Review article: Back to life from being declared dead in the Resus Bay: An integrative review of the phenomenon of autoresuscitation and learning for ED.

This is a literature review of ED autoresuscitation. The impetus for this review was a case which revealed a lack of understanding about Lazarus syndrome among ED staff. The primary objective was to see the proportion of cases who survived neurologically intact to discharge and the time frame when this occurred after death had been declared. A secondary outcome was to see whether these studies mention whether bedside echo was performed prior to deciding whether to terminate resuscitation. A systematic search of five databases was undertaken with keywords, 'autoresuscitation', 'cardiac arrest' and 'emergency department'. Articles published in the English language were selected for inclusion. No time frame was selected because of the low number of articles. A total of 240 articles were identified, that yielded 26 cases that were relevant and could be synthesised to create a discussion on the current clinical guidelines around resuscitation. Our analysis demonstrates that of the 11 survivors who were discharged neurologically intact, the average age was 42.9 years; otherwise, the average was 62.6 years. The majority (23/26) 88% auto-resuscitated within 10 min after being pronounced dead. Only five patients are mentioned as having had a bedside echo prior to deciding to cease efforts. Under-reporting of autoresuscitation is suspected because of fears of blame. Passive monitoring for 10 min after resuscitation is ceased, is recommended. There is need for more data on this phenomenon to help inform further research on the topic.

Audit of ultrasound usage in emergency departments in greater metropolitan Brisbane.

OBJECTIVE: The Australasian College for Emergency Medicine identifies five ultrasound applications which the College deem core to the practice of emergency medicine but there is scant information as to the uptake of ultrasound or the qualification of users. This study aims to determine the percentage of ED physicians in one metropolitan area who utilise ultrasound for core diagnostic and procedural applications in participating hospitals and the percentage of users who have been formally assessed in any ultrasound application. METHODS: The EDs of eight major public hospitals in greater metropolitan Brisbane area participated in this audit. Data-collectors at each participating ED approached every senior house officer, registrar and senior medical officer in the department and, after obtaining informed consent, asked the participant six questions pertaining to their use of ultrasound for five core applications and about ultrasound training and recorded the answers without information as to the identity of the participant. RESULTS: 94.4% of the physicians participated. Of those participating, 90% used ultrasound for venous access, with progressively fewer using E-FAST (69%), AAA (51%), Lung (40%) and BELS (29%) for diagnostic purposes. Ninety-eight percent of participants were in favour of enhanced departmental training. Only 33% of participants had their ultrasound skills assessed by a qualified person for even one application. CONCLUSION: While use of ultrasound in some applications is widespread, few users have had their skills assessed. Assessment being a routine part of structured training, it cannot be assumed that these users can competently use ultrasound for procedural or diagnostic applications.

Benefits to utilising ultrasound in examining the eye.

Ocular ultrasound (US) is not one of ACEMs 'big 5' in terms of US capability that is expected of a trainee or FACEM. Most texts have a small chapter dedicated to ocular US but it is usually at the back or a subsection of a chapter where it is rarely seen or appreciated. However, it is a straightforward scan to perform with many benefits which will be discussed in this article. The eye offers an excellent medium for US beam penetration, making good quality images of the retina easy and quick to acquire. This has the added benefit of being able to share images with an ophthalmologist remotely, improving time to definitive treatment. It can also be used in patients who cannot cooperate with sitting at a slitlamp, for example moribund or trauma patients. The authors propose that ocular US teaching should be incorporated into the ACEM syllabus, being a vital adjunct to a comprehensive eye examination.

Continuing the ultrasound credentialing conversation.

While the Australasian College for Emergency Medicine (ACEM) encourages all emergency physicians to be competent in at least the five core areas of emergency ultrasound (US), departmental training in most hospitals does woefully little to prepare most ACEM members to attain these competencies. While full day courses are a common method of mandatory and discretionary in-service training, that method has not been adopted for US training. We propose the development of full day courses for each of the five core competencies, taught by accredited US instructors and with emphasis on hands-on training. These courses alone will not produce fully competent US users but will provide a solid foundation for further training.