bluuebunny/crossref_metadata_2025 huggingface dataset:
Untersuchungen über den Einfluß einer Ver” gärung von Buchenholz” und Fichtenholzsäge” mehlen unter Zusatz eines Molke” Phosphor” säuregemisches sowie von Zucker auf die Verdau” lichkeit der Nährstoffe durch den Wiederkäuer
Authors: Kirsch W. , Jantzon H.
Published: August 2010

Die vorliegenden Versuche hatten den Zweck, ein von den Chemischen Werken Albert angegebenes Verfahren zu prüfen, wonach Holzsägemehl durch eine Vergärung mit Molke‐Phosphorsäurezusatz im Sinne einer “Aufschließung” für den Wiederkäuer verdaulicher gemacht werden kann. Auf Grund von Verdauungsversuchen am Hammel gelangten wir zu folgenden. Ergebnissen:

Frisches Buchensägemehl, nach Vorschrift mit Molke‐Phosphorsäurezusatz vergoren, wurde nur in geringem Umfang und nicht besser verdaut, als frisches Buchensägemehl im unvergorenen Zustande bzw. nach einer Vergärung mit Zuckerzusatz. Eine “Auf‐schließung” (im Sinne einer Erhöhung der Rohfaserverdaulichkeit) durch die Vergärung mit Molke‐Phosphorsäurezusatz ist nicht eingetreten.

Bei Fichtensägemehl (Weichholz) konnte eine wenn auch geringe Verbesserung der Rohfaserverdaulichkeit infolge der Vergärung mit Molke‐Phosphorsäurezusatz festgestellt werden (Rohfaserverdaulichkeit unvergoren 11,9%, vergoren mit Molke‐Phosphor‐säure 19,0%).

Eine Verfütterung von älterem, d. h. länger gelagertem Fichtensägemehl hatte genau die gleiche geringe Verdaulichkeit wie das frische Fichtensägemehl.

Eine Einsäuerung von Buchen‐ bzw. Fichtensägemehl im Gemisch mit gehäckseltem Futterrübenblatt erbrachte das gleiche Ergebnis wie die Versuche mit dem frisch verfütterten Sägemehl bzw. der Verfütterung von vergorenem Sägemehl, dem Zucker zugesetzt worden war.

Demnach hat die Vergärung von Buchensägemehl (Hartholz) rait Molke‐Phosphorsäurezusatz keine Wirkung. Bei Fichtensägemehl (Weichholz) — mit Molke‐Phosphorsäurezusatz vergoren — ist eine geringe Verbesserung der Rohfaserverdaulichkeit festzustellen, wahrscheinlich als spezifische Wirkung des Phosphorsäurezusatzes. Sie blieb aber zu niedrig, um daraus irgendwelche Schlüsse auf wirtschaftliche Anwendung ableiten zu können.

Die Untersuchungen wurden ausgeführt mit Unterstützung des A. T. F. Ausschuß für Technik in der Forstwirtschaft, Berlin W 9, dem an dieser Stelle gedankt sei.
Die Bestimmung des Chloridgehaltes pflanzlicher und tierisdier Substanzen auf potentiometrischem Wege
Authors: Scharrer K. , Jung J.
Published: August 2010

Die mit der genauen Erkennung des Endpunktes bei der maßanalytischen Chloridbestimmung zusammenhängenden Schwierigkeiten lassen die potentiometrisch indizierte Chloridtitration als besonders vorteilhaft erscheinen. In der vorliegenden Arbeit wird eine Methode mitgeteilt, die mit Hilfe üblicher Meßgeräte eine sehr genaue und schnelle Bestimmung des Chloridgehaltes pflanzlicher und tierischer Substanzen auf potentiometrischem Wege gestattet.
Einfluß von Antibiotika‐Zusätzen auf die Proteinverwertung nicht entölter und entölter Sojabohnen vor und nach einer Hitzebehandlung
Authors: Columbus A. , Gebhardt G.
Published: August 2010

Es wurden N‐Bilanz‐Versuche an wachsenden Albinoratten mit nicht entöltem und extrahiertem Sojabohnenmehl vor und nach einer Hitzebehandlung unter Zusatz von Penicillin und Streptomycin durchgeführt, um der Frage der Ausschaltung des wachstumshemmenden Prinzips der rohen Sojabohnen durch Antibiotika nachzugehen. Unter den Versuchsbedingungen ließ sich eine solche Wirkung nicht erfassen, da Hitzebehandlung und Antibiotikazugaben unabhängig voneinander wirkten und ein Antibiotikaeinfluß auch bei Fütterung hitzebehandelter Soja nachweisbar war.
Catfish sting
Authors: FULDE GORDIAN W O
Published: August 2010

This case serves as a reminder of the effectiveness of immersion in very warm water in the early management of pain following catfish and other marine stings. The importance of tetanus prophylaxis in such patients is emphasized.
Bilateral hypoglossal nerve palsies following head injury
Authors: BRENNAN RICHARD J , SHIRLEY JOHN P , COMPTON EFFREY S
Published: August 2010

Bilateral hypoglossal nerve palsies following head injury are very rare, with only two cases previously being reported. We present the case of an 11 year old boy who developed this disorder after being struck by a car and discuss the mechanism of injury which is most likely traction on the hypoglossal nerve.
Tricyclic antidepressant overdose at Westmead and Mount Druitt Hospitals
Authors: MORGAN J E
Published: August 2010

Tricyclic antidepressants are frequently taken in overdose and may be lethal.

In this study, over nearly four years, there was only one death from tricyclic antidepressant overdose at the Westmead Hospital, that patient being transferred comatose and probably brain‐dead after a cardiac arrest at another hospital.

The pharmacology of tricyclic antidepressants is reviewed and recommendations are made for the treatment of overdose.
Pre‐hospital triage: the national perspective
Authors: FITZGERALD GERARD J
Published: August 2010

Triage in emergency medicine describes the process of categorising patients on the basis of urgency.

Triage of patients is of importance in three main areas; firstly as a component of primary assessment to guide the treatment of individual patients, secondly as a basis for individual allocation of resources and finally as a case mix description of patient groups.

In the pre‐hospital environment the first and second of these are of most concern. Ambulance officers are faced with deciding how much treatment is offered to the patient in the pre‐hospital area, and the effects of treatment in the field on outcome, both good and bad. Vital decisions are often required, in the knowledge that the time required to apply that treatment must be balanced against the delay in accessing advanced care.

The ambulance officer is also confronted with choices to be made regarding the source of medical care most appropriate to the patient in the circumstances.

This paper reviews the concepts of triage as it applies to pre‐hospital care, the current status of triage models used in the pre‐hospital environment both internationally and in Australia and finally presents a plea for consistency based on scientific grounds both within the pre‐hospital environment and the hospital system.
The hazards of practising emergency medicine
Authors: FULDE GORDIAN W O
Published: August 2010

Emergency physicians work in a unique environment which provides the full gamut of emotions — tension, excitement, depression, joy, anger, feat.…. The challenges of the profession are simultaneously extremely rewarding and personally hazardous, and while the specialty is still new and rapidly developing, attention must be paid to the long‐term effects of such a life style on its practitioners. This is of significance both on a personal level to each emergency physician, and also to emergency medicine as a whole. In terms of the longevity of the specialty, we need to both attract young doctors with their enthusiasm and innovative ideas, and to retain more senior practitioners with their accumulated wisdom and experience.

This article outlines some of the hazards of the practice of emergency medicine in the hope that more attention can be given to alleviating these stresses.
Snake bite
Authors: KNOX IAN
Published: August 2010

Australian snakes (elapids) are from‐fanged, producing venom in a modified salivary gland primarily for hunting prey but which can also act as deterrent if the snake itself is attacked. The venom is a complex mixture of proteins whose clinical effects may include neurotoxic, myolytic, haemotoxic and other problems. The effects are primarily systemic rather than localised to the bitten part.

The “pressure‐immobilisation” technique has become established as the most appropriate first‐aid for bites from snakes and many other venomous Australian creatures. While there are no published clinical trials of its use, there is an accumulating body of experience attesting to its effectiveness. It has been found so effective that there has been a tendency to leave the bandage on too long. It is now recognised that the pressure bandage should be removed once antivenom therapy is available. The use of antivenom has produced a major reduction in the mortality of snake bite. As an aid to the selection of the most appropriate antivenom to use in any particular patient, a venom detection kit, recently updated, is available and is now an indispensable adjunct to the management of snake bite.
Crush syndrome
Authors: DUNJEY S J , BROWN A F T , MYERS C , CLEARY M I
Published: August 2010

Objective: To describe the clinical features of crush syndrome, the inter‐relationship between rhabdomyolysis, compartment syndrome and crush syndrome, and to make recommendations on the pre‐hospital and emergency department management of the condition.

Clinical features: Three case reports are described of patients presenting with crush syndrome following drug induced coma, including one patient in cardiac arrest. Raised compartment pressures were confirmed by manometry, and extensive rhabdomyolysis by myoglobinuria and raised creatine kinase.

Intervention and outcome: Vigorous medical management was undertaken including infusion of large volumes of intravenous fluid, and therapy with bicarbonate; mannitol, frusemide and dopamine. Surgical fasciotomy was not performed and a good outcome resulted in each case.

Conclusion: Drug induced coma is now the commonest cause of the crush syndrome. Effective medical management may obviate the need for surgical fasciotomy in cases with raised compartment pressures.
Graduates' comments on the training and examination programme of the Australasian College for Emergency Medicine
Authors: GAUDRY P L
Published: August 2010

A survey instrument was mailed to 85 candidates who were successful at the Fellowship Examination of the Australasian College for Emergency Medicine in 1986 to 1991. They were asked to comment on the College Training and Examination Programme. The comments have been edited and reproduced for information and critical appraisal by both Trainees and Fellows of the College.
Addisonian crisis
Authors: WHYTE KIERAN
Published: August 2010

Previously well patients presenting to emergency departments with Addisonian crisis are rare. A 20 year old man presented with the clinical picture of meningitis and septic shock. Septic screens were negative, and CT scan (brain) and lumbar puncture were normal. The only focus of infection was Campylobacter in the faeces. Autoantibody screen was negative, however thyroid and adrenal antibodies were elevated and testosterone was low with insufficient gonadotrophin response.

The patient improved with steroids and intravenous fluids and was discharged well ten days later. The Addison's disease was thought to be autoimmune in aetiology, with autoimmune hypogonadism and autoimmune thyroid disease also present.
Clostridial infections encountered in an aeromedical retrieval service
Authors: GAVAGHAN CHRIS , BENNETT MICHAEL
Published: August 2010

This paper describes four patients with clostridial wound infections recently treated by the Life Saver Rescue Service. A review of the current literature on tetanus and gas gangrene is presented.
Trauma scoring
Authors: THORPE A P
Published: August 2010

Since their inception, trauma scoring systems have developed to become a valuable aid in the management of traumatised patients, and in trauma audit and research. This article reviews the accepted trauma scoring methods and the attributes and weaknesses of each. Scoring systems may be useful at an individual patient, departmental and national level, with the TRISS methodology being particularly useful in national audit. The fundamental drawbacks affecting all systems are discussed along with the advances anticipated in the next few years.
Presenting successfully at scientific meetings
Authors: KELLY ANNE‐MAREE
Published: August 2010

Presenting a paper at a scientific meeting is at once challenging and anxiety‐provoking. It is also very important to us, both individually and as a developing specialty, representing our ability and willingness to contribute to medical knowledge and culture.

This article aims to provide some practical guidelines to turn this potentially traumatic experience into the successful and rewarding one it should be.
Oxygen therapy in emergency medicine Part 2. Paediatric oxygen therapy, special considerations and complications
Authors: SMART DAVID R , MARK PAUL D
Published: August 2010

This is the second of a two part article reviewing oxygen therapy in emergency medicine. The first part covered the physiology of oxygen, measurement of oxygenation and oxygen delivery apparatus. This section reviews oxygen therapy in specific clinical settings including paediatrics, acute medical conditions and shock. Oxygen therapy during patient transport, complications of oxygen therapy and special delivery systems are also reviewed. The emergency physician should possess a thorough knowledge of this therapeutic modality which forms one of the cornerstones of emergency medicine.
The outcome of patients after “collapse”
Authors: Symmons David A D , CAMERON PETER
Published: August 2010

Objective: There have been few studies examining patients with a triage diagnosis of collapse and none which has determined the outcome of these patients as a group. This study was undertaken to determine the frequency of the triage diagnosis of collapse, the differential diagnosis in these patients, and if any errors in diagnosis occurred.

Design: Case notes over a six month period from the 1 October 1991 to the 31 March 1992 were retrospectively studied. Outcome was assessed at six months.

Setting: The Emergency Department of the Geelong Hospital, a 450 bed teaching hospital serving a population of 250,000 in a large provincial centre in Victoria.

Results: There were 17,588 attendances to the ED during the study period. One hundred and seventy four patients (1%) had a triage diagnosis of collapse, of whom 173 were included in the study. One hundred and seventy patients were followed up at six months. Faint was the commonest diagnosis (28%), and was usually benign. In particular, faint was the commonest diagnosis in patients over 75 years of age. For patients in whom the diagnosis of faint was made, it was correct in 98% of cases. There was a high overall mortality (9%), and a very high mortality in patients over 75 (24%). No patient less than 60 years of age died. Early deaths were generally due to major cerebrovascular accidents. Later deaths were mostly due to either untreated cardiac disease in very elderly or demented patients or metastatic cancer. The high death rate did not reflect misdiagnosis. It reflected the high morbidity and mortality of conditions which present with collapse, particularly in patients over 75 years of age. Misdiagnosis in these patients was uncommon (3%) and was generally related to three diagnostic areas, epilepsy, arrhythmias and gastrointestinal haemorrhage.

Conclusion: Patients presenting with a triage diagnosis of collapse form a significant part of the emergency department workload. Faint is the commonest diagnosis and is usually benign. However, many conditions which present with collapse are associated with a high morbidity and mortality, particularly in patients over 75 years of age. Therefore care must be taken to exclude these more serious conditions, particularly epilepsy, arrhythmia and gastrointestinal haemorrhage, before a diagnosis of simple faint is made.
Time to definitive management of open fractures of long bones
Authors: MCCASKILL MARY E , LITTLE DAVID G
Published: August 2010

A retrospecive review of 97 fractures in 89 patients attending the Emergency Department at Royal North Shore Hospital between January 1988 and June 1992 was performed to study the effect of time to definitive management on outcome in open fractures of long bones.

Time in the Emergency Department to receiving antibiotics averaged 1.5 hours, time from injury to antibiotics averaged 2.5 hours. Average time from injury to debridement was 7.3 hours, of which 5.7 hours was in‐hospital time. A delay in receiving antibiotic prophylaxis of greater than three hours was associated with a significantly higher infection rate (13%) than less than three hours (0%) (p = 0.04). Similarly, operative delay of more than eight hours was associated with a significantly higher infection rate (13%) than less than eight hours (0%) (p = 0.04). The combination of these factors was highly significant, in fact accounting for all cases of infection (p = 0.02).

The combination of delayed antibiotic administration and debridement contributed more to the likelihood of infection in open fractures than either factor alone. Thus early antibiotic prophylaxis and rapid processing of the patient assume great importance in the management of these injuries in the emergency department.
The Tower of Babel or uniform reporting of cardiac arrests?
Authors: FULDE GORDIAN W O , PREISZ PAUL , HAMER WAYNE
Published: August 2010

Objectives: To assess the uniformity of reporting and data collection for cardiac arrests in Australia.

Methods: Twenty seven Australian teaching hospitals were surveyed. They were asked whether they used specific CPR/arrest forms and their content.

Results:: The survey showed only 12 of 27 hospitals had specific forms recording cardiac arrests. Nine of 27 captured 25% or more of essential data as defined by the “Utstein” conferences. A CPR/arrest form is presented which is based on a form that has been successfully used by major hospitals for over four years and incorporates the major Utstein data required for meaningful review and research.

Conclusion: Uniformity of data collection on CPR/cardiac arrest has been agreed to internationally. In order to assess, compare and improve our results in Australia, such a format is needed A suggested data collection form is presented. At present the information chain from the time of a collapse to a cardiac arrest, through bystander CPR, general practitioner treatment, ambulance treatment, in hospital management and outcome is not usually, let alone uniformally, recorded. This is a vital step in order to improve patient care and effectively allocate resources.
Teaching and learning in the emergency department
Authors: KELLY ANNE‐MAREE
Published: August 2010

Emergency physicians are increasingly being called upon to take on roles as teachers. For many, this is a new role and one for which they feel ill‐prepared. This paper aims to provide an overview of some of the key issues and challenges that accompany the acceptance of this new role.
Tension pneumopericardium following blunt trauma
Authors: FITZGERALD MARK C , FOORD KATRINA A
Published: August 2010

Tension pneumopericardium is uncommon after thoracic trauma and generally occurs following penetrating injury. Survivors of tension pneumopericardium secondary to blunt thoracic trauma are rare.

We present the case of a 41 year old woman with multiple injuries after a high speed motor vehicle crash, who developed tension pneumopericardium shortly after endotracheal intubation and positive pressure ventilation. Aspiration of 110 mls of air from the pericardium in the Emergency Department produced a dramatic improvement in her condition and she was discharged 28 days later.
Hepatitis A to G
Authors: BOUGHTON C R
Published: August 2010

Since the discovery that the “Australia antigen” was the surface antigen of the hepatitis B virus in the late 1960s, great advances have been made in the study of hepatitis B and other types of viral hepatitis. Different techniques have been used to characterise the non‐B agents, resulting in the identification of hepatitis A, C, D and E. The agents causing hepatitis F and G remain to be characterised. Some of these viruses are transmitted enterically (A and E), the rest are transmitted parenterally. Workers in emergency medicine need to be aware of these entities and to ensure their own protection by immunisation against hepatitis B, and hepatitis A when a vaccine becomes available.
Planning undergraduate education programs for emergency departments
Authors: Paget Neil , Kelly Anne‐Maree , Wassertheil Jeff
Published: August 2010

Summary of outcomes of a workshop focusing on undergraduate education in emergency medicine held at the Annual Scientific Meeting of the Australasian College for Emergency Medicine in Christchurch, New Zealand, August 1993.
Hypokalaemic periodic paralysis associated with hyperosmolar diabetes mellitus
Authors: Bryant Michael G
Published: August 2010

A 23 year old Chinese man presented with hypokalaemic periodic paralysis and hyperosmolar diabetes mellitus. Diabetes mellitus has not previously been reported in combination with hypokalaemic periodic paralysis. Although periodic paralysis is a rare condition, this man is likely to represent with further episodes, as insulin and glucose fluctuations precipitate paralysis.
The management of the sexual assault victim in the emergency department
Authors: Knox Ian
Published: August 2010

The management of the sexual assault victim is a complex challenge for the emergency physician. A combination of medical, forensic and psychological consequences for the victim require a well prepared, team based approach which includes doctors, nurses, counsellors, police and others. Protocols for the reception of the victim in the emergency department, the medical assessment and subsequent follow up must be in place before the victim's arrival. The most important aspect of caring for the survivor is to ensure that she (or he) is in control of the manner in which support is provided. This review details the important aspects of the provision of medical care, the forensic evaluation and the psychological effects of the sexual assault.
Ultrasound in emergency medicine
Authors: Kruk Christopher
Published: August 2010

Ultrasound is a safe, non‐invasive portable imaging modality, applicable to many areas of emergency medicine. Its use in emergencies such as suspected ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy, haemoperitoneum secondary to blunt abdominal trauma and cardiac tamponade is well established. Its efficacy in such diverse conditions as acute appendicitis, gallstones, renal stones and urinary obstruction, obstetric and gynaecological conditions, deep venous thrombosis, scrotal pain and soft tissue foreign body localisation has also been demonstrated.

Echocardiography is particularly useful in the investigation of aortic dissection, ischaemic heart disease, suspected pericardial effusion and cardiothoracic trauma. Emergency physicians have been successfully trained in the technique in other countries. The time is right for Australasian emergency physicians to become trained in ultrasonography, use the technique in daily practice and share this knowledge with other emergency physicians and trainees.
Cardiac arrest due to digoxin toxicity
Authors: Dean Andrew M , Fitzgerald Mark C , Gocentas Robert
Published: August 2010

This paper describes the successful outcome from cardiac arrest of a 70 year old woman following digoxin toxicity. Cardiopulmonary resuscitation was continued for 55 minutes, until the return of cardiac output within minutes of digoxin‐specific Fab fragment (Digibind®) therapy. The pharmacology and indications for using digoxin‐specific Fab fragments are discussed. Cardiopulmonary resuscitation should be prolonged in such a situation.
Three cases of envenomation by Stephen's banded snakes
Authors: Comadira Gregory P , Green David
Published: August 2010

Objective

To describe three cases of envenomation by the Stephen's banded snake, a species not previously identified as likely to cause serious illness.

Clinical features

Three cases of envenomation by Hoplocephalus stephensii are presented. Two of the patients had no symptoms and one mild symptoms only. All had significant coagulation disturbances.

Intervention and outcome

Two patients were managed with tiger snake antivenom. All three recovered uneventfully.

Conclusion

The venom of Stephen's banded snake produces major disturbances of coagulation. In these three cases there were few systemic symptoms. Tiger snake antivenom was shown to be the appropriate antivenom.
Pulmonary and cardiac contusion sustained in utero: an unusual cause of neonatal death
Authors: Dent Andrew , Davies Glen
Published: August 2010

A 30 year old woman fell from a cocoa tree when 37 weeks pregnant, sustaining a fractured pelvis. She went into early labour, delivering a live infant the next day, with Apgar scores of 7 and 9. The child developed progressive respiratory distress and died at 12 hours. The clinical, radiological, and post mortem macroscopic and microscopic appearances were those of pulmonary and cardiac contusion, most likely sustained in utero during the maternal fall.

Pulmonary and cardiac contusion are recognised as principal causes of respiratory distress associated with chest injury in children. This is the first report of pulmonary contusion sustained in utero causing neonatal death.
Ankle fractures after slipping on pea gravel at Rally Australia
Authors: Morgan Joanna L
Published: August 2010

Accident injury is prevalent at large public events. Two cases of significant ankle fractures which occurred from slipping on a pea gravel surface at the 1994 Rally Australia in Perth are discussed. This paper addresses the patient morbidity and offers suggestions to prevent recurrence of such accidents for similar public events.
Failed prehospital resuscitation following out‐of‐hospital cardiac arrest: are further efforts in the emergency department warranted?
Authors: Brennan Richard J , Luke Colin
Published: August 2010

Study objectives

To compare the clinical course and survival rates of patients who arrive in the emergency department with a pulse and those who arrive pulseless following out‐of‐hospital cardiac arrest.

Study design

Retrospective chart review.

Patients

All normothermic adult patients presenting to the emergency department of an Adelaide teaching hospital following an arrest of presumed cardiac origin over a two year period.

Results

Of 27 patients arriving with a pulse in the emergency department, 15 (56%) survived to hospital discharge. Of 247 patients arriving pulseless in the emergency department, 20 had return of spontaneous circulation following further resuscitation and were admitted. Only three (1%) of these patients survived to hospital discharge. The comparative survival rates for the pulse present (56%) and pulseless (1%) groups is statistically significant (P < 0.0001) with odds ratio of 102. All three survivors in the pulseless group arrested in the presence of ambulance personnel, two in the ambulance just prior to arrival at the hospital.

Conclusion

Continued resuscitation of patients who arrive pulseless in the emergency department following out‐of‐hospital cardiac arrest is not indicated. Exceptions are patients who arrest in the presence of ambulance officers and those with persistent ventricular fibrillation. We propose a set of national guidelines that will assist ambulance personnel and emergency department staff in determining when to discontinue resuscitative efforts.
Primary meningococcal pericarditis complicated by tamponade
Authors: Brennan Richard J , Davis Lloyd
Published: August 2010

Pericarditis as a complication of meningococcal meningitis or meningococcaemia is uncommon, occurring in approximately 5.1% of cases. Meningococcal infection of the pericardium in the absence of meningitis is even rarer, with only 22 cases previously described. We report a case of primary meningococcal pericarditis complicated by cardiac tamponade in a 27 year old male and review all previously reported cases. The clinical features, epidemiology, investigations and management of primary meningococcal pericarditis are discussed.
Is routine screening for paracetamol in intentional drug ingestion of clinical value?
Authors: Garner Alan
Published: August 2010

This retrospective study assesses the value of routine screening for paracetamol in all adults with known or suspected drug overdose. The cases of 421 patients who presented with known or suspected drug overdose between 1 January 1994 and 31 October 1995 were reviewed. There were 119 patients with suspected paracetamol ingestion of whom 85 had elevated paracetamol levels and 17 required treatment with N‐acetylcysteine. There were 293 patients in whom paracetamol ingestion was not initially suspected and of these six had elevated paracetamol levels but none were potentially hepatotoxic. No history was available in nine patients, one of whom had an elevated level which was in the potentially hepatotoxic range. The incidence of potentially hepatotoxic paracetamol ingestions which are missed by clinical assessment is very low. Therefore all adults suspected from their history of a toxic paracetamol ingestion and those in whom a history cannot be obtained, but drug ingestion is suspected should have rapid screening for paracetamol performed. Other patients may safely have the necessity for a serum paracetamol level determined by a thorough and directed history.
Patients with adverse drug reactions attending an emergency department
Authors: Collits Brian L , Kennedy Michael , Wu Michael , McIntosh(Deceased) James
Published: August 2010

Aim

To study the incidence and identify the economic impact of patients with adverse drug reactions attending the emergency department.

Setting

A metropolitan district hospital.

Methods

Over a one year period, all attendances were screened for adverse reactions in accordance with specific criteria. An economic assessment was conducted to ascertain the direct cost to the health care system of identified patient presentations.

Results

One hundred and one attendances (0.59%) were due to adverse drug reactions and adverse reactions accounted for 44 hospital admissions via the emergency department (0.88%). Using a clinical costing model, adverse drug reactions cost $162,000 per annum.

Conclusion

Patients with adverse drug reactions form a small percentage of attendances but are a significant cost to manage.
Electronic injury surveillance in an emergency department
Authors: Pitt W Robert , Jones Denise , Graham Cheryl , Nixon James W , Balanda Kevin P
Published: August 2010

Injury control is one of the four priorities of the current National Health Strategy. Injury control targets are an integral part of this strategy and these require the measurement of the incidence of selected injuries. The strategy encourages local community based injury prevention programs. These programs need local data describing the determinants and distribution of injury in the particular community. Emergency department injury surveillance data is one source for this data. However manual data collection has been difficult to implement in Australian hospitals. This study reports an evaluation of the first electronic injury surveillance system integrated into an emergency department patient management system in Australia. This system was well accepted by emergency department staff and achieved good criteria validity in the range 88% to 100% on the injury data items. Emergency department nurses described the departmental requirement to collect injury data as being acceptable. Most nurses rated the injury coding system as satisfactory.
Drowning is rarely associated with spinal injury
Authors: Angley Christopher J , Allen Mervyn R
Published: August 2010

A nine year retrospective review was conducted of the case notes of 60 patients with spinal injury related to water accidents presenting to the Spinal Injuries Unit of the Royal Adelaide Hospital. A retrospective review was also performed of the South Australian Coroner's records of 113 drowning deaths occurring between January 1990 and May 1995.

Ninety percent of patients admitted to the spinal injuries unit were males, most were young (13–62 years, mean 25 years) and 75% sustained injury diving into shallow water. Seventy three percent of injuries were to the lower cervical spine (C5, C6, C7). Thirty percent resulted in permanent tetraplegia. An additional 25% had transient neurological loss. Thirteen percent had loss of consciousness, half of which were near‐drownings. There were no deaths and only one case of aspiration pneumonia. Prehospital spinal immobilisation was poorly documented. Only 15% of cases were recorded as having adequate spinal immobilisation applied. Only 2% of drowning deaths in the Coroner's records were reported as having associated spinal injuries.
The technical requirements for warming during fluid replacement
Authors: Russell W John
Published: August 2010

Equipment available for warming during fluid replacement frequently fails in basic ways to meet its requirements. The fluids which need warming most are blood or blood products which have been stored close to 0°C. These require sufficient heat to raise the temperature to at least 32°C but some warmers are underpowered. Heat transfer is also a problem but if water is used, the difficulty can be reduced by agitation.

All passive devices may benefit from use of a container with material which has a good heat transfer characteristic. However, the common polyvinyl chloride (PVC) is a good insulator and will impede heating unless very thin. Denser material such as the polythenes gives better heating. Units made of aluminium which has excellent heat conductivity will give a good warming performance.

Units which have passive transfer systems cannot have heating above 42°C or blood may haemolyse. However, setting the heater at 37°C lessens the performance at high flow as there is a smaller gradient for the heat transfer.

Unless the basis for fluid heating is understood, medical practitioners who use rapid fluid replacement will continue to accept poorly performing equipment and may jeopardise the recovery of their patients.
Brachial plexus and major vascular injury during parachuting
Authors: Lui Jeffrey , Holdgate Anna
Published: August 2010

A case of bilateral shoulder injuries during parachuting with a unilateral brachial plexus and major vascular injury is reported. A literature review over the past 50 years describes the distribution of parachuting injuries and predictive risk factors. The combination of injuries in the reported case has never been described in the literature.
Steam inhalation
Authors: Martin Hugh , Brodie Lynne , Fitzgerald Dominic , Van Asperen Peter
Published: August 2010

A description is given of burn injuries caused by hot water during inhalational therapy for croup and upper respiratory tract infections. Thirty children were admitted to the Royal Alexandra Hospital for Children Burns Unit. Most children were under six years (range from seven months to 14 years). The injuries were more severe than average scalds. The majority (23 of 30) had burns of less than 15%, but more than half required skin grafting. The average length of stay was 18.5 days (1 to 77 days). Steam inhalation has no beneficial effects and can cause serious injury.
The diagnosis of traumatic intra‐abdominal haemorrhage in patients with normal vital signs
Authors: Wilkes Garry J , McSweeney Peter A
Published: August 2010

Two cases of haemorrhagic shock from intra‐abdominal blood loss are presented. In both cases the pulse rate and blood pressure remained in the normal range following minimal volume resuscitation, despite significant blood loss. The presentation and evaluation of patients with suspected intra‐abdominal haemorrhage following blunt abdominal trauma is discussed. The value of a high speed helical CT scanner located in the emergency department is demonstrated.
Emergency medicine registrars and perceptions of rural practice
Authors: MBBS Steven Doherty , Hungerford Philip , Beeney Linda
Published: August 2010

Aim

To determine those factors which influence trainees' attitudes to the practice of emergency medicine in rural areas.

Method

A questionnaire containing a rating scale was sent to all trainees of the Australasian College for Emergency Medicine who had passed their primary examination up to and including examination 1995.1, asking them to rate the influence of a number of variables on their likelihood to practice emergency medicine in rural areas.

Results

Registrars who spend greater than six months of basic or advanced training in rural areas or who intend spending greater than six months training in rural areas believe they are more likely to work as emergency medicine specialists in rural areas.

The broader clinical role, smaller and friendlier hospital environment, different casemix of rural medicine and rural lifestyle are significant positive attractions of rural emergency medicine.

Potentially greater on‐call arrangements, perceived lack of resident medical officers and perceived lack of specialist services are significant deterrents to rural emergency medicine practice.

Conclusion

The study demonstrates those factors which influence trainees' attitudes to rural emergency medicine.
The predictive significance of presenting symptoms, signs and radiography in paediatric head injuries
Authors: Wyllie Peter
Published: August 2010

Objective

To analyse the significance of commonly used symptoms, signs and radiography in predicting skull fractures, intracranial injuries and the need for neurosurgical intervention in paediatric head injuries.

Setting

A paediatric tertiary referral hospital in central Sydney.

Method

A 10 year retrospective chart review of all patients admitted with head injuries.

Results

Skull fractures were associated with decreasing age, findings of a scalp haematoma, clinical signs of a basal skull fracture and suspected skull depression/penetration. Intracranial injury (ICI) was associated with decreasing GCS scores, eye signs, suspected skull depression/penetration and skull fractures. Neurosurgical operative treatment was associated with decreasing GCS scores, eye signs, and skull fractures.

Skull fractures were associated with neurosurgical operative treatment in all age groups. However the association of skull fractures and ICI was not significant in three of the five age groups examined.

Conclusions

In stratifying the risk of a complicated paediatric head injury, a greater focus should be made on specific physical findings. Less emphasis should be placed on historical features. Abnormal skull radiography may assist in stratifying the risk of intracranial injuries or the need for neurosurgical treatment. However the limitations of this imaging modality need to be acknowledged.
Which rewarming therapy in hypothermia? A review of the randomised trials
Authors: Rogers Ian
Published: August 2010

Introduction

Hypothermia may be encountered at some time in most parts of Australasia. There is a need to evaluate the merits of the various practical rewarming therapies available.

Method

An electronic and manual search of databases to identify randomised trials published between 1966 and 1996 inclusive which evaluated rewarming therapies in hypothermia.

Results

There is a paucity of randomised trials on this subject and many of the rewarming therapies recommended in authoritative texts and reviews have never been evaluated in randomised clinical trials. In published trials core afterdrop is typically <0.5 C and is least with active core rewarming. Passive rewarming alone may be expected to raise core temperature by 0.75 C/hr and the addition of inhalation and/or forced air rewarming can be expected to at least double this.

Conclusions

The choice of rewarming therapy may be largely one of practicality and availability. Future rewarming research should focus on clinical outcomes in patients with moderate to severe hypothermia.
Metabolic acidosis associated with volatile substance abuse
Authors: Hazell Wayne C
Published: August 2010

A young female presented to Auckland Hospital Emergency Department complaining of shortness of breath associated with paint sniffing. She was found to have a normal anion gap acidosis.

The diagnosis, mechanisms and clinical course of the acidosis are discussed. Some practical management issues and difficulties of the case are highlighted.
Management of periorbital infections
Authors: Bryant Michael
Published: August 2010

A case of orbital infection complicated by a subperiosteal abscess is presented. Orbital infections may be distinguished clinically from preseptal (periorbital) cellulitis by the presence of proptosis, pain and limitation of eye movement and reduced visual acuity.

Complications of orbital infections include blindness, central nervous system infection, cavernous sinus thrombosis and death. Suspected orbital infections require CT scanning to stage the lesion and determine the need for surgery. Orbital infections require aggressive parenteral antibiotic therapy. Orbital abscesses require urgent surgical exploration and drainage.
Resuscitation outcomes in the elderly
Authors: Day Robert
Published: August 2010

The elderly are using an increasingly greater proportion of emergency department resources. Age alone is a poor prognostic indicator of outcome from life threatening illness. The outcomes of resuscitation from major injury, primary cardiac arrest, myocardial infarction and sepsis in the elderly are well documented in the medical literature. A summary of the current literature concerning outcomes of resuscitation in the elderly is presented.

The predictors of in hospital mortality for the elderly after major trauma are a high injury severity score, a low trauma score, increasing age, severe head injury, burns, shock, sepsis, prolonged ventilation and pre‐existing disease. Those who survive and are discharged from hospital do not usually require long term nursing care. Elderly major trauma victims should be treated aggressively in the emergency department.

The outcome of resuscitation from primary cardiac arrest in the elderly differs little from that of the younger population, where the initial rhythm is the main determinant of survival rather than age.

Myocardial infarction and its complications are more prevalent in the elderly. There is a greater net reduction in mortality in those aged over 75 years treated with thrombolytic agents than in any other age group.

No reliable early predictors of outcome from sepsis in the elderly have been found. Factors such as severity of illness, pre‐existing disease and functional status are more important than the age per se.
Urethral self‐insertion case report and review of the literature
Authors: Lamberth Paul
Published: August 2010

Self insertion of foreign bodies into the urethra is an unusual cause of presentation to the emergency department. In this case, a 36 year old man inserted a safety pin into his urethra. Medical advice was sought 10 hours after the pin became lodged in an open position with the point facing distally. After local anaesthetic gel was instilled into the urethra, the pin was closed with external pressure and removed.

An open safety pin in the urethra has previously been reported only once in the medical literature. This appears to be the only definite description of a safety pin with such an unfavourable orientation being easily removed.

Though removal of foreign bodies in the emergency department is likely to be an exceptional occurrence, there are important implications for emergency department staff. These include the diagnosis of foreign bodies presenting with complications, where the history of foreign body may not be given, and the issue of psychiatric review.
Recognition of deficits of physical and cognitive function in the elderly by medical staff in the emergency department
Authors: Caplan Gideon A , Croker William D , RN Ann Brown
Published: August 2010

Aims

To evaluate the recognition of deficits of physical and cognitive function in the elderly by emergency department medical staff.

Methods

Retrospective survey of the records of 486 patients aged 75 years and over discharged from the emergency department.

Results

Assessments of cognitive and physical function were noted in 88 (18.8%) and 115 (24.6%) records respectively. Less experienced doctors recorded assessments less frequently for cognitive and physical function than senior doctors (16.3% vs 32.6%; Chi2 = 10.0; p = 0.0015 and 21.9% vs 38.2% Chi2 = 12.0; p = 0.0005 respectively). Senior doctors recorded more assessments on cognitively or physically impaired patients than non‐impaired patients. Less experienced doctors did not.

Conclusion

More experienced doctors exhibited unwritten clinical judgement in recording assessments for impaired patients more frequently than non‐impaired patients. There is a need for better teaching of geriatric emergency medicine to improve the assessment of cognitive and physical function of elderly patients in the emergency department by junior doctors.
Trauma in the western region of Saudi Arabia
Authors: Ansari Mohammed ZRH
Published: August 2010

Objective

To evaluate the pattern of injuries and available prehospital and hospital care in this rapidly emerging country with western type hospital and trauma care resources serving a population that in many areas is still considered to be developing.

Setting

Accident & Emergency Department of King Khalid National Guard Hospital, Jeddah, Saudi Arabia.

Method

Records of all patients admitted to the accident and emergency department sustaining injuries due to trauma were studied, including patients brought in dead.

Results

Injuries represented 10% of all accident and emergency referrals. Falls were the most common cause of injury, followed by sports injuries and road traffic accidents. The male to female ratio for all injuries was 3:1; 84% of injured patients were below the age of 30 years with 34% 10 years old or less.

Sprains and strains were the commonest injury type (23%); followed by lacerations (20%) and fractures (19%).

Total mortality among seriously injured patients was 35%. Eight out of 14 brought in dead to the accident and emergency department had an ISS of less than 30 and four had a score of less than 18.

Conclusions

Trauma constitutes a major cause of mortality in Saudi Arabia. Road traffic accidents account for only 10% of injured patients, but cause greatest mortality and morbidity.

Untrained ambulance staff and the lack of paramedics were identified as causal in the mortality among patients brought dead to the accident and emergency department with a very low injury severity score. Recommendations are made to improve the outcome of trauma victims.
Severe subcutaneous emphysema and pneumomediastinum
Authors: MBChB Craig Hourigan , Bergman Jack
Published: August 2010

Spontaneous pneumomediastinum has been commonly associated with recreational drug abuse. This often follows vigorous inhalation and the performance of a ritual valsalva‐type manoeuvre. We describe a case of extensive pneumomediastinum and subcutaneous emphysema associated with intravenous drug abuse and bystander mouth‐to‐mouth resuscitation. This case presents a new dimension to the clinical presentation of illicit drug abuse, and supports the importance of appropriately learned Basic Life Support in high risk population groups.
Haematoma block: a potentially useful technique for Australasia
Authors: Gulick Tod , Pederson Leigh
Published: August 2010

Haematoma block is a simple, safe and effective anaesthetic technique used to facilitate the reduction of closed fractures. It was described in the 1920s and is in common use worldwide. Haematoma block has been used effectively in patients as young as two years of age. It has the advantages of ease of administration, fast onset, long duration of fracture‐site analgesia, and it does not require specialised equipment. Haematoma block may be safely administered by a single doctor. It is unique in the ability to provide fracture‐site analgesia without sedation or cumbersome tourniquet, making it ideal for many medical retrieval situations. The safety of the technique makes it well suited to rural practice. The speed and minimal monitoring requirement enhances its utility in the busy urban emergency department.