Arterial line insertion.

Arterial line insertion is a common ED procedure with considerable clinician variation in preferred technique and equipment. This article aims to review some of the controversies and evidence surrounding this common ED procedure.

Trauma care in the tropics: addressing gaps in treating injury in rural and remote Australia.

In Australia, over half a million people are admitted to hospital every year as a result of injury, and where you live matters. Rural populations have disproportionately higher injury hospitalisation rates (1.5-2.5-fold), higher rates of preventable secondary complications, higher mortality rates (up to fivefold), and higher costs (threefold) than patients injured in major cities. These disparities scale up rapidly with increased remoteness, and shift the service needle from 'scoop and run' to 'continuum of care'. Poorer outcomes, however, are not solely due to longer retrieval distances or delays; they arise from inefficiencies in one or more potentially modifiable factors in the chain of survival. After discussing the burden of injury in Australia, we present a brief history of retrieval services in Queensland and discuss how remoteness requires a different kind of service delivery with many moving parts from point of injury to definitive care. We next address the ongoing challenges for the Australian Trauma Registry, and how centralisation of data from the metropolitan cities masks the inequities in rural and remote trauma. There is an urgent need for accurate data from all service providers around Australia to inform state and federal governments, and we highlight the paucity of trauma data analysis in North Queensland. Last, we identify some major gaps in treating rural and remote polytrauma and en-route patient stabilisation, and discuss the relevance of combat casualty care research and practices. We conclude that a greater emphasis should be placed on collecting more robust trauma patient records, as only accurate data will drive change.

A right to refuse: legal aspects of dealing with intoxicated patients who refuse treatment.

Doctors in hospital emergency departments are frequently confronted with intoxicated patients who may be uncooperative, aggressive and refuse to undergo diagnosis and treatment. In the chaotic environment of the emergency department, the doctor must decide whether to override the patient's refusal and detain the patient for treatment or respect the refusal and allow the patient to leave and potentially suffer further injury. A preliminary pilot survey of emergency doctors in a regional Queensland hospital indicated that those surveyed had limited understanding of the circumstances in which they could, or could not, legally detain and continue to treat an intoxicated patient who refuses treatment, and the concomitant legal consequences. This article considers the complex common law and statutory framework existing in Queensland to determine the legal position of doctors treating intoxicated patients who refuse treatment.