bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of assault within a regional Victorian population
Authors: Taylor David , Eddey David , Cameron Peter 
Published: August 2010

AbstractThe reported incidence of interpersonal violence and assault is increasing in Victoria and contributes to the rising health bill, personal grief and social disruption.This study is a retrospective analysis of the injuries sustained by 890 assault victims presenting to the Geelong Hospital over the two year period of 1993 and 1994.The results indicate that most injuries were relatively minor in nature and were managed in a short space of time. The head and face were injured in a high proportion of cases and few patients sustained injury as a result of stabbing or shooting. Few patients required admission to the hospital although a high proportion required follow‐up management.The study identified the nature of physical injury suffered by the assault victims. Such knowledge is of use in the assessment of these patients in emergency departments. The study helps to elucidate the extent of this increasing yet potentially preventable social problem. The results may be used as a baseline to monitor changing patterns of assault within the region.
Venous air embolism related to the use of a pressure device for rapid blood transfusion
Authors: Hore Craig T 
Published: August 2010

AbstractA 70 year old woman received a transfusion of packed red blood cells via the distal port of a subclavian central venous catheter. In order to facilitate flow, the blood pack was placed within a manually inflatable pressure bag. When the patient's oxygen saturation and systolic blood pressure fell precipitously, it was noticed that the blood pack was empty and that air was present along the entire length of the intravenous tubing. A provisional diagnosis of venous air embolism was made. Management consisted of positioning the woman head‐down in the left lateral decubitus position and ventilating with 100% oxygen. Air was unable to be aspirated from the affected central venous catheter port. Her condition improved and her subsequent intensive care unit course was uneventful.A pulmonary artery catheter recorded haemodynamic changes at the time of the venous air embolism. There was an initial increase in pulmonary artery pressure and central venous pressure, associated with a decrease in mean arterial pressure and oxygen saturation. Similar observations have been made in animal models of graded (infusion type) venous air embolism.The diagnosis of venous air embolism is generally clinical, aided by echocardiogram, end‐tidal carbon dioxide monitoring, pulse oximetry, chest radiography and haemodynamic monitoring. Current management of venous air embolism includes prevention of further air entry, positioning the patient head‐down in the left lateral decubitus position and administration of 100% oxygen. External cardiac massage, aspiration of air (via central venous catheter, pulmonary artery catheter or transcutaneously) and hyperbaric oxygen may also play a role.
Inter‐rater reliability of the National Triage Scale over 11,500 simulated occasions of triage
Authors: Jelinek George A , Little Mark 
Published: August 2010

AbstractSince its introduction in 1993, the National Triage Scale (NTS), a five‐category scale based on the optimal time to medical intervention, has been introduced into most Australasian emergency departments as the basis of triage, clinical indicators and in some departments, casemix classification. The scale is a modification of the Ipswich Triage Scale (ITS), developed in 1989. This scale was shown in separate studies in Ipswich and Perth to be reliable and valid. The NTS however, although well validated, particularly with regard to resource use, workload and admission rates, has not been formally tested for inter‐rater reliability.In this study the inter‐rater reliability of the NTS was assessed in eight Western Australian hospital emergency departments, covering teaching, non‐teaching, rural and private hospitals, using the same methodology and patient profiles as the original ITS study. One hundred and fifteen triage nurses in these hospitals triaged 100 written patient profiles using the NTS. Inter‐rater reliability was acceptable. Of the 115 respondents, 95% were within one category of the modal response for all but four patient profiles and 86% were within one category for all patient profiles. Concurrence, or the percentage of responses in the modal category, was good. For 89% of the profiles, more than 50% of trieurs agreed with the modal response. The distribution of modal responses was not significantly affected by hospital type or triage nurse experience. The inter‐rater reliability of the NTS overall was slightly better than for the ITS in 1989.Emergency physicians, hospital administrators and government authorities can be confident that this widely used scale is a reliable measure of urgency.
A review of the usefulness of D‐Dimer in the diagnosis of pulmonary embolism
Authors: Mountain David , Brown Anthony FT 
Published: August 2010

AbstractPulmonary embolism is a potentially fatal condition that is extremely difficult to accurately diagnose clinically, usually relying on radiological investigations to make the diagnosis. These confirmatory tests are expensive, time consuming and may be associated with considerable morbidity. Thus, the utility of a blood test that reliably makes or refutes the diagnosis is apparent.Most blood tests involve the later stages of thrombolysis. Of these, the D‐Dimer tests are the most sensitive, and when combined with monoclonal antibody technology, are of clinical value.Enzyme‐linked immunosorbent assay D‐Dimer tests have good sensitivity (95%) and moderate specificity (30–45%), but technical considerations prevent their routine use. Latex agglutination tests overcome these technical problems, but their sensitivity is variable (46–100%).Two recently introduced tests show promise. The NYCO‐CARD D‐Dimer test is a semiquantitative modified enzyme‐linked immunosorbent assay test. Relatively few clinical studies have been performed and further validation studies are required. The SimpliRED D‐Dimer test uses a new bispecific antibody technique, allows bed‐side testing, and has good sensitivity (84–100%) and negative predictive values (92–99%).These tests could be used to screen low risk patients, thus avoiding ventilation‐perfusion scans, or in combination with ventilation‐perfusion scans and lower limb studies to avoid angiograms in intermediate probability pulmonary embolism patients. Future research will define where these tests show greatest utility, particularly in which patient subgroups, or symptom time intervals.
Lumbar puncture: risks and complications
Authors: Taylor David McD 
Published: August 2010

AbstractLumbar puncture is a procedure commonly performed in the emergency department. This paper reviews the indications, contraindications and the complications of lumbar puncture such as post‐lumbar puncture headache, traumatic tap and cerebral herniation. As well as highlighting the particular risks of lumbar puncture in different disease processes, this paper aims to provide physicians with an understanding of the procedure that will assist them in their clinical decision making. The role of computed tomography and medico‐legal aspects of lumbar puncture are also discussed.
Retropharyngeal meningioma is a rare cause of acute respiratory distress
Authors: Raftos John R , Matheson John M 
Published: August 2010

AbstractA 69 year old man presented to hospital with acute respiratory distress following a fall. A retropharyngeal tumour mass was delineated by computed tomography and subsequently resected transorally. The tumour was identified as a meningotheliomatous meningioma. There was no evidence of intracranial meningioma. Extracranial meningioma is an unusual condition with the rare potential for causing respiratory insufficiency mediated by either mechanical airway obstruction or denervation.
The identification of costs associated with emergency department attendances
Authors: Erwich‐Nijhout Marianne A , Bond Malcolm J , Phillips David G , Baggoley Chris 
Published: August 2010

AbstractAimsTo calculate the cost of patient attendances to an emergency department and to identify the cost drivers of those attendances.SettingThe Emergency Department, Flinders Medical Centre, a metropolitan teaching hospital in Adelaide, South Australia.MethodsA prospective analysis of all attendances presenting over a five month period, incorporating detailed costings of staff and resource usage. The effects of four cost drivers were evaluated: urgency, outcome, age and diagnosis.ResultsThe mean measured cost for each patient attendance was $103.79, varying from $36 for discharged category 5 patients to $429 for admitted category 1 patients. The mean total cost was $191.29, which included non‐measured and overhead components of $87.50.ConclusionThis study identifies the costs associated with treating emergency department patients. We believe this study will be reproducible in other emergency departments. The variables that we predicted would influence the cost of clinical activities (urgency, outcome, age and diagnosis) were all found to be important determinants of the cost of emergency department attendances.
Death caused by air embolism associated with lower limb and pelvic trauma
Authors: Doley Andrew J 
Published: August 2010

AbstractA 53 year old male with pelvic and lower limb injuries suffered acute cardiovascular and neurological deterioration leading to cardiac arrest. Despite aggressive resuscitation, the patient never regained a cardiac output and died of presumed massive internal injuries and hypovolaemia. Post mortem demonstrated uncomplicated rib fractures, a fractured femoral neck and a minor pelvic fracture. Death was attributed to cerebral air embolism arising from a ruptured vein in a perineal laceration.Venous air embolism is associated with chest, head and neck trauma but is rarely seen with lower extremity and pelvic trauma. Diagnosis is difficult due to a lack of distinct diagnostic criteria and the variability in presentation. Aggressive medical and surgical management is usually unsuccessful.
Quality assurance to continuous quality improvement: development of an emergency department system
Authors: Kennedy Marcus P , Cleaton Phillip GA , Harrington Tony P , Lee Therese , McGuirk Shelley 
Published: August 2010

AbstractThe development of a contemporary Continuous Quality Improvement (CQT) program for an emergency department is described. The evolution of such an initiative is not complex, but requires organisational commitment and leadership.As the focus within emergency departments becomes increasingly patient and process oriented the CQI model for quality management will become a standard managerial expectation.We aim to present a practical description of our system which may be of use as a template for other emergency departments.
Thirty cases of Irukandji envenomation from far north Queensland
Authors: Mulcahy Richard , Little Mark 
Published: August 2010

AbstractThe Irukandji jelly fish (Carukia barnesi) is responsible for a significant number of envenomations in northern Australia during the summer. Emergency physicians in these coastal areas frequently manage patients who have been envenomed by this potentially serious marine creature. The jelly fish is small (its bell is up to 2.5cm across) but the tentacles may be up to half a metre in length. It is rarely seen before envenomating. The sting usually initially causes localised pain followed by systemic symptoms known as the ‘Irukandji syndrome’, which include potentially life threatening pulmonary oedema. This article discusses Irukandji envenomation and its treatment, and reviews our experience in treating 30 patients who presented to the Emergency Department of Cairns Base Hospital in December of 1996 having been stung by the Irukandji. Of these cases, 27 (90%) patients developed systemic symptoms (the Irukandji syndrome) and 19 (63%) required admission. Twelve (40%) patients required more than 100mg of titrated, intravenous pethidine to relieve the pain. There were no cases of pulmonary oedema. All patients were discharged home well within 24 hours.
A review of triage nursing practice and experience in Victorian public hospitals
Authors: Standen Pat , Dilley Stuart J 
Published: August 2010

AbstractAimThe aim of this study was to make an assessment of the way in which triage is conducted in Victoria's public hospital emergency departments, and to determine the degree of uniformity that exists in relation to staff experience, triage guidelines and physical observations recorded at triage.MethodNurse managers of 14 Victorian public hospital emergency departments completed surveys regarding their triage nurses' experience and triage practices.ResultsAll hospitals utilised triage guidelines distributed by the Australasian College for Emergency Medicine. In addition, 10 hospitals had developed guidelines specific for the individual hospital. Four hospitals had predetermined triage categories for certain presentations. The nature and extent of physical observations recorded at triage varied widely. Triage nurse experience and training requirements also varied.ConclusionsTraining, experience and clinical aspects of the triage role vary in Victorian public hospitals. A more uniform approach to the role of triage and the training of triage nurses should be developed.
A protocol helps emergency triage nurses to request X‐rays
Authors: Wong Tai‐wai , Lee Kwong‐ming , Lau Chor‐chiu , Fu Yiu‐kai , Fung Kai‐hung 
Published: August 2010

AbstractObjectivesTo assess the feasibility of delegating X‐ray requests for simple limb injuries to triage nurses prior to patients being seen by a doctor, based on a protocol.MethodsPatients with acute blunt injury to one region of a limb were included in the study. Patients who were critically ill, younger than three years, with multiple limbs injuries, or with hip or pelvis injuries were excluded. The criteria for requesting X‐ray were local bony tenderness at the site of injury plus one of the following findings: gross swelling, deformity, bruising, limitation of joint movement or inability to weight bear.ResultsA total of 934 patients were included in the study. Of these, 883 (94.54%) patients had X‐rays requested by the triage nurse. In 917 (98%) cases, nurses were judged to have adhered to the protocol. 5.44% of X‐rays requested by nurses were considered to have been unnecessary by the attending doctor. Fractures were identified in 25% of the injuries X‐rayed. Twelve (1.3%) fractures were not identified in the initial films requested by the triage nurse. The five clinical indicators used in addition to local tenderness were sensitive (98%, 95% CI 97–100%) but not specific (7%, 95% CI 5.1–8.9%) in the identification of fractures.ConclusionsWhen triage nurses requested X‐rays of simple limb injuries using a protocol, this did not result in significant over‐request when compared with physicians. The protocol used was sensitive but had poor specificity.
The incidence, severity and nature of violent incidents in the emergency department
Authors: Brookes Jennifer G , Dunn Robert J 
Published: August 2010

AbstractThere have been few published studies investigating violent incidents occurring in the emergency department. A prospective descriptive study was undertaken over a 25 week period in two emergency departments in Melbourne, with a combined number of attendances of 56,000 patients per year. There were 79 reported violent incidents (2.8 per 1000 attendances) and staff injury occurred during nine incidents (0.3 per 1000 attendances). The frequency of incidents was highest between 1600 and 2400 hours, involved verbal violence alone in 30 (38%) incidents and physical violence in 49 (62%) incidents. In 52 (66%) incidents more than two staff members were involved. None of the possible predictors of violent behaviour studied were considered to be clinically useful in the identification of patients likely to become involved in violent incidents. Violent incidents in the emergency department place significant demands on staff and resources.
The medical consequences of a golden oldies rugby tournament
Authors: Ardagh Michael W 
Published: August 2010

AbstractThe 1995 International Golden Oldies Festival of Rugby attracted nearly 6000 rugby players to Christchurch for one week of rugby and socialisation. The staff of Christchurch Hospital Emergency Department were apprehensive about the likely increased demand for the department's services. This paper discusses the medical planning and the medical consequences of the tournament. This may assist medical planning for similar tournaments in the future.
Good outcomes using mask continuous positive airway pressure in elderly patients with acute pulmonary oedema
Authors: Kelly Anne‐Maree , Georgakas Con , Bau Shan , Rosengarten Pamela 
Published: August 2010

AbstractObjectiveTo report our experience with the use of continuous positive airway pressure therapy in acute cardiogenic pulmonary oedema in patients aged 80 years and over, with particular reference to complications, intubation rates, impact on resources and quality of care.SettingUrban teaching hospital.MethodRetrospective chart review of all patients aged over 80 years presenting with acute severe pulmonary oedema between 1 January and 31 December 1995.ResultsThirty‐nine patients met the study criteria of whom 29 (75%) were treated with adjuvant mask continuous positive airway pressure. The average age of patients was 85 years. The mean duration of continuous positive airway pressure was 1.9 hours. There was one adverse event related to mask continuous positive airway pressure: one case of intolerance. All patients were managed in general medical wards after treatment in the emergency department.ConclusionGiven the proven effectiveness of mask continuous positive airway pressure and its safety, we strongly advocate the use of continuous positive airway pressure therapy as an adjunct to standard medical therapy for patients with acute severe pulmonary oedema.
Vagal manoeuvres and drug therapy for terminating paroxysmal supraventricular tachycardias
Authors: Bonnin Robert LL , Kuhn Marie 
Published: August 2010

AbstractVagal manoeuvres are frequently used, with or without drug therapy, in the acute management of paroxysmal supraventricular tachycardia. This review provides the practical details needed to maximise the effectiveness of vagal manoeuvres and reviews the data concerning safety and relative efficacy of these techniques.Vagal manoeuvres should be performed with the patient relaxed and supine to maximise efficacy. The valsalva manoeuvre with sphygmomanometric measurement appears to be the most effective and safest manoeuvre in adults, while the diving reflex has been demonstrated to be successful in children. Carotid sinus massage should be used with caution in the elderly as it is relatively ineffective and carries a small risk of neurological sequelae. Combining techniques to augment each other may prove useful in cases resistant to individual manoeuvres.
Undergraduate emergency medicine education in a developing country: experience from Kuala Lumpur, Malaysia
Authors: Mohamed Abdul Ali R , Aziz Azhar Abdul , Goh Emily 
Published: August 2010

AbstractOf the three leading medical schools in Malaysia, the University of Malaya Medical Faculty in Kuala Lumpur is the only one currently offering a formal posting in emergency medicine. Fourth year medical students undergo two weeks of emergency department training consisting of tutorials, lectures, observation and practical sessions, bedside teaching and participation in various emergency medical activities. The structure of this teaching program at a busy teaching hospital is described in more detail. The posting is concluded with an examination consisting of an oral examination, MCQs and an essay question.From our five years experience in conducting this program, we strongly support international recommendations for the inclusion of emergency medicine education in undergraduate medical curricula.
Integration of emergency medicine into the undergraduate medical curriculum at the Christchurch School of Medicine
Authors: Ardagh Michael 
Published: August 2010

AbstractEmergency medicine has been integrated into the undergraduate curriculum of the Christchurch School of Medicine. Vertical integration has been achieved by consideration of the five stages of medical education, with the undergraduate emergency medicine contributions coming in the junior clinical student and senior clinical student stages. Horizontal integration has been achieved by defining the complete emergency medicine undergraduate curriculum and identifying those parts not adequately covered elsewhere. This paper describes how this process was achieved at the Christchurch School of Medicine.
Interaction of sertraline and moclobemide induces the serotonin syndrome in the rat
Authors: Castle Craig , Jablonski Paula , Thomson Graeme , Taylor James , Kambourakis Anthony , Troupakis Steven 
Published: August 2010

AbstractObjectiveTo determine if sertraline, a selective serotonin reuptake inhibitor, and moclobemide, a reversible inhibitor of monoamine oxidase, are more likely to induce serious side effects when given to rats in combination than each of the drugs administered alone.MethodsRats were given intraperitoneal injections of one of sertraline, moclobemide, or sertraline plus moclobemide in ratios varying from 0.5:1 to 1:0.5, or solvent alone. The animals were then observed for signs of the serotonin behavioural syndrome and temperature elevation.ResultsRats given either drug singly developed mild behavioural changes but there were no statistically significant differences from the control group. Those given drug combinations developed severe serotonin syndromes with marked behavioural changes, convulsions and hyperthermia. The effects on behaviour and temperature were significant when compared to the control group (p<0.01). Five of the six rats given full doses of both drugs either died or had to be killed prematurely in the observation period.ConclusionThe simultaneous administration of sertraline and moclobemide has the potential to induce a severe serotonin syndrome and these drugs should not be prescribed together.
Evidence based medicine and practice guidelines for management of fever without source in young children
Authors: Smith Brendon 
Published: August 2010

AbstractObjectiveTo assess the advantages and disadvantages of implementation of published practice guidelines’ advocating administration of antibiotics to children aged 3–36 months having high fever without apparent focus of infection.MethodStudies were identified by Medline search, index search of major paediatric journals, The Cochrane Library, Emergency Medicine Abstracts and from citations in review articles. All relevant studies were included.ResultsThe Practice Guidelines1 are based on consensus of expert opinion and not based solely on evidence. The conclusions of meta‐analyses supporting the Guidelines were not confirmed by subsequent large randomised controlled clinical trials. Original studies and reviews interpreted data in a manner that exaggerated the proposed benefit of giving ceftriaxone. Areas not adequately addressed in the Guidelines are the importance and value of clinical evaluation, adverse effects of intervention, antibiotic resistance, applicability to children vaccinated against H. influenzae type b, applicability to racial groups at lower risk of S. pneumoniae infection and meningitis than the study population, cost, patient acceptance of interventions and treatment advocated, and outcome rather than incidence of focal infection and meningitis.ConclusionsAvailable evidence does not indicate a convincing benefit from giving parenteral or oral antibiotics empirically compared to no antibiotic for children aged 3–36 months presenting with high fever without apparent source. Novel approaches to better quantify risk of adverse outcome in a heterogeneous population at risk of serious infection are discussed.