bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tricyclic antidepressant overdose at Westmead and Mount Druitt Hospitals
Authors: MORGAN J E 
Published: August 2010

ABSTRACTTricyclic 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

ABSTRACTTriage 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

ABSTRACTEmergency 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

ABSTRACTAustralian 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

ABSTRACTObjective: 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

ABSTRACTA 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

ABSTRACTPreviously 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.
Trauma scoring
Authors: THORPE A P 
Published: August 2010

ABSTRACTSince 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

ABSTRACTPresenting 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

AbstractThis 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

ABSTRACTObjective: 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

ABSTRACTA 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

ABSTRACTObjectives: 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.
Tension pneumopericardium following blunt trauma
Authors: FITZGERALD MARK C , FOORD KATRINA A 
Published: August 2010

ABSTRACTTension 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

ABSTRACTSince 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.
Hypokalaemic periodic paralysis associated with hyperosmolar diabetes mellitus
Authors: Bryant Michael G 
Published: August 2010

AbstractA 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

AbstractThe 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

AbstractUltrasound 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

AbstractThis 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

AbstractObjectiveTo describe three cases of envenomation by the Stephen's banded snake, a species not previously identified as likely to cause serious illness.Clinical featuresThree 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 outcomeTwo patients were managed with tiger snake antivenom. All three recovered uneventfully.ConclusionThe 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

AbstractA 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.
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

AbstractStudy objectivesTo 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 designRetrospective chart review.PatientsAll 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.ResultsOf 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.ConclusionContinued 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

AbstractPericarditis 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

AbstractThis 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.