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  1. Daniel M Fatovich (Daniel.Fatovich@health.wa.gov.au), specialist in emergency medicine
  1. Royal Perth Hospital, Wellington Street, Perth WA 6000, Australia

    Most people believe that the emergency department is always available to help provide non-elective acute hospital care. Daniel Fatovich explains why this is not necessarily so

    Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis, and management of the acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders.1 It is a specialty in which time is critical. Anyone who has been to an emergency department will appreciate that it is a complex and often turbulent environment. The emergency department is like the fire brigade—you hope you won't need it, but if you do, you expect a timely response.

    Emergency medicine is a fairly new specialty. Resuscitation, toxicology, and clinical criteria for imaging represent some of the core topics of the practice of emergency medicine. This review focuses on these key areas and underlines the major problem that the specialty faces—namely, overcrowding.

    Summary points

    Overcrowding is the most serious issue confronting emergency departments in the developed world, with quality and timeliness of emergency care being compromised

    Amiodarone is the antiarrhythmic drug of choice for cardiac arrest due to shock refractory ventricular fibrillation and ventricular tachycardia

    For calcium channel blocker toxicity, the induction of hyperinsulinaemia and euglycaemia has striking bemefits

    Octreotide prevents the rebound hypoglycaemia of sulphonylurea overdose

    Validated clinical criteria for requesting imaging have been developed for cervical spine injury and are being developed for minor head injury

    Methods

    Many advances have been made in emergency medicine recently. I surveyed colleagues both locally and internationally to nominate suitable topics. The topics I have chosen were considered to be clinically useful and educational. They reflect subjects of change or advancement. Once the topics were chosen, I performed a directed review …

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