnight. “

Mr. Matthew Salter

Based on the new head injury guidelines, Jakob fulfills several risk factors for CT scan and observation.

Mr Salter said it was comforting to know these guidelines were in place to ensure all children receive the same treatment wherever they live in Australia.

Professor Franz Babl, Leader of the MCRI Emergency Research Group, said Australia and New Zealand do not yet have specific guidelines to help doctors decide how best to treat every child under 18 who comes to the emergency department with mild to moderate head injuries.

“Even though we need to rule out bleeding in the brain, we don’t want to order a CT scan unnecessarily, because it increases the lifetime radiation exposure of children,” he said.

“The lack of standardized guidelines means children receive different treatments depending on where they are seen. Broad adoption of these guidelines will change that.”

Following an extensive search and assessment of international guidelines such as those used in Canada, the US and the UK, the PREDICT working group developed 71 recommendations and imaging / observation algorithms relevant to the Australian and New Zealand setting. The new guidelines cover patient triage, imaging, observation versus admission, transfer, discharge and follow-up.

Head injuries are one of the most common reasons children come to the emergency department.

In Australia and New Zealand about 10 per cent of children who present with head injuries of all severity undergo CT scans. Although traumatic brain injury is rare, persistent post-concussion symptoms affect more than a third.

Professor Stuart Dalziel, Chair of Cure Kids Child Health Research at The University of Auckland and pediatric emergency doctor at Starship Children’s Hospital in New Zealand, said identifying traumatic brain injuries in children with seemingly minor injuries could be difficult and over the past 15 years has occurred. research focus in emergency departments around the world.

He said across Australia and New Zealand there had been variations in practice in the management of child head injuries.

The PREDICT working group that developed the guidelines includes emergency physicians, pediatricians, neurologists, neurosurgeons, radiologists, sports medicine doctors, neurologists, general practitioners, paramedics and nurses.

Guidelines can be found at predict.org.au


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Health service providers urge to stop using hydroxycholoroquine for COVID-19 | Instant News

The sacred oaths taken by doctors during graduation from medical school to “First do no harm,” the first words of the Hippocratic Oath, provide a powerful impetus for comments that have just been published in The American Journal of Medicine.

Researchers from Florida Atlantic University’s Schmidt School of Medicine and collaborators from the University of Wisconsin School of Medicine and Public Health urge all health care providers to prioritize compassion with reliable evidence about efficacy and security.

They recommend a moratorium on prescription chloroquine or hydroxychloroquine, with or without azithromycin, to treat or prevent COVID-19, with the exception of getting the evidence needed in randomized trials and loving use.

Despite the fact, or maybe partly due to the fact that there are no therapeutic or preventative measures for the COVID-19 pandemic in the United States, which accounts for less than 5 percent of the world’s population and about 30 percent of cases and deaths, prescription drugs are widespread nine times bigger than in the last few years.

This widespread use leads to national deficiencies in patients with lupus and rheumatoid arthritis, for whom hydroxychloroquine has been an approved indication for decades. These patients cannot fill their prescriptions.

On March 28, the US Food and Drug Administration (FDA) issued an emergency use permit for chloroquine and chloroquine hydroxy for the treatment of COVID-19. However, on April 24, the FDA issued a drug safety communication warning regarding chloroquine hydroxy disorders and heart rhythm disorders that can cause sudden cardiac death.

If this drug needs to be prescribed for patients with COVID-19, initial evaluation and serial monitoring are an absolute necessity. “

Richard D. Shih, M.D, Study First Author and Professor of Emergency Medicine, Florida Atlantic University

Shih is also a division director and founding program director for emergency medicine residency programs at FAU’s Schmidt College of Medicine.

Furthermore, the authors suggest that the convincing safety profile of chloroquine may be more real than it really is.

Data on safety comes from decades of prescription by healthcare providers, especially for their patients with lupus and rheumatoid arthritis, both of which have a greater prevalence in young and middle-aged women, whose risk of fatal cardiac outcomes due to hydroxychloroquine is very convincing. low.

In contrast, the risk of hydroxychloroquine for patients with COVID-19 is significantly higher because of fatal cardiovascular complications due to these drugs is much higher in older patients and those who have heart disease or risk factors, both of which are mostly male .

In basic research, hydroxychloroquine and chloroquine are structurally related and have similar mechanisms to inhibit the virus that causes COVID-19. Despite their structural similarities, in vitro, hydroxychloroquine seems to be more effective.

Additionally, when used for lupus and rheumatoid arthritis, hydroxychloroquine has fewer side effects, less drug interactions and is less toxic in overdoses.

The authors note that the evidence currently available is limited to eight published studies, five on hydroxychloroquine alone; two in chloroquine hydroxy plus azithromycin; and one in both in combination or alone.

Of these only three were randomized trials enrolling 225, 62, and 30 patients – all of them too small to provide reliable evidence. All three tested hydroxychloroquine alone versus the standard of care in China.

One showed no significant difference in cleansing the virus at 28 days, second, there was no difference in cleansing the virus at seven days, and third, some improvements in fever, coughing and chest computed with tomographic findings.

“With regard to hypothesis testing, only large-scale randomized trials with sufficient size, dosage and duration can reliably detect the most reasonable small to moderate effects, which can have enormous clinical and public health impacts,” said Charles H. Hennekens, MD, Dr.PH, senior writer, first professor Sir Richard Doll and senior academic advisor at FAU’s Schmidt College of Medicine.


Journal reference:

Shin, R D., et al. (2020) Hydroxychloroquine for Coronavirus: Urgent Need for Prescription Moratorium. American Journal of Medicine. doi.org/10.1016/j.amjmed.2020.05.005.


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