Treatment of a simulated child with anaphylaxis: an in situ two-arm study.

AIM: This study aims to determine whether junior medical staff correctly identify and treat paediatric anaphylaxis and whether the presence or absence of hypotension influenced the treatment, using a standardised simulated patient encounter. METHODS: Junior medical staff from the emergency department of a large paediatric tertiary hospital were invited to participate in a two-armed cohort study to assess recognition and management of anaphylaxis in a standardised scenario using a simulated patient with and without hypotension. The primary outcome measure was administration of adrenaline. The secondary outcome measures included time to adrenaline administration, ability to seek and identify relevant features of history and clinical examination and use of other medications. RESULTS: Fifty-six junior medical staff participated (90% participation rate). Only 50% of participants administered adrenaline in scenarios of definite anaphylaxis. Adrenaline was more likely to be administered if the scenario included hypotension, where the junior medical officer had previous formal resuscitation training (Advanced Paediatric Life Support) and by medical officers with more years of training. CONCLUSION: Anaphylaxis is a life-threatening presentation and requires prompt recognition and appropriate adrenaline administration. Junior medical staff may require more emphasis on recognition and prompt adrenaline administration in both undergraduate and in hospital training and education. Simulated scenarios may provide a platform to deliver this training to ultimately improve patient care.

Paediatric resuscitation training: is e-learning the answer? A before and after pilot study.

AIM: To determine whether an e-learning resuscitation programme was able to improve the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in a simulated cardiac arrest. METHOD: A prospective before and after pilot study comprising of a simulated paediatric resuscitation before and after participants undertook an e-learning programme. Participants were emergency department doctors and new graduate nurses from The Children's Hospital at Westmead, Australia. Primary outcome measures were the ability to perform successful basic life support (BLS) and advanced life support (ALS) according to published guidelines. Secondary outcome measures were the individual steps in performing the overall resuscitation and subjective feedback from participants. RESULTS: Fifty-six clinicians were enrolled in the study (29 doctors and 27 nurses). Thirty-seven were re-tested (25 doctors and 12 nurses). The mean time between tests was 49 days (17 standard deviation). The e-learning module led to an improvement in participants' ability to perform BLS by 51% (P < 0.001) and ALS by 57% (P= 0.001) overall resulting in an overall competence of 89% (BLS) and 65% (ALS). There were also significant improvements in time to rhythm recognition (P= 0.006), time to first defibrillation (P= 0.009) and participants' self-reported knowledge and confidence in BLS and ALS (P < 0.001). CONCLUSIONS: E-learning does improve both the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in the simulation environment.

Predicting the impact on workload with the application of inpatient clinical review criteria into a paediatric emergency department.

OBJECTIVE: Inpatient paediatric clinical observation charts that have predefined physiological criteria, which when reached might generate a mandatory medial review, are to be introduced into EDs in New South Wales. The present study estimated the increased workload of introducing these charts. METHODS: The present study was carried out in the ED of The Children's Hospital at Westmead, Sydney, Australia. All patients admitted directly to the inpatient wards or to the Emergency Medical Unit for a 2 week period in April 2010 were included. The last set of clinical observations prior to the child being transferred out of the ED were recorded. These data were compared to the review criteria defined by the observation charts. The primary outcome was a possible activation of a review. Secondary outcomes were an attempt to quantify the extra time in the ED required before the review would be completed and the patient would be ready for transfer. RESULTS: There were 1822 presentations. Two hundred and fifty-three were admitted to the wards and 109 to the Emergency Medical Unit. There were 126 possible activations. Fifty-seven (52%) of Emergency Medical Unit patients and 69 (28%) of ward patients met review criteria at the time of transfer. The review activations might have generated an extra 7060 min of additional workload. CONCLUSIONS: Individual units must decide where in the patient journey to introduce the charts for acute paediatric admissions based on the number of acute paediatric admissions and their severity as well as the availability and ability of staff to respond to calls.

Teaching medical students to resuscitate children: an innovative two-part programme.

OBJECTIVE: The objective of the present study was to design and evaluate a novel, 'blended learning' approach to the teaching of paediatric resuscitation to medical students. METHODS: Participants were recruited from the Graduate Medical Program at the University of Sydney. The course incorporated an initial e-learning module and a subsequent practical component. The e-learning module taught basic and advanced life support. Students then attended a 90 min practical session, which focussed on team work and the psychomotor components of resuscitation. Improvement in knowledge was measured by a multiple choice question (MCQ) test. The MCQ was completed prior to beginning the whole course, after completion of the e-learning module and again at follow up 8 months later. Students also completed an evaluation survey. RESULTS: Twenty-one students participated. There was a significant objective increase in knowledge from pre-course to post e-learning scores, median scores (interquartile range) from 12/23 (10.5 to 13.5) to 21/23 (20 to 22.5), P < 0.001. This significant increase in knowledge was still apparent at follow up 8 months later. Median MCQ score at follow up was 17/23 (14 to 18.5), P < 0.002. Students self-rated significant improvements in their knowledge, confidence and ability to perform basic and advanced life support for the whole course and between individual components (P < 0.001). CONCLUSIONS: A novel paediatric resuscitation course for medical students was developed and evaluated. This demonstrated significant objective improvements in student knowledge throughout the course, at course completion and at 8 month follow up. There were also significant subjective improvements in knowledge, confidence and ability to perform paediatric resuscitation.

Can e-learning improve medical students' knowledge and competence in paediatric cardiopulmonary resuscitation? A prospective before and after study.

OBJECTIVE: To determine whether the use of an e-learning package was able to improve the knowledge and competence of medical students, in a simulated paediatric resuscitation. METHODS: A prospective before and after study was performed with medical students at the Children's Hospital at Westmead, Australia. Participants undertook a simulated paediatric resuscitation before and after completing the e-learning. Primary outcome measures were the ability to perform successful basic life support and advanced life support according to published guidelines. Secondary outcome measures were the individual steps in performing the overall resuscitation, the change in pre- and post-e-learning multiple choice question scores and subjective feedback from participants. RESULTS: A total of 28 students were enrolled in the study, with 26 being retested. There was an improvement of 57.7% from 30.8% to 88.5% (P < 0.001, 95% CI 34.9-80.5%) in basic life support competence and an improvement from 0% to 80.0% (P < 0.001, 95% CI 61.8-99.8%) in advanced life support competence. Significant improvements were seen in all secondary outcomes particularly time to rhythm recognition and time to first defibrillation (P < 0.001). Multiple choice question test scores showed a significant improvement of 27.8% or 6.4 marks (95% CI 5.3-7.5, P < 0.001). CONCLUSION: E-learning does improve both the knowledge and competence of medical students in paediatric cardiopulmonary resuscitation at least in the simulation environment.

Knowledge and attitude towards paediatric cardiopulmonary resuscitation among the carers of patients attending the Emergency Department of the Children's Hospital at Westmead.

The present study aimed to describe the knowledge and attitudes of parents and carers in performing cardiopulmonary resuscitation on infants and children. A self-administered questionnaire distributed to a convenience sample of parents and carers attending the Emergency Department of The Children's Hospital at Westmead, Australia from February to March 2008. Main outcome measures were the prevalence of previous cardiopulmonary resuscitation training, willingness and confidence to perform cardiopulmonary resuscitation on infants and children compared with adults, and an objective assessment of knowledge of current resuscitation guidelines. A total of 348 parents and carers were surveyed; 53% had received previous cardiopulmonary resuscitation training, 75% prior to the previous year. There was no significant difference on their willingness to perform cardiopulmonary resuscitation on an adult versus a child (75.6% and 75.8% respectively, P= 0.870). However, 81% were willing to perform cardiopulmonary resuscitation on a relative whereas only 64% were willing to perform cardiopulmonary resuscitation on a stranger (P < 0.001). Respondents were moderately confident in delivering cardiopulmonary resuscitation to a collapsed child; mean score of 2.9 on 5-point Likert scale. Only 11% of respondents knew the correct rate for chest compressions and the ratio of compressions to ventilations; 8% had performed cardiopulmonary resuscitation in a real situation. Parents and carers are willing to perform cardiopulmonary resuscitation, especially on family members. However, their knowledge of the current guidelines was poor. More public education is required to update those with previous training and to encourage those who haven't to be trained.

Community acquired needlestick injuries in non-health care workers presenting to an urban emergency department.

OBJECTIVES: To review the epidemiology and demographics of community acquired needlestick injuries in non-health care workers attending an urban ED. METHODS: A retrospective analysis of patients with needlestick injuries attending the Royal Prince Alfred Hospital from 1996 to 2001. RESULTS: One hundred and twenty cases were reviewed. The most common mechanism of injury was exposure to discarded syringes (68%). Forty three (36%) injuries were work related. Twenty four (20%) were non-accidental. Ten (8%) patients received human immunodeficiency virus post exposure prophylaxis. There were no viral seroconversions in the patients with data available. CONCLUSIONS: We have identified three groups, males, cleaners and police officers, who are at particular risk of injury. Community education is required so that medical assessment is sought early and to increase awareness of these injuries. The provision of post exposure prophylaxis requires individualized risk assessment, as only in a minority of cases is the source available for testing.

Fatal leptospirosis presenting as musculoskeletal chest pain.

After holidaying in Vanuatu, a 24-year-old man presented with pleuritic chest pain and chest wall tenderness thought to be musculoskeletal in origin. He developed fatal acute renal failure, jaundice, respiratory failure, myocarditis and rhabdomyolysis. Subsequent serological results showed a rise in serum titre of antibodies to Leptospira grippotyphosa, from 1 : 50 to 1 : 800, consistent with acute infection.