bluuebunny/crossref_metadata_2025 huggingface dataset:
The epidemiology of pregnancy outcomes in rural Burkina Faso
Authors: Bell Jacqueline S. , Ouédraogo Moctar , Ganaba Rasmane , Sombié Issiaka , Byass Peter , Baggaley Rebecca F. , Filippi Véronique , Fitzmaurice Ann E. , Graham Wendy J.
Published: August 2010

Objectives  To describe levels and causes of pregnancy‐related mortality and selected outcomes after pregnancy (OAP) in two districts of Burkina Faso.

Methods  A household census was conducted in the two study districts, recording household deaths to women aged 12–49 years from 2001 to 2006. Questions on pregnancy outcomes in the last 5 years for resident women of reproductive age were included, and an additional method – direct sisterhood – was added in part of the area. Adult female deaths were followed‐up with verbal autopsies (VA) with household members. A probabilistic model for interpreting VA data (InterVA‐M) was used to determine distributions of probable causes of death. An OAP survey was conducted among all women with an experience of pregnancy during the prior 12 months. It aimed to document physical and psychological disabilities, economic and social consequences and discomfort that women may suffer as a result of a pregnancy.

Results  The maternal mortality ratio (MMR) was 441 per 100 000 live births (95% CI: 397, 485), significantly higher in Diapaga [519 per 100 000 (95% CI: 454, 584)] than Ouargaye [353 per 100 000 (95% CI: 295, 411)]. MMRs were associated with wealth quintile, age and distance from a health facility. The causes of death showed higher than expected rates of sepsis (30%) and lower rates of haemorrhage (7%). A substantial proportion of all women had difficulty performing day‐to‐day tasks as a consequence of pregnancy. Women who had experienced stillbirths or Caesarean sections reported symptom‐related indicators of poor physical health more frequently than women reporting uncomplicated deliveries, and were also more likely to be depressed.

Conclusions  Expectations on the levels and causes of pregnancy‐related mortality in Burkina Faso may need to be re‐examined, and this could have programmatic implications; for example high levels of sepsis could prompt renewed efforts to reach women with skilled attendance at delivery and follow‐up during the postpartum period. Further documentation of how complication‐induced disabilities affect women and their families is needed. For mortality and morbidity outcomes, demonstrating variation between study districts is important to empower local decision makers with evidence of need at a subnational level.
HIV serological screening in a population of pregnant women in the Republic of Congo: suitability of different assays
Authors: Bruzzone Bianca , Bisio Francesca , Ventura Agostina , Nigro Nicola , Miguel Landry M. , Mayinda Mboungou Franck A. , Nzagou Abdon C. , Mayembo Patrice , Uberti Filippo , De Maria Andrea , Icardi Giancarlo , Viscoli Claudio
Published: August 2010

Different strategies can be applied for the screening of HIV infection, depending on the local seroprevalence. Within a WHO type III strategy, we compared the results of two different second‐line methods for HIV screening of a population of pregnant women in the Republic of Congo. Sera from 3614 consecutive pregnant women were tested for HIV with Genescreen Plus Ag/Ab EIA assay; positive specimens were retested with two different second‐line methods. (Determine HIV‐1/2 rapid test and Vironostika HIV Ag/Ab specific EIA assay). Discordant samples were tested with HIV‐1/2 Western Blot and, if necessary, HIV RNA molecular assay. Of the 3614 sera, 221 were positive with Genscreen. Among them, 21 and 10 tested negative with Vironostika and Determine, respectively. A 100% correspondence with 3rd line confirmation test results was found in Genscreen positive/Vironostika negative samples, whereas a 5.5% overestimation of HIV seroprevalence was observed when Determine, instead of Vironostika, was used as second‐line test. The choice of appropriate assays in adequate sequence, within the correct WHO strategy, is pivotal to minimize the risk of overtreatment of HIV infection.
Violence in society: fact or fiction?
Authors: FULDE GORDIAN W O , CUTHBERT MARJORIE , KELLY ROBYN
Published: August 2010

Five hundred and twelve of the patients who presented to an inner city emergency department over a six month period with injuries sustained as a result of another's violence were studied. This demonstrated that the emergency department can play a significant role in the collection of data on violence.

Until now Australian data on violence have come mainly from police files. However, 57% of the victims questioned in this study had not reported the attacks to the police.

The data obtained have been analysed to provide information on recurring and preventable factors in the incidence of violence. A majority of victims had consumed drugs (54% alcohol, 5% other), and 33% of assailants were influenced by alcohol (39% unknown). Street violence was experienced in 78% of cases, but female victims were more likely to have been victims of violence in their own home, and usually knew the assailant. Only 9% of injuries were caused by a knife or other sharp instrument, the most common “weapon” was the assailant's fist. The usual site of injury was the head and neck (54%). Young single males were the most frequent victims.
A descriptive study of 100 emergency department patients with abdominal pain
Authors: HENRY SIOBHAN
Published: August 2010

One hundred consecutive patients with abdominal pain attending the Department of Emergency Medicine of the Royal Hobart Hospital were studied.

There was a bimodal age distribution, with peaks in the 10–30 and 60–80 year groups. Admitted patients were likely to be older, and were more likely to present in working hours.

When compared with later diagnosis, the emergency department diagnosis was “correct” in 75% of cases. No patient admitted with “unspecified abdominal pain” was later diagnosed more definitively.

The findings suggest that one may be reasonably confident of a diagnosis made in the emergency department in patients with abdominal pain.
Rapidly progressive and overwhelming meningococcal septicaemia in a 14 year old girl
Authors: HOLMES JOHN L , PEAKE PAUL W
Published: August 2010

Septicaemia due to Neisseria meningitidis may be overwhelming and has a high mortality, especially in children. A case is described of rapidly fulminating mening‐ococcal septicaemia without meningitis in a previously well 14 year old girl who died within hours of the onset of illness. Clinical features of meningococcal septicaemia, the pathology, and the principles of management are described. The recent introduction of monoclonal IgM antitoxin may play a significant role in the future management of this condition.
Lumbar puncture in the emergency department is useful and safe
Authors: DUNJEY STEVEN J , DANCOCKS ANGELA C , MAGUIRE JOHN E , JELINEK GEORGE A
Published: August 2010

A 12 month retrospective study was carried out by the Department of Emergency Medicine at Fremantle Hospital to evaluate lumbar puncture in the Emergency Department.

Sixty‐four patients underwent lumbar puncture in the study period. The main indication was suspicion of central nervous system (CNS) infection.

Fifty‐three percent of patients had an abnormal cerebrospinal fluid. Diagnoses in order of frequency were viral meningitis, subarachnoid haemorrhage, bacterial meningitis, and viral encephalitis, confirming the importance of this investigation in the diagnosis of CNS infection.

No side effects were recorded.

With appropriate selection criteria and supervision, lumbar puncture is a safe, simple and valuable investigation in the emergency department.
The examination process in emergency medicine
Authors: Walpole Bryan , GAUDRY P L
Published: August 2010

The Australasian College for Emergency Medicine has held examinations since 1985. The Primary Examination is an examination in Anatomy, Pathology, Physiology and Pharmacology taken after medical registration. The Fellowship Examination is a certifying examination in emergency medicine taken in the fifth year of a 5 year advanced training programme. In this review the format and results of the examinations held during 1985 to 1991 are compared with the examinations in emergency medicine held by the American Board of Emergency Medicine, The Royal College of Physicians and Surgeons of Canada and The Royal College of Surgeons of Edinburgh and The Royal College of Physicians of Edinburgh.
Emergency acne: a case of acne fulminans with erythema nodosum and respiratory failure
Authors: RICHARDSON DREW B
Published: August 2010

Acne fulminans is a rare and severe form of acne with systemic involvement. A young female presented to the Emergency Department with acne and erythema nodosum and subsequently developed respiratory failure. Although systemic symptoms may be marked, acne fulminans is not normally associated with illness of this severity.
Facial and scalp injuries
Authors: FONG SAI YAN
Published: August 2010

The aim of this study was to define the aetiology, demographic detail, pattern or attendance and outcome of patients with facial or scalp injury (FSI) attending the Department of Emergency Medicine at the Royal Hobart Hospital over one month. A total or 168 patients (120 male, 48 female) were recruited. Seventy two percent were less than 30 years old and 6% were over 60 years. Injuries from assaults, accidents, falls and sports were more common in males than in females. Most patients presented “out of hours” with victims of assault coming in frequently between 2200 and 0300 hours. One hundred and four patients were discharged home, half being followed up in outpatient clinic. Only ten were admitted, six because of their FSI. This study shows that most FSIs are managed in the emergency department.
Neuropathy from household electric shock
Authors: FATOVICH DANIEL M
Published: August 2010

While neuropathy following electric shock has been well documented, this complication has always been associated with coexisting soft tissue injury. Two cases are reported of neuropathy following accidental household electric shock to the hand in which there was no associated soft tissue injury. These resulted in pain and disability for up to six months. Emergency physicians should be aware of the potential for this injury and that it has a good prognosis.
Envenomation by a death adder (Acanthophis antarcticus) in Perth
Authors: JELINEK GEORGE A , WAMBEEK NICHOLAS
Published: August 2010

Objective: Recently it has been recommended that a combination of brown snake and tiger snake antivenom be given to a patient envenomed by an unidentified snake in Perth, except when the bite occurred in the areas where the death adder is prevalent.

We present the first reported case of envenomation by a death adder (Acanthophis antarcticus) in Perth, with a view to examining the appropriateness of that recommendation.

Clinical features: A 36 year old woman, bitten in a suburb of Perth where death adders are not usually seen, presented with progressive paralysis.

Intervention and outcome: Rapid and complete recovery immediately after one ampoule of death adder antivenom confirmed the diagnosis of death adder envenomation.

Conclusion: The recommendation is appropriate. Death adder envenomation is in effect “the exception that proves the rule”. Vigilance for this rare envenomation is necessary.
Pneumoperitoneum following cardiopulmonary resuscitation
Authors: SMITH P B , McDONALD G
Published: August 2010

A case of pneumoperitoneum complicating cardiopulmonary resuscitation in a 54 year old man is presented. With clinical evidence of evolving peritonism, he underwent laparotomy, but no visceral rupture was discovered. A search of the literature reveals at least 12 cases of pneumoperitoneum following cardiopulmonary resuscitation, the majority from lesser curve gastric rupture, with several cases showing no evident rent at laparotomy or autopsy. To assist critical management decisions, especially with respect to performing laparotomy, several authors have proposed investigations and algorithms to separate those with visceral rupture from those without. These are evaluated, and in the context of the case presented, considered neither highly specific nor sensitive.
Value of the urine dipstick test for leukocytes in screening for urinary tract infection
Authors: YEUNG KAI‐CHO , WONG TAI‐WAI
Published: August 2010

A prospective study to assess the value of white cell detection in the urine as a screening test for urinary tract infection was carried out in an emergency department.

Commercially available dipsticks were used to detect urinary leukocytes.

A total of 105 adult female patients were entered into the study. The criterion for patient selection was the presence of urinary symptoms.

All urine samples were cultured. The presence of pure growth of a single organism with a colony count of greater than 105CFU per millilitre was taken as proof of urinary tract infection and was compared with the dipstick result.

A good negative predictive value was found in this study.

Dipstick testing for urinary leukocytes may be useful in ruling out a urinary tract infection in emergency departments.
The structure, process and outcome of emergency medicine training
Authors: GAUDRY P L
Published: August 2010

A study was conducted of 85 graduates of the Australasian College for Emergency Medicine to determine their perceptions of the quality of their graduate training and the status of their current practice. Participants were asked to use a scale of 1 to 5 (with 1 being a low or very poor rating, 5 being a high or very good rating) to rate their satisfaction with the structure of their training, the adequacy of the learning environment during training and the adequacy of their training relative to the emergency medicine curriculum. A response rate of 94% was achieved. Training in emergency departments (EDs) rated 4.0. Training in off‐service rotations rated 3.6. The learning environment during training rated 3.8. The scope of educational experiences, access to teaching and research resources, and the quality and quantity of supervision by non‐emergency physician specialists rated the lowest. The adequacy of their training relative to the curriculum rated 3.5, with a number of clinical areas including paediatrics, administrative aspects of emergency medicine and emergency medical systems, rated among the lowest. These perceptions in the context of the current practice of most graduates will help highlight the aspects of training that need further monitoring and improvement.
A change in road trauma attendances associated with a major campaign to lower the road toll
Authors: ROGERS I R , ABRAMSON M
Published: August 2010

Objective: To document the patterns of hospital attendances due to road trauma before and after a campaign, which commenced in Victoria in late 1989, to reduce the road toll.

Design: A retrospective review of the medical records of all patients presenting to an emergency department as a result of road trauma during June/July of 1989 and the corresponding period in 1990.

Setting: Emergency department of a secondary level hospital in the outer eastern suburbs of Melbourne.

Patients: Four hundred and twenty five patients presenting during June/July 1989 and 307 patients during June/July 1990.

Main results: In the period following the new road toll initiatives, road trauma attendances and admissions dropped significantly. With respect to demographic data and measures of injury type and severity the two groups were similar.

Conclusion: The savings to the community and health care system reflected in the observed changes should provide support for continuing campaigns to reduce the incidence of road trauma in Australia.
Undergraduate teaching of emergency medicine in Australasia
Authors: KELLY ANNE‐MAREE
Published: August 2010

Study objective: To describe current undergraduate teaching of emergency medicine in Australasia and analyse the structural features of this teaching.

Design: Cross sectional mail survey.

Setting and participants: Fellows of the Australasian College for Emergency Medicine.

Intervention: Questionnaires were sent requesting details of undergraduate teaching of emergency medicine at Fellows' parent institutions.

Measurements and results: Australasia has 30 undergraduate programs in emergency medicine. Teaching is occurring across the clinical years with concentrations in years 4 and 6. Seventy‐seven percent of programs employ a combination of structured and opportunistic learning experiences. Contact hours per student vary greatly, averaging 13 hours structured and 41 hours unstructured contact. Content of programs is highly variable. Input into assessment of programs is suboptimal. Program distribution across Australasia is uneven.

Recommendations: An undergraduate strategy and learning objective guidelines for emergency medicine should be developed. Pressure must be placed on medical schools for the inclusion of emergency medicine in curricula with appropriate input into student assessment. Emergency physicians should be encouraged to develop skills in education.
The safety of oxygen‐driven nebulisers in patients with chronic hypoxaemia and hypercapnia
Authors: CAMERON PETER , COLERIDGE JOHN , EPSTEIN JOSEPH , TEICHTAHL HARRY
Published: August 2010

There is potential to cause deterioration due to hypoxia in patients with acute exacerbation of obstructive airways disease with the indiscriminate use of aerosol bronchodilators delivered by air‐driven nebulisers without supplemental oxygen. Traditionally, air‐driven nebulisers have been reserved for the treatment of chronically hypoxic and hypercapnic patients with an exacerbation of chronic obstructive pulmonary disease (COPD). The purpose of this pilot study was to assess the safety of oxygen‐driven nebulisers (6 L/min) in the treatment of COPD patients.

Sixteen patients received bronchodilator via an oxygen‐driven nebuliser for 30 minutes. No patient deteriorated clinically and in all the PaO2 rose significantly (mean baseline 43.7 ± 6.3 mmHg (± SD) post nebuliser 108.8 ± 30.4 mmHg). There was an insignificant rise in PaC02 from 59.7 ± 9.1 mmHg to 66.4 ± 15.3 mmHg and this was not important clinically.

On the basis of this pilot study, we suggest that aerosol bronchodilators may be safely delivered by oxygen‐driven nebulisers in chronically hypoxic and hypercapnic COPD patients. A larger scale formal trial is indicated to compare oxygen‐driven versus air‐driven nebulisers in COPD.
Melioidosis presenting to the emergency department
Authors: HODGE JONATHON V
Published: August 2010

Melioidosis is a well recognised disease in the tropics. During the wet season of 1990/91, of 14 patients with melioidosis presenting the Townsville General Hospital, three were identified as presenting through the Emergency Department. These cases demonstrated the necessity for emergency physicians in the tropics to be vigilant for the disease.
Caustic ingestion still causes death and disability
Authors: EDWARDS ROBERT J , HANSON RALPH M , KILHAM HENRY A
Published: August 2010

Objective: To review the experience over five years of a major paediatric referral centre with caustic ingestion.

Design, setting and patients: A retrospective review was performed of 25 consecutive children with caustic ingestion who were managed at the Royal Alexandra Hospital for Children, Camperdown between June 1983 and December 1988.

Results: Sodium hydroxide (NaOH or lye) was the commonest caustic ingested. The remainder ingested various products used for household cleaning. All ingestions were accidental with a peak incidence between the ages of 12 to 36 months. Eighty percent of patients recovered without complications. One patient died and another patient made a full recovery after a Bilroth 1 gastrectomy for gastric burns. Four children developed recurrent strictures requiring repeated oesophageal dilatations for persistent dysphagia.

Conclusion: Caustic ingestion is still a cause of death and significant morbidity in children. A review of the literature shows that clinical findings do not reliably predict endoscopic findings and that there is little evidence in controlled human studies of the value of corticosteroids in reducing caustic injury to the oesophagus.
Prehospital defibrillation in Geelong
Authors: JACKSON TREVOR , CAMERON PETER
Published: August 2010

Introduction: In 1988, a defibrillation/CPR protocol was phased in over 12 months for the management of ventricular fibrillation (VF) by ambulance officers, in the Geelong region of Victoria. This study reviews the three years following its inception.

Study objective: To determine the success of this intervention in terms of survivors to hospital discharge, and compare this to the previous Australian and international literature.

Methods: A retrospective case analysis of the initial three years from June 1988‐June 1991. Ambulance case sheets and hospital records were studied for all patients where the protocol was exercised.

Results: Of 125 cases studied, 46 were excluded. Fourteen (18%) of the 79 patients included survived to hospital discharge.

Conclusion: The results compare favourably with previously published reports, and reaffirm early defibrillation as the key intervention in the management of VF.
Analysis of 24 cases of bullrout envenomation
Authors: FITZGERALD GERARD J
Published: August 2010

Notesthes robusta (bullrout) is a spined freshwater fish found in the rivers, creeks and estuaries of the east coast of Australia.

Its sting causes intense pain at the site of envenomation. The symptoms may be successfully treated by immersion of the affected part in hot water and infiltration with local anaesthetic.

This is a review of 24 cases of presumed bullrout envenomation presenting to the Emergency Department of Ipswich General Hospital. The characteristic and pathognomonic presentation is described and the response to treatment demonstrated.
Community‐acquired Aeromonas hydrophila meningitis
Authors: FRATZIA JAMES D
Published: August 2010

Objectives: To present a unique case of pyogenic meningitis due to Aeromonas hydrophila.

Clinical features: A previously healthy 66 year old man presented with fever, tachypnoea, back ache and delirium the day after he had been turning compost. Diagnoses of bronchopneumonia, septicaemia and meningitis were made on clinical, radiological and microbiological laboratory assessments.

Intervention: He was treated with IV cefotaxime for three weeks. He required ventilation for eight days.

Outcome: Recovery was complicated by persisting unilateral deafness and urinary retention secondary to prostatomegaly.

Conclusion: Previous reported cases of Aeromonas hydrophila meningitis have occurred in neonates or in adult hosts with compromised immunity. A single case of an immunocompetent adult who developed Aeromonas hydrophila meningitis three days after craniotomy has been reported. However, there have been no community‐acquired cases described in immunocompetent adults. Circumstantial evidence suggested that the organism had been inhaled while working with a compost heap. There have been no previous reports of acquisition of the organism in this manner.
Does undergraduate emergency medicine teaching equip junior doctors for ward emergencies?
Authors: ARDAGH MICHAEL , KELLY ANNE‐MAREE
Published: August 2010

Objectives:

To assess the competence of junior doctors in recognising and managing life‐threatening ward emergencies.

To compare the competence of a group which had received emergency medicine teaching with one which had not.

Method:

Sixty seven final year medical students participated in a structured written clinical examination designed to test their competence in recognising and managing four life threatening ward emergencies.

Papers were marked numerically against a pre‐determined marking schedule and were also reviewed for the presence of fatal management errors.

Comparisons were made between the group which had received emergency medicine teaching and the group which had not.

Results:

For the group which had not received emergency medicine teaching (n = 15) the average total score was 218/400. The group which had received emergency medicine teaching (n = 52) had an average score of 290/400. There was a significant difference between these groups (p<0.0001).

The group which had not received emergency medicine teaching committed 0.28 fatal errors per student per case. The group which had received emergency medicine teaching committed 0.07 fatal errors per student per case. This difference was significant (p<0.001).

Conclusions:

There is considerable scope to improve the competence of junior doctors for dealing with life‐threatening ward emergencies.

Junior doctors who received emergency medicine teaching scored significantly better than those who did not.

Emergency medicine teaching is a suitable tool to help equip junior doctors to deal with life threatening ward emergencies.
Factors affecting entry into prospective research in the emergency department
Authors: RICHARDSON DREW B
Published: August 2010

This paper presents systematic analysis of the rates of entry of patients into a large prospective descriptive study in an emergency department. Lower entry rates were associated with higher triage urgency and higher entry rates with increased department transit time and the presence of the principal investigator in the department. These findings have implications for the way in which emergency medicine uses the resources available for research.
Rapid HIV agglutination testing by clinicians
Authors: FULDE GORDIAN W O , EDWARDS ROBERT , DOWSETT ROBERT , PREISZ PAUL
Published: August 2010

Objectives: To evaluate the usefulness and practicality of clinicians performing rapid whole blood agglutination tests for the detection of HIV antibodies in a busy emergency department.

Methods:: Seventy seven patients agreed to participate in the study. Specimens from each were tested separately in the reference laboratory as well as in the Emergency Department. A different clinician performed the rapid test from the one who had collected the specimen. No investigator knew the status of the serum tested.

Results:: Seventy of those tested were negative on both series of tests. Seven tested positive on both the rapid and laboratory tests.

Conclusion: The rapid testing of blood for HIV antibodies within the emergency department is an essential diagnostic tool which easily and reliably determines the need for specific therapies in acutely ill patients.
Postgraduate emergency medicine training in the United States of America
Authors: TOTTEN VICKEN Y
Published: August 2010

Objectives: To describe the structure of emergency medicine residency training to Australasian emergency physicians and emergency medicine educators.

Method: This paper begins with an overview of general education, traditional medical education and residency training in the United States. Postgraduate emergency medicine training is covered in detail. Fellowships and the status of sub‐specialty training is discussed.

The Residency Review Committee mandates certain structural aspects of a postgraduate training program, including the Core Content and Core Curriculum. Criteria are being developed for sub‐specialty certification fellowships. Fellowships in emergency medicine remain mostly informal.

The scope of practice of emergency medicine in the United States is described, along with the interim compromises made necessary because of the shortage of trained emergency physicians.

Summary: Emergency medicine as a medical specialty is gaining recognition. An international exchange of information about training programs should improve emergency medicine everywhere.
Organochlorine ingestion
Authors: HORE CRAIG , GEORGE TERRY
Published: August 2010

A 48 year old man rapidly deteriorated and died following the intentional ingestion of a commercial pesticide mixture containing chlordane and dichloroethyl ether with kerosene as the solvent vehicle.

After oral ingestion, chlordane is primarily a neurotoxin. Dichloroethyl ether is a respiratory tract irritant. Both have effects on several other systems. Kerosene is a potent cause of aspiration pneumonitis when inhaled and gastric emptying is not recommended unless it is the vehicle for other, more toxic substances, as in this case.

Management for both chlordane and dichloroethyl ether ingestion is supportive, involving airway maintenance, decontamination, and gastric lavage and charcoal administration.
Measuring capillary refill time is useless
Authors: WATSON ADAM , KELLY ANNE‐MAREE
Published: August 2010

The objectives of this study were to define the range of normal capillary refill times for an adult population and to assess the contribution of age, gender and environmental temperature to any variability shown.

Data from 331 healthy adult volunteers were collected including age, gender, environmental temperature and capillary refill time by a standard method. Multiple regression analyses were used to assess the contribution of temperature, age and gender to the variation in capillary refill times.

A wide range of capillary refill times were found. Taking the 95th centile as the upper limit of normal, the upper limit of normal for males aged 14–65 years was 2.2 seconds, for females in the same age group 3.0 seconds; for males over 65 years 3.6 seconds and for females over 65,3.8 seconds. Capillary refill times varied significantly with age, gender and environmental temperature (p<0.01), however, taken together, these factors accounted for only 20% of the observed variance.

From this study and a review of the available literature it is concluded that measurement of capillary refill time does not perform satisfactorily as a test nor does it give useful information about the patient's circulatory status. Its use as an assessment tool in trauma should be discontinued.
Australian emergency departments and hospital‐acquired needlestick injuries
Authors: ROGERS IAN R , DUNN ROBERT , BRENTNALL EDWARD
Published: August 2010

Hospital‐acquired needlestick injuries are frequently managed in Australian emergency departments. In July 1992 a survey was conducted of all Australian emergency departments accredited by the Australasian College for Emergency Medicine in order to quantify the problem and identify common themes or deficiencies in management. The average rate of reported needlesticks was 2.9 per 100 hospital beds per month. At least 350 initial needlestick consultations occur per month in ACEM‐accredited EDs Australia‐wide or 4,200 per year.

More than two thirds of initial consultations for such injuries were in emergency departments but the majority of continuing care was provided in other sites. Over one third (37%) of emergency departments had inadequate or absent needlestick reporting sheets and three quarters failed to provide exposed workers with written information sheets. Zidovudine (AZT) was frequently unavailable or delayed in availability. Control of providing AZT was often vested in non‐emergency department clinicians. These problems are discussed together with suggestions for the format of an ideal needlestick protocol.
Profile of emergency department attendances
Authors: COLERIDGE JOHN T , CAMERON PETER A , WHITE JAMES B , EPSTEIN JOSEPH
Published: August 2010

Following the implementation of a computerised Emergency Department (ED) attendance record, the data collected were analysed to describe the profile of ED attendances. A McDonnell Douglas ED module (1988 version) upgraded at Western Hospital was installed one year prior to the study period. Data entry was performed by clerical staff at the time of attendance. Diagnostic coding was performed by hospital medical officers. Introduction of the computerised attendance record was associated with no increase in staffing and was accepted by the staff with minimum difficulty.

From 1 March 1989 to 28 February 1990, 48,748 attendances to the ED were documented at Western Hospital, Melbourne, Victoria, a 305 bed metropolitan hospital situated in the mixed residential and industrial western suburb of Footscray in Melbourne. Males predominated (55% of attendances overall), especially in the 16–25 year age group. Peak attendances were in the very young and young adult age groups. There was little seasonal variation in the number of attendances.

Just under 30% of attendances were due to trauma. This percentage is considerably lower than that reported by comparable overseas studies. Upper respiratory tract infections, asthma and other respiratory disorders made up 8.1% of all attendances, and gastroenteritis and non‐specific gastrointestinal disorders made up a further 4.6%.

It is essential that all Australasian EDs develop a computerised attendance record with data which are comparable between hospitals.
Australasian College for Emergency Medicine: Fellowship Examination 1986 to 1992
Authors: GAUDRY PAUL L
Published: August 2010

Study objectives: To determine the pass rate to the Fellowship Examination of the Australasian College for Emergency Medicine (ACEM) in 1986 to 1992, in relation to age and sex of candidates, the entry criteria to sit the examination and the number of attempts by candidates.

Design: Retrospective review of application forms, mark sheets and examination results of all attempts by candidates in the first 10 administrations of the examination.

Main results: One hundred and forty six candidates (124 male and 22 female) made 245 attempts at the examination. One hundred and eight candidates were successful. Pass rate among male candidates was 43% of attempts and among female candidates was 52% of attempts. Pass rate among candidates who had passed the ACEM Primary Examination was 52% of attempts and among candidates who had passed the Primary Examination of another College was 41% of attempts. The pass rate was 50% at the first attempt, 38% at the second attempt and 32% at the third or more attempts. The pass rate at repeat attempts was significantly related to the number of sections passed at the last previous attempt. The pass rates in the five clinical and oral sections (66%) was significantly lower compared with the pass rates in the three written sections (74%). The pass rates in the two sections of short cases (59%) was significantly lower compared with the pass rates in the six other sections (73%).

Conclusion: Candidates need to be better trained and better prepared for the examination and a programme of examiner training and monitoring is needed, so that the examination process is appropriate for the needs of ACEM.
The Royal Melbourne Hospital Emergency Department twenty years on
Authors: Waller Richard H
Published: August 2010

Introduction:

This study compared the patients who chose to attend the Royal Melbourne Hospital Emergency Department (RMH ED) for an arbitrary week in 1993 to those from a similar study completed 20 years before.

Method:

Of all patients presenting to the RMH ED over the week, those that chose to attend were entered into the survey.

Results:

The survey population was predominantly male, spoke English, was aged less than 45 years, had a relatively stable place of abode, and received an after tax income of less than $200 per week. Patients were less likely to be of Anglo‐Celtic descent than in 1973 and were unlikely to have attempted tertiary studies unless of Asian descent. The day of highest attendance had changed from Monday to Sunday. Although patients were likely to have a local doctor, they were unlikely to have seen him or her for the complaint. Patients stated that they were prepared to pay $10‐$20 for the ED consultation. As in 1973, most patients chose RMH ED for reasons of convenience, though more patients had attended the hospital before. In this study less patients were privately insured and more were pensioners, although more patients used private transport to come to hospital.

Conclusions:

Times have changed. If we are to provide optimal service to our patients we need knowledge of their background, social circumstances, and expectations as we provide emergency services into the 21st century.
Fatal fluoride toxicity from silver brazing flux ingestion
Authors: TILLEARD JAMES
Published: August 2010

Aim:

To describe a case of fluoride poisoning due to ingestion of silver brazing flux and review the pathophysiology and treatment of such ingestions.

Introduction:

The dominant hazardous constituent of silver brazing flux is KHF2 (potassium hydrogen fluoride). This compound is toxic, corrosive and rapidly absorbed from the gastrointestinal tract to produce systemic fluoride toxicity.

Case report:

A woman ingested an unknown amount of silver brazing flux and was brought to the Emergency Department hypotensive and obtunded. Despite vigorous resuscitation and electrolyte replacement she developed refractory ventricular fibrillation and died eight hours later in intensive care.

Discussion:

Hydrogen fluoride and its salts are widely used in industrial and domestic products but poisoning by these agents is uncommon. Rapid absorption produces systemic fluoride toxicity. This generates hypocalcaemia, hypomagnesaemia and hyperkalaemia with death resulting from refractory ventricular arrhythmias. These chemicals are corrosive and may cause haemorrhage or perforation of the gastrointestinal tract.

Conclusion:

Survival from such ingestions is rare. Early recognition and appropriate treatment are essential to optimise outcome.
The incidence and implications of haematuria in renal colic
Authors: LAU HC , SYME RRA
Published: August 2010

The aim of the study was to investigate the incidence of haematuria in patients presenting to the emergency department with renal colic, subsequently proven to be due to renal or ureteric calculus. Of 461 files reviewed, 239 satisfied the study criteria. Twenty two of these (9.2%) had no haematuria. Injectable narcotic analgesic was required in 203 of 239 cases whilst the remaining 36 patients received oral analgesic. Analysis of data from the study group as well as two other groups selected from the rejected files showed that the incidence of haematuria was the highest (91%) when patients presented with acute renal colic requiring injectable narcotic analgesic (active state) and was the lowest (47%) for patients admitted for elective management of calculi (quiescent state). Emergency intravenous urogram should be performed in patients presenting with suspected renal colic without haematuria.
A study of emergency admissions at the Flinders Medical Centre using the Appropriateness Evaluation Protocol
Authors: BAGGOLEY C J , PHILLIPS D G , APLIN P J
Published: August 2010

Analysis of 3,046 consecutive admissions through the Emergency Department at Flinders Medical Centre was performed to determine whether they were valid acute admissions. The study period was 15th December, 1992 to 28th February, 1993. There was an average of 40.1 admissions from just over 140 presentations per day during this period.

The admissions were reviewed against a modification of the Appropriateness Evaluation Protocol (AEP). This Protocol had been evaluated in a study for the Clinical Advisory Committee of the South Australian Health Commission. The modifications involved adding to the survey form criteria which had been accepted as overriding clinical reasons for admission in the Evaluation of the AEP report and conducting the survey prospectively as patients were admitted, rather than in a retrospective manner.

Analyses were made of the day and time of day of admission. A separate analysis was conducted of patients referred by general practitioners (GPs). The busiest days were Sunday, Tuesday and Thursday, the busiest time for admission was 1600 to 2000 hours. For GP referred patients the quietest day was Sunday.

Particular analyses were conducted on those criteria which had been added to the original AEP and on those patients who met none of the criteria, by definition, non acute admissions.

There were very few non acute admissions through the emergency department. Only 83 patients (2.72%), met none of the 24 criteria, although many of these admissions could be justified on the basis that there were no viable alternatives to admission.

If the AEP is to be used, the method chosen consumed fewer resources and provided the opportunity for more immediate analysis and feedback than the previous study.
Missed fractures in the emergency department
Authors: CAMERON MG
Published: August 2010

This study analyses missed fractures in the emergency department of an Australian teaching hospital. The proportion of fractures not identified on initial presentation of 42,795 patients to Princess Alexandra Hospital in Brisbane over 18 months from July 1991 to December 1992 was 0.11% of attendances, 0.47% of patients with injuries and 2.1% of patients with fractures. These rates are considerably lower than those reported in past studies. The implications of this as a measure of quality of care are discussed. It is postulated that this may be related to 24 hour cover in the emergency department by emergency medicine registrars.
Emergency management of wide complex tachycardia
Authors: SPRIVULIS PETER
Published: August 2010

Wide complex tachycardia (WCT) is a challenging clinical problem. Priorities in management are the rapid establishment of an appropriate diagnosis and the restoration of sinus rhythm with a minimum of discomfort or danger to the patient. Diagnosis is based upon clinical assessment and analysis of the 12‐lead ECG. Pitfalls in the assessment of the 12‐lead ECG are reviewed and a simple approach to 12‐lead ECG assessment described. Adenosine may be used as a diagnostic test when the underlying rhythm is uncertain. Current recommendations for the treatment of WCT and the role of newer therapies, including trans‐cutaneous pacing, are reviewed.
The emergency department management of status epilepticus
Authors: BROWN ANTHONY F T , WILKES GARRY J
Published: August 2010

Status epilepticus (SE) may be defined as two or more seizures without full recovery of consciousness between seizures, or recurrent epileptic seizures for more than 30 minutes. Generalised convulsive, tonic‐clonic status epilepticus is the form of SE with the greatest immediate threat to life, and is a medical emergency with morbidity and mortality related to duration of seizure activity.

This article reviews the pathophysiology and management of SE with particular emphasis on the pharmacotherapy of generalised convulsive SE.
Dystonia
Authors: CHEN STEPHEN K
Published: August 2010

Dystonia is a common reason for presentation to emergency departments. The drug‐induced form is rarely misdiagnosed, but there are a number of other causes of which the emergency physician should be aware. The purpose of this paper is to review the clinical features, relevant investigations and treatment of dystonia in the emergency department.
Post‐transportation mortality following acute traumatic spinal cord injury
Authors: Sansom Guy W , Brown Douglas J , Imran Bakht
Published: August 2010

Objective: To identify the mortality rate and cause of death from traumatic spinal cord injury following transfer to an acute spinal injuries unit.

Design: A five year retrospective analysis of mortality in adults admitted with suspected traumatic spinal cord injury to a specialised acute spinal injuries unit.

Setting: Spinal Injuries Unit, Austin Hospital, Melbourne. The sole acute adult unit in a catchment area of 5 million people.

Patients: Three hundred and ninety‐two patients admitted to the unit from 1 January 1988 to 31 December 1992.

Results: Twenty‐six patients died during their admission (6.6%), they had a mean age of 52.3 years, and death occurred a mean 35.6 days after admission. The common causes of death were pneumonia, pulmonary embolus, and multiple trauma. The highest mortality rate was during the first 24 hours following arrival at the unit.

Conclusion: There were no deaths attributable to inadequate stabilisation prior to transfer. Leading causes of death were pneumonia, pulmonary embolus, and multiple‐trauma. Comparison with previous studies is difficult due to wide variations in the selected study population.
Go‐karts and an emergency department: A case report in injury prevention.
Authors: Kelly Anne‐Maree
Published: August 2010

This report describing six cases of serious injury resulting from go‐kart crashes at a new facility within the first six months of its operation, demonstrates the important role emergency departments can play in the prevention of injuries by hazard identification and advocacy with appropriate authorities.
Anaphylactic shock: mechanisms and treatment
Authors: Brown Anthony FT
Published: August 2010

This paper reviews the mechanisms of anaphylactic shock in terms of the immunoglobulin and non‐immunoglobulin triggering events; and the cellular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule associated mediators and the rapidly formed, newly synthesised mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately curtail the anaphylactic reaction. The roles of these mediators in the various causes of cardiovascular collapse are examined.

The treatment of anaphylactic shock involves oxygen, adrenaline and fluids. The importance and safety of intravenous adrenaline are discussed. Combined H1 and H2 blocking antihistamines and steroids have a limited role. Glucagon and other adrenergic drugs are occasionally used, and there are several new experimental drugs.
Does alcoholic ketoacidosis go undetected?
Authors: Ragg Michael , Eddey David
Published: August 2010

Objective

To review the condition of alcoholic ketoacidosis.

Data sources

English language literature search using Medline® for the period 1973 to 1993. A total of 34 articles, abstracts and book chapters were used.

Data synthesis

Alcoholic ketoacidosis has been recognised for over 50 years yet there seems to be a lack of knowledge about this condition. The patient usually abuses alcohol, and presents with nausea, vomiting and abdominal pain. Laboratory tests show an increased anion gap metabolic acidosis and electrolyte changes secondary to vomiting and dehydration. Urinalysis may be negative for ketones. The differential diagnosis is that of a raised anion gap metabolic acidosis in the setting of chronic alcohol consumption. Intravenous fluids and glucose are the mainstays of treatment.

Conclusion

Acutely unwell patients who abuse alcohol commonly present to the emergency department. Failure to consider alcoholic ketoacidosis may lead to inappropriate discharge.
Guidelines for the rational use of paracetamol in febrile paediatric patients
Authors: Spain David J
Published: August 2010

Fever itself is usually not harmful and may enhance immune function. Paracetamol is widely used as an antipyretic in children. Paracetamol provides little or no benefit to the majority of these children. Significant harm, including death, has been described with paracetamol. This paper examines current understanding of the management of fever, in relation to the role of paracetamol. Recommendations are made for its less frequent use.
A middle aged woman with fluctuating conscious level and unsteady gait ACEM Queensland Faculty Inaugural Clinicopathological Conference
Authors: Sinnott Michael
Published: August 2010

This article is an edited version of a clinicopathological conference held by the Queensland Faculty of the Australasian College for Emergency Medicine. The case discussed by a panel of emergency medicine specialists, advanced trainees and invited guests, is of a 55 year old lady presenting with progressive deterioration in conscious state.

A list of important issues that may influence the daily routine of medical staff working in the emergency department is included in the conclusions.
Intermittent subclavian artery occlusion following clavicular fracture
Authors: Williams Sean RW , Pike Ian AH
Published: August 2010

Although fractures of the clavicle are common, complications are rare. A 41 year old painter developed two uncommon complications of clavicular fracture, mechanical intermittent subclavian artery occlusion and subclavian vein thrombosis. Both conditions were clearly identified on the clinical symptoms and signs and confirmed with dynamic angiography and computerised tomography. Operative intervention led to complete resolution of symptoms.