bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute pulmonary oedema secondary to thromboembolic occlusion of the distal aorta in a patient with hypertrophic cardiomyopathy
Authors: Ardagh Michael
Published: August 2010

A 49 year old man with hypertrophic cardiomyopathy and atrial fibrillation presented with bilateral lower limb ischaemia due to embolism of a left ventricular mural thrombus causing occlusion of the distal aorta and common iliac arteries. The patient developed severe pulmonary oedema. This was thought to be caused by the elevated cardiac after‐load imposed by the aortic obstruction.

He was successfully treated with continuous positive airway pressure prior to definitive treatment of the obstruction by bilateral aorto‐iliac embolectomies.
Methotrexate poisoning
Authors: Canestra Jane
Published: August 2010

Three case studies of accidental methotrexate ingestion in paediatric patients are presented. Two patients had toxic methotrexate levels. Treatment included the administration of charcoal, intravenous hydration, alkalinisation of urine and the administration of the specific antidote folinic acid. All patients made an uneventful recovery. Parenteral folinic acid therapy should be commenced without delay in all cases of suspected methotrexate poisoning in equimolar concentration to the suspected dose of methotrexate. It is recommended that methotrexate tablet packaging be altered to reduce the likelihood of paediatric access.
Size does make a difference in management of spontaneous pneumothoraces
Authors: Aplin Phil
Published: August 2010

Objectives: The study looked at the relationship between pneumothorax size and the likelihood of successful microcatheter aspiration, rate of surgical intervention and the rate of recurrence.

Design

A retrospective case study analysis of 117 consecutive cases of spontaneous pneumothorax over a four‐year period was undertaken with patient follow up for a minimum of 12 months.

Pneumothoraces were classed as small (less than 20% of hemithoracic volume), moderate (between 20% and 60%) and large (greater than 60%).

Results

The success rate of microcatheter aspiration was significantly higher in moderate sized pneumothoraces compared to large pneumothoraces (82% vs 43%, P<.01). Increasing pneumothorax size was also associated with an increased surgical intervention rate (12.5%, 34% and 50% respectively for small, moderate and large groups, P<.05). Increasing pneumothorax size was not associated with an increased recurrence rate.

Conclusion

Increased pneumothorax size is associated with a significantly lower rate of successful management using microcatheter aspiration techniques and an increased rate of thoracic surgical intervention.
Blood volume regulation
Authors: Isbister James P
Published: August 2010

The maintenance of adequate cardiac output and tissue perfusion is dependent on intravascular blood volume and its adequate return to the heart. Considering the numerous functions of the cardiovascular system in providing adequate flow to the peripheral microcirculation, it is not surprising that there may be conflicts of interest when stresses are placed on the system. Of particular importance are the stresses in which there are increased oxygen demands, decreased oxygen availability and concomitant requirements for temperature regulation.

In the context of depleted intravascular blood volume, the splanchnic circulation provides an autologous blood bank until transcapillary refill of the circulation occurs. On the other hand centralisation of blood from the venous capacitance compartment, as seen with acute hypoxia, leads to overfilling of the heart, release of atrial natriuretic peptide and subsequent reduction of the plasma volume by transcapillary efflux.

In this review the basic physiology of blood volume, red cell mass and plasma volume regulation will be presented, followed by a consideration of the pathophysiological changes occurring in the context of a variety of clinical settings. Recent insights into neurohormonal aspects of blood volume regulation, the role of the spleen, the interstitial compartment, colloid oncotic pressure, vasomotion and red cell function will be presented.
Massive transfusion: a review
Authors: Harvey Michael P
Published: August 2010

The most generally accepted definition of massive transfusion is the replacement of the patient's blood volume in under 24 hours. This corresponds to 3000ml of red cells or approximately 10 units of packed cells in an average weight person. The most frequent reasons for massive transfusion include trauma, GIT bleeding, obstetric bleeding, bleeding abdominal aortic aneurysm, and major elective vascular surgery. Survival in massively transfused patients will vary depending on the underlying disease process. Overall survivals of 45–67% have been reported and of these 90% regain full independence and 75% return to work. Massive transfusion imposes a considerable strain on blood banking resources and in many centres a relatively small number of patients consume 10–15% of the total blood supply annually. Severe coagulopathy (INR and/or APTT double normal) will develop in 40% of patients and severe thrombocytopenia (platelets <50 × 109/L) in 30% of patients between 10 and 20 units of units transfused. Coagulopathy, hypothermia and tissue injury all contribute to the phenomenon of microvascular oozing which develops in approximately 30% of massively transfused patients. There is only a weak correlation between the severity of coagulopathy/thrombocytopoenia and the total units transfused suggesting that factors such as duration of tissue hypoperfusion and consumption are likely to play a more important role than simple haemodilution of coagulation factors. Because of the lack of clear correlation between coagulopathy/thrombocytopenia and the number of units transfused, “formula” replacement with plasma and platelets is not recommended. The approach to blood product support in the massively transfused patient will be discussed.
Fluid resuscitation in children
Authors: Henning Robert
Published: August 2010

Children most often need fluid resuscitation because of fluid loss (especially from diarrhoea), while bleeding and sepsis account for a minority of cases. The child's immature body systems (especially cardiovascular and renal), age‐dependent fluid compartment sizes and lack of degenerative vascular diseases of adulthood affect the child's clinical signs and the response to hypovolaemia and to resuscitation.

The issues of what fluid, how much, how fast and by what route are interdependent. In general, aggressive early fluid resuscitation reduces mortality and morbidity in children with burns and sepsis, while slow rehydration over 48 hours is safer in dehydrated children with diarrhoea or diabetic ketoacidosis. There are few specifically paediatric data comparing hyper‐ or isotonic crystalloid with colloid, or the various colloids with each other, so that legends abound in paediatric resuscitation. The empirical basis of these legends will be discussed in this paper.

Safe resuscitation requires close observation of the cardiovascular system, conscious state, urine output and blood chemistry. When close biochemical monitoring is not possible, a fluid regime should be chosen which is least likely to cause biochemical changes.
The changing pattern of self‐poisoning in Hong Kong over nine years
Authors: Lau Fei Lung , Liu Rico , Yip Sai Hang
Published: August 2010

Three thousand four hundred and twenty poisoned patients presenting to the Accident & Emergency Department of an inner‐city hospital from July 1985 to June 1994 were studied retrospectively. There was a predominance of females (F:M = 7:3) and young adults (45% aged between 21 years and 30 years). Hypnotics and tranquilisers made up more than half of the agents taken. Most of the patients (57%) poisoned themselves deliberately. The majority of patients had taken a single drug (97%). There was a significant drop in poisoning with Mandrax (methaqualone/diphenhydramine), Lendormin (brotizolam) and aspirin (acetylsalicylic acid) after 1990 while poisoning with narcotic analgesics and hallucinogens increased significantly.
Ketamine anaesthesia in Papua New Guinea
Authors: Roberts Penny , Dent Andrew W
Published: August 2010

This study examines the incidence and severity of adverse effects of ketamine anaesthesia used for short outpatient procedures in Papua New Guinea. Nine hundred and twenty consecutive ketamine anaesthetics were observed. Eighty‐two adverse events in 77 anaesthetics (8.4% of anaesthetics) were observed. Twelve anaesthetics (1.3%) were complicated by a severe adverse event. These were severe emergence phenomena (nine cases), seizure (one case) and pain necessitating abandonment of the procedure, which occurred twice with the same patient who also suffered laryngospasm during one of these anaesthetics. There were no deaths. Young adult male patients with painful or prolonged procedures had the highest frequency of hallucinatory adverse effects. This study confirms the safety and efficacy of ketamine anaesthesia.
Practical guidelines for emergency department photography and video recording
Authors: Ryan John M , Gaudry Paul L
Published: August 2010

Clinical photography and video recording by emergency department staff are important adjuncts to the teaching and practice of emergency medicine. A single‐lens reflex camera with a manual zoom 35–105mm macro lens is the recommended camera for most teaching purposes. A built‐in ringflash mounted around the lens allows for shadowless and uniform illumination. The instant developing camera has some specialised applications in wound care and trauma triage. The digital camera, which captures high resolution colour images that can be individually computer edited and enhanced provides exciting possibilities for photographic presentation in the future. A system for video recording resuscitations can be readily installed and used for quality improvement.
A review of detection techniques for oesophageal intubation
Authors: Ardagh Michael
Published: August 2010

Inadvertent intubation of the oesophagus is an occasional complication of endotracheal intubation and can be fatal if unrecognised.

Visualising the endotracheal tube pass between the vocal cords and capnography are established as the gold standard methods of ensuring tracheal placement, but both may be either impossible or impractical in certain emergency intubations.

Colourimetric end tidal CO2 detectors and oesophageal detector devices are alternative techniques. Of these oesophageal detector devices are the more accurate.
A review of ACEM accreditation: 1986–1995
Authors: Yuen Allen
Published: August 2010

This review summarises the findings of all accreditation inspection visits performed by the College from 1986 until 1995. All hospitals in Australia and New Zealand which requested inspection for the purpose of accreditation of training positions for advanced trainees of the College during this period, were inspected. Hospitals which did not fulfil the basic criteria for accreditation were not inspected until these requirements were satisfied.

Altogether, 109 inspections have occurred, comprising 76 hospitals and two helicopter retrieval services. Twenty hospitals have been inspected twice, eight have required three inspections. All but one major metropolitan hospitals were included in the first round of inspections.

The reasons for success, failure or downgrading of accreditation are analysed. This information may prove useful for hospitals seeking to have training positions approved in their hospital in the next round of inspections.
Usage of alternative medicines by patients presenting to an emergency department
Authors: Way Bruce , Stewart Antony , Croker Bill
Published: August 2010

Objective

To survey the usage of alternative medicines by emergency department patients.

Setting

An adult emergency department of a major teaching hospital in the eastern suburbs of Sydney.

Method

Over a five day period, 261 patients responded to a questionnaire examining their use of alternative medicines. Data on the alternative medicines used, details of the prescribers and opinions on safety were collected.

Results

Seventy two percent of respondents had taken some form of alternative medicine before and 48% were currently taking one or more on a regular basis. Alternative medical therapy was most common amongst middle aged, well educated females. Seventy percent were self prescribing and 92% felt that they were completely safe.

Conclusions

Use of alternative medicines is common amongst patients presenting to the emergency department. Most are taken without supervision and patients generally feel that they are completely safe.
Boerhaave's syndrome complicated by tension pneumothorax
Authors: Doherty Steven
Published: August 2010

Tension pneumothorax secondary to oesophageal perforation has only twice been reported in the medical literature, and has never been described in association with Boerhaave's syndrome. A case of tension pneumothorax secondary to spontaneous oesophageal rupture in a 47 year old man is presented.

If Boerhaave's syndrome is suspected because of back or abdominal pain, vomiting, dyspnoea and radiological signs, a gastrograffin oesophagram is the imaging procedure of choice. Early surgical drainage and repair produce the best outcome.
Clinical intervention in retrieval medicine
Authors: Merchant John , Tall Gary , Manning Ron
Published: August 2010

Objective

To describe the clinical interventions undertaken by retrieval physicians during interhospital transfer between different hospital types and discuss the implications for staff training.

Method

Case sheets from all interhospital transfers undertaken by the Sydney Aeromedical Retrieval Service for the 1995 calendar year were analysed retrospectively. Clinical interventions were categorised into airway management, invasive procedures, fluid resuscitation and drug therapy. Each category was then reviewed according to the functional level of the referring hospital.

Results

A total of 577 interhospital transfers occurred during this period. Two hundred and fifty eight (44.7%) patients transported required at least one clinical intervention. A total of 421 interventions were made. Of the 421 interventions performed 43% were classified as drug therapy, 34.4% as invasive procedures, 13.3% as fluid resuscitation and 9.3% as airway management. The overall intervention rate for those patients transported from tertiary hospitals was 0.31, for other metropolitan hospitals 0.78, for rural base hospitals 0.70 and for other rural hospitals 1.06.

Conclusion

Those physicians with advanced training in critical care medicine are most suited to the requirements of retrieval medicine. Patients from smaller hospitals have a greater likelihood of requiring intervention by the retrieval physician.
Attitudes and beliefs of emergency department doctors towards domestic violence in Hong Kong
Authors: Wong Tai‐wai , Chung Mimie MY , Yiu Jackson JK
Published: August 2010

A questionnaire was sent to all doctors working in emergency departments in Hong Kong to survey their attitudes and beliefs towards domestic violence. Beliefs concerning privacy and traditional cultural values were found to be important factors affecting the doctor's ability to identify cases of wife abuse. Most respondents had no formal training in this area and felt inadequate in the handling of domestic violence cases. Ways to improve training and identification of at risk cases are discussed.
Never eat an ugly fish: three cases of tetrodotoxin poisoning from Western Australia
Authors: Ellis Rodney , Jelinek George A
Published: August 2010

Tetrodotoxin is a powerful axonal blocking agent found in a number of marine creatures, including puffer fish. Fatal and near fatal poisonings due to puffer fish ingestion have been described in the medical literature, but few reports are from Australia.

Three adults from the same family (two men aged 40 and 24 years and one woman aged 47 years) presented to the Fremantle Hospital Emergency Department six hours after catching and eating an unknown fish. Two developed typical symptoms of tetrodotoxin poisoning including tongue and lip paraesthesiae, blurred vision, ataxia, vomiting and progressive muscular paralysis with inability to stand. They were admitted to the intensive care unit although neither required mechanical ventilation. The third had minimal signs and was observed in the emergency medicine observation ward overnight. All were discharged the next day with some residual ataxia.

Clinically significant tetrodotoxin poisoning may culminate in respiratory failure and death if untreated. There is no specific antidote and treatment is supportive. The literature on this unusual poisoning is reviewed.
The serotonin syndrome
Authors: Williams Aled
Published: August 2010

The serotonin syndrome is an increasingly recognised clinical condition characterised by a triad of motor, mental status and autonomic changes. In most cases it is mild and self limiting. In severe cases it can progress to rhabdomyolysis, disseminated intravascular coagulation and death.

The syndrome is caused by an increased level of serotonin in the central nervous system. This is usually the result of the administration of combinations of serotinergic agents.

This article describes two cases of the syndrome where the diagnosis was not immediately apparent. The pathophysiology, clinical course and treatment are then discussed. Serotonin syndrome is also compared to neuroleptic malignant syndrome. This is a disorder with similar signs and symptoms and may have a similar pathophysiological basis.

Serotinergic agents are commonly prescribed. Emergency physicians must be vigilant for this easily overlooked, potentially fatal but treatable disorder.
New drugs in the treatment of depression and schizophrenia
Authors: Gowardman John
Published: August 2010

Pharmacological agents are important in the treatment of many patients with major depression or psychotic illness. Antidepressant drugs such as the tricyclic antidepressants and non‐selective monoamine oxidase inhibitors are associated with significant adverse effects, especially in overdose. Newer antidepressants include selective serotonin reuptake inhibitors and reversible, selective monoamine oxidase inhibitors. These new drugs are clinically effective and have greatly improved side effect profiles, being considerably safer in overdose than older agents. In the treatment of psychosis, risperidone and clozapine represent clinical advances and are less likely to induce adverse neurological effects than existing neuroleptic agents.
Intrathecal baclofen overdose
Authors: Merchant John , Hollis Gregory
Published: August 2010

Intrathecal baclofen administered by bolus or continuous infusion has been shown to be of benefit in the treatment of spinal spasticity.

Reporting of complications has been limited, particularly in the emergency medicine literature. Reports have been primarily associated with clinical trials.

We report a case of intrathecal baclofen overdose in a patient presenting to the emergency department with an altered level of consciousness and cardiorespiratory depression, who required mechanical ventilation, fluid resuscitation and intensive care admission.

The literature is reviewed with respect to the action and effectiveness of intrathecal baclofen, use of the relevant implantable devices, suggested methods of management in overdose and the other reported complications from this treatment modality.
Mild traumatic brain injury
Authors: Cameron Peter A , Ponsford Jennie L
Published: August 2010

Mild head injury is a common emergency presentation. Previously medical attention has focused on risk of injury requiring surgical intervention. The importance of long term sequelae in patients not requiring surgical intervention has now been recognised. It is not clear, however, how frequently this occurs, which patients are at risk and whether interventions improve outcome. The symptoms associated with mild traumatic brain injury have an organic basis. Some people will be helped by strategies to deal with these symptoms. Emergency physicians should develop better methods to ensure adequate screening in the emergency department to target at risk groups and introduce interventions which are proven to be effective.
Outcome from prehospital cardiac arrest in Melbourne, Australia
Authors: Bernard Stephen
Published: August 2010

Although the incidence and outcome of prehospital cardiac arrest have been reported for many cities, relatively few have originated from Australia. This study reviewed ambulance and hospital records of all patients who were in cardiac arrest when first attended by ambulance officers in metropolitan Melbourne between 1 February and 31 July 1995. Of 361 patients with a presumed primary cardiac cause of arrest, 113 (31%) were initially in ventricular fibrillation. The average ambulance response time was 9.4 minutes. Bystander cardiopulmonary resuscitation was performed on 22% of patients. Ten patients (3%) were discharged alive from hospital of whom eight (2%) were to independent living at home. All survivors were in ventricular fibrillation when first seen. It is concluded that survival from prehospital cardiac arrest in Melbourne is low. Strategies to improve outcome are suggested.
Comparison of lignocaine 1% injection and adrenaline‐cocaine gel for local anaesthesia in repair of lacerations
Authors: Dart Cameron J
Published: August 2010

Objective

To compare adrenaline‐cocaine gel (adrenaline 1:1000 [0.5ml], cocaine 12%[1ml]) with injectable lignocaine 1% solution in efficacy, side effects and safety, cosmetic and patient acceptability in the repair of dermal lacerations on patients who attend the emergency department.

Design

Randomised, prospective, single‐blinded clinical trial.

Setting

Rural base hospital emergency department.

Participants

Patients presenting to the emergency department aged six years and over with dermal lacerations to face, scalp, trunk and limbs, excluding areas below knee or with end‐artery blood supply. Those patients with altered mental state were also excluded.

Intervention

Patients with lacerations were randomly assigned to local anaesthesia with either topical adrenaline‐cocaine gel or injection of lignocaine 1% solution. Patients were then asked to rate the pain on application of either adrenaline‐cocaine gel or lignocaine 1% solution. The emergency doctor who performed the local anaesthesia then sutured in the usual way. A blinded observer recorded pain response using verbal and visual indicators.

Measurement

Ninety patients participated in the trial: 49 randomised to lignocaine 1% solution and 41 to adrenaline‐cocaine gel. A total of 924 skin punctures were recorded and measured.

Conclusion

Adrenaline‐cocaine gel compared favourably with lignocaine 1% solution efficacy, side effects and cosmetic results. It was less painful on application than lignocaine 1%. Adrenaline‐cocaine gel may be considered as an alternative for anaesthesia in the repair of selected dermal lacerations.
Time analysis of assessment and admission procedures for elderly patients in a Sydney emergency department
Authors: Chan Adam , Caplehorn John , Mather Andrew , Sprivulis Peter
Published: August 2010

Objective

To identify factors influencing the time taken to either admit or discharge elderly patients from an emergency department.

Design

A cohort of patients aged 60 years and over was followed by an independent team of investigators until discharge from the emergency department.

Setting

The study took place over one week in the winter of 1995 in the St George Hospital Emergency Department, Sydney, a 600 bed teaching hospital.

Main outcome measures

The time spent waiting for medical attention, time taken to prepare the patient for admission or departure home and time spent waiting for transfer to a ward or home.

Results

The waiting times for less urgent cases did not meet the current NSW Health Department targets. Emergency department staff specialists and registrars took less time to prepare patients for admission compared with residents and interns (two hours vs three hours). While elderly patients generally had to wait long periods in the emergency department for a ward bed, there were significant differences in the waiting times for different specialties; average times were 4.8 hours for a surgical, 8.8 hours for a medical, and 27.2 hours for an aged care bed.

Conclusion

More medical staff may be required to reduce waiting times for less urgent cases. The time taken to ready patients for admission would be reduced if there were a higher proportion of senior medical staff. There is a need for improved availability of ward beds, particularly medical and aged care beds, for patients admitted through the emergency department.
Factors influencing resuscitation decisions in the emergency department
Authors: Biegler Paul , Thomson Graeme
Published: August 2010

Objective

To determine the factors considered most important by emergency physicians when deciding to institute or withhold resuscitation in a hypothetical patient with a life‐threatening illness.

Method

A self‐administered questionnaire containing a clinical scenario was posted to all Victorian emergency physicians in April 1997. Respondents were asked to decide between intubation and no active treatment, to rate the importance of various factors in making this decision and to rate the likelihood of altering the decision given hypothetical changes in the scenario.

Results

The response rate was 67% (46/69). Of those choosing intubation (89%), most would have changed the decision if the patient had dementia, was permanently bed‐bound or was totally dependent for activities of daily living. Decisions were most influenced by reversibility of the illness, the patient's functional state and the perceived quality of life.

Conclusion

Emergency physicians consider many factors when deciding whether or not to actively resuscitate patients. Further study of the decision making process is recommended.
Incidence of recall of emergency intubation: a preliminary report
Authors: Smith Brendon , Bishop Rod
Published: August 2010

Objective

To determine the incidence of recall of intubation performed during resuscitation as part of emergency care.

Method

Patients intubated as an emergency procedure during prehospital, emergency department and inpatient care were identified in a prospective manner over a six month period from the admission register and interviewed after recovery during their hospital stay.

Results

A total of 34 patients with a variety of conditions were able to be assessed. Recall of intubation occurred in two patients, neither of whom considered the experience unpleasant. Both were intubated for respiratory failure. One was obtunded and given no induction agent, the other had a Glasgow Coma Scale score of 14 and was given a moderate dose of thiopentone and midazolam.

Conclusion

This is a preliminary report which finds a low incidence of recall of intubation performed during resuscitation. The methodological difficulties in controlling for all relevant variables are discussed.
Angio‐oedema and ACE inhibitors: an association which is still not well recognised
Authors: O'Donnell Daniel
Published: August 2010

The angiotensin‐converting enzyme inhibitors are associated with angio‐oedema Three cases are recorded here which document the frequent delay in recognition of this association, the variability in time of onset after exposure to the drug, the variable severity of attack and the potential fatality of such an attack.
Rapiscope™—a portable fibre optic device to establish endotracheal tube position
Authors: Petroianu Georg , Werth Wolf , Subotic Svetozar , Maleck Wolfgang , Bergler Wolfgang , Ruefer Roderich
Published: August 2010

Clinical methods to determine endotracheal tube position are unreliable. The Oesophageal Detector Device and capnometry allow a quick and reliable assessment of tube position (oesophageal vs airway), but neither can differentiate between a tracheal or bronchial tube position. The Rapiscope™ (Cook Critical Care, Bloomington, USA) is a battery powered, ultralight fibrescope designed to visualise upper airway anatomy and to confirm the endotracheal tube position. The Cook Airway Exchange Catheter™ is designed to be used with the Rapiscope™ and to protect the fibre optic.

During experiments with intubated minipigs, an additional, identical tube was inserted into the oesophagus. Anaesthetists and medical students were asked to determine the position of one of the tubes (randomly chosen after disconnection of the pig from the ventilator) using the Rapiscope™ with and without the Cook Airway Exchange Catheter. The decision (tracheal or oesophageal) was then confirmed with the Oesophageal Detector Device and subsequently, whether tracheal or bronchial, was checked with a conventional endoscope. The time needed to determine the tube position was recorded.

Using the Rapiscope™ either alone or with the Cook Airway Exchange Catheter it was not possible, in most cases, to determine the correct tube position. The failure in establishing tube position was caused by the ‘foggy’ optic. The visibility could not be improved by using the Cook Airway Exchange Catheter or by oxygen insufflation. Consequently, the use of the Rapiscope™ cannot be recommended at this stage.
Urgency, disposition and age groups: a casemix model for emergency medicine
Authors: Bond Malcolm , Erwich‐Nijhout Marianne , Phillips David , Baggoley Christopher
Published: August 2010

Aim

To evaluate the performance of Urgency and Disposition Groups and Urgency Related Groups, and to develop other casemix systems for use in emergency departments based on easily collected variables.

Setting

Emergency Department, Flinders Medical Centre, a general metropolitan teaching hospital in Adelaide, South Australia.

Methods

Cost data from a prospective analysis of 17,819 emergency patient attendances were used to construct casemix systems by evaluating the cost drivers urgency, outcome, age and diagnosis.

Results

Urgency Related Groups were good predictors of costs (55.32% trimmed for outliers), but the least easy system to construct, and not particularly clinically relevant. Urgency and Disposition Groups were useful predictors of costs (43.90% trimmed), with the advantage of being easy to collect and clinically relevant. However, the same advantages are true of the newly developed Urgency, Disposition and Age Groups, which incorporate age as a partitioning variable, and were found to predict 51.23% (trimmed) of total costs.

Conclusion

Urgency, Disposition and Age Groups can be used as a simple, cost‐efficient method of costing patient attendances to emergency departments. Evaluation of Urgency, Disposition and Age Groups in other emergency departments in Australasia is recommended.
Seeing primary care patients in emergency departments
Authors: Bryant Michael , Tan Gim
Published: August 2010

Aims

This study aims to quantify the number of perceived primary care patients attending an emergency department, to determine whether it was safe to send them away and to estimate the costs of treatment.

Setting

The Emergency Department, Ballarat Base Hospital, a major provincial hospital.

Methods

A prospective analysis of all attendances over a 14 day period, including the costs of managing primary care patients.

Results

One thousand and forty nine patients attended the emergency department during the study period. Data were complete for 858 patients. There was agreement between medical and triage staff that 263 patients were primary care patients. Triage staff considered 295 patients to be primary care patients. Nine of these patients were subsequently admitted. The average cost for each patient visit to the emergency department was $120.38. The cost of staff contact time for a 15 minute visit was $23.59. If it is assumed that the number of primary care patients attending does not affect staffing levels then the cost is $16.99.

Conclusion

There is disagreement between triage and medical staff about who is a primary care patient.

Three percent of patients thought to have been able to be managed by a general practitioner needed admission.

There are large numbers of patients presenting to the emergency department thought to have been able to be managed by a general practitioner but their numbers are insufficient to support a separate primary care facility within Ballarat Base Hospital.

Costs are less to manage primary care patients in the emergency department at Ballarat Base Hospital than in general practice. The cost associated with teaching medical and nursing students, including postgraduate education, in the emergency department has not been quantified.
Emergency department telephone advice: a survey of Australian emergency departments
Authors: Fatovich Daniel , Jacobs Ian
Published: August 2010

Objective

To ascertain the nature and extent of telephone advice to the public provided from the emergency department.

Method

A postal survey of all emergency departments in Australia (n=147).

Results

An 88% response rate was achieved. Sixty seven percent of emergency departments provide telephone advice. Seventy five percent of Directors of Emergency Medicine consider telephone advice to be worthwhile. The mean number of calls received each month is 627 per emergency department (range 4–12,500). Only 24% of emergency departments provide training on telephone advice. Fifty nine percent of departments do not document the calls.

The general impression was that providing telephone advice was time consuming and distracted emergency department staff from direct patient care. Lack of funding to provide a dedicated service was frequently commented upon.

The survey data indicated that there are at least 27.6 calls per 100 emergency department attendances; i.e. for every 100 attendances, there are a further 27.6 occasions of service.

Conclusions

The provision of telephone advice from emergency departments is common practice in Australia and appears to be ad hoc. This service has a particular advantage for those who have difficulty accessing medical care. More formalised systems should be established. This would relieve a considerable burden from emergency departments freeing resources for direct patient care.
Prehospital treatment of head injuries ‐ can we do better?
Authors: Havill Jack , Sleigh Jamie , Kersel Denyse , Marsh Nigel
Published: August 2010

Aims

To examine prehospital factors associated with head injuries.

Method

Prehospital and outcome data were collected on a group of 123 patients with head injuries admitted to Waikato Hospital over 41 months.

Results

Over 80% of the head injuries were due to road trauma. Over 60% occurred >30km from the first admission hospital, 35% were >60km away and 43% took more than 90 minutes to arrive in hospital. Helicopter transport was used for 34% of patients. Hypoxia was present in 50% of the patients at the accident scene and 54% of the unintubated patients were breathing poorly on admission to hospital (64% unintubated). The average Glasgow Coma Scale score was 5.4. Glasgow Outcome Scores at six months were: dead (24), vegetative (0), severely disabled (25), moderately disabled (19), normal or mildly disabled (40), and not available (15). The presence of hypoxia and the worst Abbreviated Injury Scale scores occurred more commonly in those who died.

Conclusions

Many New Zealanders suffer head injuries a long distance from hospital. The use of helicopter transport shortens admission times. Poor breathing patterns and hypoxia are still major problems. Facilitating early intubation by widening the skills of ambulance officers or utilising doctors in first response teams must be considered.
Multiple bee stings
Authors: Robertson Malcolm L
Published: August 2010

Multiple bee stings occur in Australia, but are rarely reported. The importance of this problem in the southern states of North America has recently been well publicised. This review examines the incidence of multiple bee stings, a comparison of European and Africanised honeybees, and the structural function of a bee sting. The toxic effects of bee venom components with reference to both pathophysiology and emergency department presentation and treatment are discussed. Aspects of immunotherapy are covered briefly. Advice for bee sting avoidance and best management of mass attack in the field are also presented.
Colchicine poisoning—overview and new directions
Authors: Harris Roger D , Gillett Mark J
Published: August 2010

Colchicine overdose is uncommon but frequently fatal. In this article we present two cases which exhibit the wide spectrum of colchicine toxicity and review the drug's pharmacology and organ system effects. Finally we provide a treatment algorithm and propose new directions for management.

Colchicine binds to intracellular tubulin and prevents its polymerisation to form microtubules.

As microtubules subserve a wide variety of roles in basic cellular function including protein assembly, mitosis, endocytosis, exocytosis, cell shape and motility, colchicine is profoundly toxic to all cell lines of the body.

Previous studies have offered little to aid the clinician in the management of such patients. We present a series of treatment guidelines based on the current literature. Specifically, we propose that patients who do not develop gastrointestinal symptoms within eight hours of a small, isolated colchicine ingestion can be medically cleared. Additionally, the onset of gastrointestinal symptoms should be seen as an indicator of possible significant systemic toxicity requiring early resuscitation and intensive monitoring.

The newer modalities of treatment including the use of colchicine‐specific Fab fragments and Granulocyte‐Colony Stimulating Factor are also addressed.
Treatment dilemmas in rapid atrial fibrillation
Authors: Richards Karen
Published: August 2010

Atrial fibrillation is a common tachyarrhythmia. Cardioversion either electrically or pharmacologically carries the risk of thromboembolism. All patients with resting ventricular rates greater than 140/min require rate control. Many drugs are effective in either slowing and or reverting atrial fibrillation but no one drug appears superior. Atrial fibrillation in the setting of acute myocardial infarction is associated with a high mortality.
Quinine toxicity
Authors: Pearson Scott
Published: August 2010

Quinine remains an uncommon but potentially lethal cause of poisoning. It is only available by prescription but is commonly prescribed for the treatment of muscle cramps. Permanent visual disturbance and life threatening cardiac dysrhythmias may occur. A case which illustrates the wide range and severity of symptoms is presented. The management of quinine poisoning includes regular activated charcoal and supportive measures. Parenteral sodium bicarbonate may be useful for cardiac toxicity.
Market Segmentation in Scientific Publications: Research Patterns in American vs European Management Journals1
Authors: Collin Sven‐Olof , Johansson Ulf , Svensson Katarina , Ulvenblad Per‐Ola
Published: August 2010

Ideal science should conform to certain criteria or goals, among them the goals of universalism and commonality. Realization of these goals may be limited, however, through the dividing up of researchers in terms of geographical borders. In this study the general hypothesis is tested that there is a segmentation of the society of management researchers into a North American (US) and a European (E) segment, a segmentation which is furthered by differences in incentive schemes and in paradigms. Four leading management journals from North America and from Europe, respectively, and the 242 articles they contained published in 1993 were selected to represent the different geographical segments. The results provide: support for the existence of two such segments; support for differences in incentive schemes influencing the articles; support for their being paradigm differences between the two segments; and support for a paradigm effect being stronger in US‐journals than in E‐journals, US‐authors are more willing, however, to conform to the E‐paradigm than vice versa. We argue for methodological pragmatism in order to reduce the presumed counter‐productive effects of paradigmatic rigidity.
Economic–social interaction in China1
Authors: Lindbeck Assar
Published: August 2010

This paper analyzes economic–social interaction in China in connection with the country's change of economic system. I define an economic system in terms of a multi‐dimensional vector of broad institutional characteristics, and I emphasize that important features of the social development are closely related to specific changes in these various dimensions. I classify China's options for future social improvements into three broad categories: (i) policies that improve the stability and distribution of factor income; (ii) government‐created wedges between factor income and disposable income; and (iii) improvements in the quantity, quality and distribution of human services, such as education and healthcare.
An actualistic perspective into Archean worlds – (cyano‐)bacterially induced sedimentary structures in the siliciclastic Nhlazatse Section, 2.9 Ga Pongola Supergroup, South Africa
Authors: NOFFKE N. , BEUKES N. , BOWER D. , HAZEN R. M. , SWIFT D. J. P.
Published: August 2010

Extensive microbial mats colonize sandy tidal flats that form along the coasts of today's Earth. The microbenthos (mainly cyanobacteria) respond to the prevailing physical sediment dynamics by biostabilization, baffling and trapping, as well as binding. This biotic–physical interaction gives rise to characteristic microbially induced sedimentary structures (MISS) that differ greatly from both purely physical structures and from stromatolites. Actualistic studies of the MISS on modern tidal flats have been shown to be the key for understanding equivalent fossil structures that occur in tidal and shelf sandstones of all Earth ages. However, until now the fossil record of Archean MISS has been poor, and relatively few specimens have been found.

This paper describes a study location that displays a unique assemblage with a multitude of exceptionally preserved MISS in the 2.9‐Ga‐old Pongola Supergroup, South Africa. The ‘Nhlazatse Section’ includes structures such as ‘erosional remnants and pockets’, ‘multidirected ripple marks’, ‘polygonal oscillation cracks’, and ‘gas domes’. Optical and geochemical analyses support the biogenicity of microscopic textures such as filamentous laminae or ‘orientated grains’. Textures resembling filaments are lined by iron oxide and hydroxides, as well as clay minerals. They contain organic matter, whose isotope composition is consistent with carbon of biological origin.

The ancient tidal flats of the Nhlazatse Section record four microbial mat facies that occur in modern tidal settings as well. We distinguish endobenthic and epibenthic microbial mats, including planar, tufted, and spongy subtypes. Each microbial mat facies is characterized by a distinct set of MISS, and relates to a typical tidal zone. The microbial mat structures are preserved in situ, and are consistent with similar features constructed today by benthic cyanobacteria. However, other mat‐constructing microorganisms also could have formed the structures in the Archean tidal flats.
Narratives of Conquest, Colonialism, and Cutting‐Edge Technology
Authors: RODRÍGUEZ‐ALEGRÍA ENRIQUE
Published: August 2010

Many empirical studies have demonstrated that some indigenous technologies in the Americas survived for a long time after European colonization. Still, a narrative of the quick replacement of “Stone Age” indigenous technologies by more efficient European technologies continues to be the main model to explain postcontact technological change. I argue in this article that an important reason for the perseverance of this model is its clear narrative quality. I discuss alternative narrative strategies and examine in detail the case of Xaltocan, Mexico, where indigenous people resumed and intensified chipped‐stone tool production and use after the Spanish conquest, instead of adopting steel knives. I argue that this trend was related to access to the means of production rather than to European notions of “practicality.” This model invites us to rewrite histories of postconquest technological change without assuming a quick replacement of indigenous tools and technologies.
Leaving Few Bones Unturned: Recent Work on Repatriation by Osteologists
Authors: KAKALIOURAS ANN M.
Published: August 2010

In this essay, I consider recent osteological and bioarchaeological contributions to literature on Native American repatriation given the heightened visibility of theoretical and methodological conflicts within physical anthropology over race and race determination. Contestations between researchers, particularly at the osteological nexus with the traditional biological race concept, have intersected with repatriation, both in and out of the anthropological literature, and in federal district court. The publications reviewed here exemplify this emerging multiplicity of practice in osteology and bioarchaeology, and therefore, in toto, incisively portray the complexities that repatriation has brought to skeletal inquiry in the United States.
A Reply to Besteman and Gusterson: Swinging the Pendulum
Authors: BUNZL MATTI
Published: August 2010

In this rejoinder to Catherine Besteman and Hugh Gusterson, I clarify that my essay “The Quest for Anthropological Relevance: Borgesian Maps and Epistemological Pitfalls” is not primarily a critique of their volume Why America's Top Pundits Are Wrong (2005). Instead, I maintain that it takes issue with the current state of sociocultural anthropology and its inability to communicate with a larger public sphere. In conclusion, I reflect on the historical location of my argument, likening my position to advocacy for a swing in the discipline's epistemological pendulum and finding additional cause for such action in the realities of the current political moment.
Remembering Exhibitions on Race in the 20th‐century United States
Authors: REDMAN SAMUEL
Published: August 2010

ABSTRACT  This museum review places the American Anthropological Association's recent exhibition entitled “Race: Are We So Different?” into historical context by comparing it to other major exhibitions on race in the 20th century. I argue that although exhibitions on race in the 19th‐century United States are frequently examined in the historical and anthropological literature, later exhibitions from the 20th century are frequently forgotten. In particular, I compare the AAA's recent exhibition to displays originally crafted for the 1915 and 1933 World's Fairs.
A Conflicted Legacy: Paul Sidney Martin as Museum Archaeologist, 1925–38
Authors: Nash Stephen E.
Published: August 2010

ABSTRACT  Paul Sidney Martin excavated archaeological sites in southwestern Colorado for the State Historical Society of Colorado and the Field Museum of Natural History between 1927 and 1938, although he began working for museums in 1925. His work in three realms—research, exhibition and outreach, and collections—helped redefine the role of the museum anthropologist at a time when archaeological research, particularly that based in museums, was in transition away from the search for exhibition‐quality objects and toward research‐driven expeditions. With data gleaned from relevant archives, in this article I present previously unpublished details of Martin's work to suggest that Martin leaves behind a conflicted legacy from an important era in the development of North American archaeology.