With an EMF Capacity Building grant, The Prince Charles Hospital Emergency Department is involved in 15 research projects. The majority involve significant input from the Hospital's emergency clinicians, who are working in collaboration with other Queensland and interstate emergency department and/or academic institutions such as as CSIRO.READ MORE
Giving intravenous fluids is one of the most common treatments used for critically ill patients in the Emergency Department; however it is difficult to know exactly how much fluid to give; too much or too little can worsen survival. Doppler ultrasound is a test that can tell us how well the heart is working, and how it is responding to treatment. Ultrasound has been used in intensive care and in the operating theatre but there is not enough research available to know whether it is practical and useful in the emergency room and whether or not using it can improve patient survival. Advances in ultrasound technology have recently made it possible to use it easily and safely at the bedside. This study seeks to assess the impact of the use of bedside Doppler ultrasound (the USCOM cardiac output monitor) in resuscitating critically unwell patients. The specific aim of the study is to assess a safe, non invasive technique using cardiac output assessment to guide the optimal fluid resuscitation in an acutely ill ED patient.READ MORE
The current project will involve the implementation and evaluation of a pioneering protocol for the online clinical assessment of practical skills (eCAPS) for medical residents and registrars training in Emergency Medicine. It will use a variety of web-based video technologies to facilitate the learning and innovative assessment of physical examinations of the musculoskeletal system initially targeting the knee and shoulder joints. Specifically, eCAPS includes three interdependent elements with a progressive (asynchronous to synchronous) organization of online instructor and learner-generated video resources to allow formative and summative assessments of practical competencies of Emergency Medicine residents and registrars performing selected physical examinations of the musculoskeletal system. This includes:
1. an integrated series of web-based video lectures and tailored clinical demonstrations of practical skill sets (musculoskeletal examinations) by experts in the field;
2. resident/registrar (“learner”) generated video demonstrations of selected, clinically relevant practical skills recorded with portable USB cameras (asynchronous) uploaded to a secure response and feedback online repository for personal and peer-community access; and
3. real time (synchronous) video assessment of residents/registrars completing practical skill sets for physical examination of the musculoskeletal system within a simulated OSCE (Objective Structured Clinical Examination) scenario using readily accessible web-based technologies (e.g. Skype).
The evaluation of the proposed implementation of the eCAPS protocol will provide important baseline information on aspects such as the flexibility, viability and generalizability of emerging online learning options for developing and assessing practical/procedural skills within an Emergency Medicine training program.
Furthermore, the current project will provide insights into the learning outcomes of the eCAPS protocol and the potential applications of this online approach for facilitating the standardization, validation and recording of clinical competence across a range of training levels and settings including rural and remote Emergency Medicine contexts.
Patients presenting to the emergency department (ED) with chest pain who are assessed as having an intermediate risk of coronary artery disease (CAD) pose a diagnostic and management problem. An unstructured approach to patient management may lead to either inappropriate discharge and a missed myocardial infarction (in 1%–5% patients) or unnecessary, prolonged admissions. This has resulted in the development of a Chest Pain Assessment Service (CPAS) at The Prince Charles Hospital (TPCH). Patients admitted to CPAS undergo an exercise stress test (EST) in order to further risk stratify them into either high or low risk groups. With their result from EST, patients are given a diagnosis of either low risk acute coronary syndrome (ACS), in which case they are discharged home for local doctor follow-up, or high risk ACS, in which case they are admitted to an inpatient Cardiology unit for further assessment and management. The average time to discharge of patients from CPAS is 14.5 hours.
Several recent international studies have demonstrated the potential of CT Coronary Angiogram (CTCA) to be used in the assessment of patients with acute undifferentiated chest pain without diagnostic ECG changes or serum troponin elevation. Locally, recent results from the yet to be published CT COMPARE trial have demonstrated that CTCA can potentially be utilised to facilitate early discharge of patients with chest pain thought to be at intermediate risk of ACS from TPCH ED.
The proposed study aims to identify whether patients with initial normal cardiac serum biomarkers and ECGs and a normal CT within 2 hours of presentation can be discharged early. This group represented 40% of the patients admitted to the CPAS unit in the CT COMPARE trial. It also aims to identify patients who have mild disease at CT and normal 6 hr serum cardiac biomarkers and ECGs as being suitable for discharge at 7 hours. Patients with mild disease represented a further 42% of the patients admitted to the CPAS unit in the CT COMPARE trial. This accelerated CT diagnostic pathway may potentially reduce time to diagnosis significantly.
CT will also allow for exclusion of coronary artery disease or the detection of coronary artery disease not normally identified by existing physiologic testing modalities and help guide implementation of appropriate medical therapy.READ MORE
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