Category Archives: MLP-research

Croup: are patients safe to discharge following nebulised adrenaline? Is ‘rebound phenomenon’ a myth?

Author: Dr Gareth Norton

Date: August 2022

Abstract:

Croup, or laryngotracheobronchitis, is an extremely common presentation of respiratory
disease in the paediatric population. The mainstay of treatment is oral corticosteroids and in moderate/severe cases nebulised adrenaline. Concerns exist around the possibility of a rebound effect where their are increased symptoms when the effect of a drug has passed. If a drug produces a rebound effect, the condition it was used to treat may return with an
increased severity. Or is there no rebound effect and the return of symptoms, even at an
increased severity is due to the natural course and progression of the treated condition?

Rivaroxaban as bridging agent for suspected DVT

Author: Dr Gary Mitchell

Abstract:

Rivaroxaban is well established as a treatment for deep vein thrombosis and pulmonary embolism, but there has been hesitation in using it as a bridging agent in clinical situations where DVT is suspected but not yet confirmed by definitive ultrasound scan. The evidence for the safety and efficacy of this approach is explored. During this time of research, the use of rivaroxaban began to gain acceptance and usage in New Zealand, leading to a brief analysis of factors involved in trying to introduce up to date guidelines into a small health organisation in New Zealand prior to widespread acceptance and definitive guidelines at District Health Board level.

Diverticulitis: the role of antibiotics in urgent care

Diverticulitis: the role of antibiotics in urgent care

Author: Dr Eleri Clissold

Abstract:

Our understanding of this common and painful disease is evolving. What was thought to be a predominantly infective process is postulated to be inflammatory and self-limiting in the majority of cases. Over several decades multiple high quality studies have emerged questioning the role of antibiotics in the management of acute diverticulitis without perforation, sepsis or other complications. No study has demonstrated the superiority of any antibiotic strategy in any one of multiple outcomes assessed. This literature search seeks to examine the evidence in-depth and place it in context for urgent care practitioners.

Point of Care Ultrasounds in the Diagnosis of Pulled Elbows

Author: Dr Jin Gao
Type: MLP-research
Date: 16 December 2020
Abstract:
The pulled elbow(PE) is a common childhood injury. In most cases, the clinical management is straight forward, however, the diagnosis and management may be difficult if there is an unclear history, an unwitnessed injury or an atypical mechanism of injury. This medical literature project evaluates the effectiveness of point-of-care ultrasound in the diagnosis of PEs.

Nausea and Vomiting in Pregnancy (NVP)

Nausea and Vomiting in Pregnancy (NVP)

Author: Dr Richard Chen

Abstract:

Aim: 

Nausea and Vomiting in Pregnancy (NVP) is a common presentation seen by a wide variety of medical professionals however the evidence around the safety and efficacy of drugs used to treat NVP is often not well understood. This review looks to explore current prescribing practices of drugs used to treat NVP and provide evidence-based recommendations. 

Method: 

The current New Zealand Guidelines for treatment of NVP was studied and an in-depth literature search into the safety and efficacy of drugs available was conducted.
In addition, a survey of current doctors working in the Urgent Care setting was conducted to determine current prescribing habits.

Results: 
Pyridoxine, Doxylamine and Metoclopramide are the medications with the most proven safety profile in pregnancy respectively. There have been significant studies into the Pyridoxine-Doxylamine combination as well as Metoclopramide to demonstrate effectiveness against placebo. However, there is insufficient evidence to suggest any drug is the most effective drug available.
A large proportion of prescribing preferences of the doctors working in Urgent Care surveyed in the context of treating NVP were not supported by the available evidence.

Conclusion:  

Considering both safety and efficacy, Pyridoxine and Doxylamine are the recommended initial drugs of choice to manage NVP. This is closely followed by Metoclopramide. More doctors working in the acute medical setting should be aware of the potential teratogenicity of drugs used to treat NVP.    

Cannabinoid Hyperemesis Syndrome

Author: Dr Sandy Crofts

October 2021

Abstract:

Cannabinoid Hyperemesis Syndrome (CHS) is a syndrome of intractable vomiting with severe abdominal pain that is associated with chronic marijuana use. Classically, symptoms are relieved by hot showers and are often unresponsive to traditional acute interventions such as antiemetics.

Patients commonly undergo multiple investigations without diagnosis.  Complete resolution of symptoms occurs with abstinence from cannabis.

The following Medical Literature Project gives an overview of Cannabinoid Hyperemesis Syndrome and review of current management.

Point of care ultrasound for the diagnosis of paediatric distal radius buckle fractures

Author: Dr Alice Mason

March 2022

Abstract:

Paediatric forearm fractures are a common presentation seen in Urgent Care, often occurring from a fall onto an outstretched hand. Currently, best practice is for an x-ray when there is suspicion of a fracture.However, this comes with exposure to ionising radiation and can be associated with prolonged waiting times, pain, and further cost. This review aims to investigate whether point of care ultrasound (POCUS) could be used as an alternative or preferred option for suspected distal radius fractures in children.

Is Adenosine safe for conversion of SVT in Urgent Care settings?

Author: Dr Imran Zia

December 2021

Abstract:

A literature review was carried out to assess the safety of Adenosine in Urgent Care (UC) setting for the termination of Paroxysmal Supraventricular tachycardia (PSVT). Thorough literature evaluation advocates the use of adenosine for the acute termination of PSVT in Urgent care settings, especially in rural and remote practices. It has the potential to improve patient management and satisfaction along with a reduction in cost, ED load, and associated hospitalization.

A Case Review of Paediatric Lateral Condylar Fractures

Author: Dr Zeeshaan Khan
Type: MLP-research
December 2022
Abstract:
Paediatric lateral condylar fractures (PLCF) are the most common fractures in children under the age of 7. This article will provide an overview of paediatric lateral condylar fractures with an emphasis on the importance of obtaining adequate radiographs and providing an accurate classification to guide management. It is essential for Urgent Care clinicians to be competent in the reading of paediatric elbow radiographs and possess a sound knowledge of the different classification systems of PLCF in order to provide the correct treatment and knowing when to refer for operative and non-operative treatment.

Review of Procedural Sedation Guideline at Pegasus 24 Hour Surgery

Author: Dr Alison Curran
Type: MLP-research
Date: July 2022
Abstract:
Procedural sedation in the urgent care setting may be used to perform minor procedures, thereby enabling a patient to receive treatment sooner and in many cases avoiding a hospital admission1. There are safety concerns around using procedural sedation, therefore the use of clinical guidelines and credentialing is strongly recommended to reduce the risk of adverse events2,3,4,5,6. This project aims to review and make recommendations on the Procedural Sedation guideline at Pegasus 24 Hour Surgery, based on up-to-date literature and inclusion of the ‘Australian and New Zealand College of Anaesthetists’ (ANZCA) guidance2,7.