bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcutaneous carbon dioxide monitoring in the emergency department: a pilot study
Authors: KELLY ANNE‐MAREE , HANSON DALE 
Published: August 2010

ABSTRACTStudy Objective: Pilot study to assess the potential place of transcutaneous carbon dioxide monitoring technology in the emergency department.Design: ProspectiveSetting: Urban emergency department.Type of participants: 30 patients requiring arterial blood gas analysis as part of their management.Measurement and main results:

Subjects with capillary return time less than two seconds: Correlation of PTCCO2 versus PACO2 0.93, bias 0.2, precision 5.9.
Subjects with capillary return time of greater than two seconds: Correlation PTCCO2 versus PACO2 0.46, bias ‐6.6, precision 20.

Conclusions:

Transcutaneous carbon dioxide measurements are unreliable in low flow states as defined by capillary return time of greater than two seconds.
Measurement of transcutaneous carbon dioxide has the following potential uses in the emergency department:a) Monitoring carbon dioxide in patients with chronic airway limitation receiving oxygen therapy.b) A screening test in respiratory patients with normal peripheral perfusion.
Prehospital resuscitation and sudden cardiac death
Authors: FITZGERALD MARK C 
Published: August 2010

ABSTRACTRates of survival horn pre‐hospital cardiac arrest are often used to judge the quality of emergency medical systems. Despite many advances in technology and pharmacotherapy over the last two decades, overall survival rates in most systems remain disappointing. Objective analysis of different systems of care and associated outcomes has been hampered by a lack of uniform data reporting. Attempts to improve survival must focus on the key to resuscitation from sudden cardiac death, that is rapid response defibrillation.
Phosphine gas poisoning
Authors: FATOVICH DANIEL M , GRAYDON ROBERT H , PRENTICE DAVID A , HIRSCH RONALD L 
Published: August 2010

ABSTRACTPhostoxin is a fumigant used in rural areas. We report a case of phostoxin ingestion which resulted in the release of lethal phosphine gas.The patient developed a profound metabolic acidosis and cardiovascular depression and died. During treatment and after death, he continued to emit the noxious gas which was dangerous to staff, and resulted in evacuation of the emergency department. Such events tend to be associated with myth and hysteria and the lack of ready access to reliable information. They represent a unique challenge to the emergency physician.
Successful treatment of 75 patients in status epilepticus with intravenous midazolam
Authors: GALVIN G MICHAEL , JELINEK GEORGE A 
Published: August 2010

ABSTRACTSeventy‐five consecutive patients attending the Emergency Department at Fremantle Hospital in status epilepticus were treated with intravenous midazolam. All seizures ceased without other therapy, after an average dose of 0.1 mg/kg midazolam. Seven percent of patients had a further seizure in the Emergency Department, a rate comparable to other anticonvulsants.Midazolam is a safe, effective agent for the treatment of status epilepticus, with possible advantages over currently accepted treatment.
Dog bites in Tea Tree Gully
Authors: KELLY ANNE‐MAREE , FENSAK SARA K 
Published: August 2010

ABSTRACTDog bite injury is a common reason for presentation to emergency departments. However the nature of this problem in Australia has not been closely studied and a number of unresolved questions remain regarding management options. This prospective study of 101 cases was undertaken to collect demographic information about victims and assailants, to describe the spectrum of injury seen and to report outcome following a standard management protocol.In common with other studies, young males were bitten most frequently, usually by German Shepherds, Heelers and Terriers. Nearly half (48%) of the facial injuries occurred in children under 10 years old. The infection rate in this study, using wound cleansing and prophylactic penicillin in all cases, was only 4%. Wound swabs on presentation were unhelpful. Controversies still exist regarding wound closure and the use of prophylactic antibiotics.
Microcatheter aspiration of spontaneous pneumothoraces in an emergency department
Authors: CRUSE DAVID , JELINEK GEORGE A 
Published: August 2010

ABSTRACTObjective: To assess the efficacy of microcatheter aspiration (MCA) of spontaneous pneumothoraces in the Emergency Department of Fremantle Hospital.Methods: From 1986–1993, patients less than 45 years old with a first spontaneous pneumothorax on chest X‐ray of greater than 20% were treated with MCA. Those with underlying lung disease or tension were excluded. MCA was performed with a 16G central venous pressure catheter. Patients were reassessed radiologically at six and 24 hours. The procedure was considered successful if there was less than 15% residual pneumothorax after aspiration and at 24 hours.Results: Of thirty patients studied, 22 (73%) had successful aspiration and were discharged the following day.Conclusions: Literature review and results of this study suggest that MCA is appropriate initial treatment for first or subsequent spontaneous or iatrogenic pneumothoraces of 20% lung volume or more, in the absence of coexisting lung disease or tension. Most patients can be successfully treated in the Emergency Department and will not require admission. This should result in less morbidity and time in hospital.
Methaemoglobinaemia due to nitrite poisoning
Authors: ZALSTEIN SALOMON 
Published: August 2010

ABSTRACTObjective: A case of severe acquired methaemoglobinaemia is reported. The condition is uncommon and the severity of this case is notable. The nature of the condition, its diagnosis and management are reviewed.Clinical features: A 35 year old woman was brought to the Emergency Department by ambulance in a moribund state with an indication that she may have ingested amyl nitrite.Interventions and outcome: The patient was treated with methylene blue, responded promptly, was admitted to the intensive care unit and subsequently discharged from hospital well.Conclusion: Although uncommon, some poisonings are rapidly fatal. It is vital that doctors practising emergency medicine are well acquainted with such poisonings so that patients may be treated in an appropriate and timely fashion.
The effect of ambulance treatment on patient temperature normalisation
Authors: GRANTHAM HUGH , FAWCETT GLENN 
Published: August 2010

ABSTRACTThe range of patient temperatures encountered in ambulance practice in winter (July to September) in Adelaide was studied using tympanic membrane infra red thermometers. The results were expressed in equivalent oral temperatures. The effectiveness of ambulance treatment in normalising hypothermia and pyrexia was also studied.Results of 383 cases were analysed. The mean temperature was 36.4 C (oral equivalent). There was no significant difference in initial temperature with age or nature of case (trauma, medical emergency and non urgent elective cases). The temperature of patients who were initially either hypothermic or febrile was significantly normalised by ambulance treatment.These results confirm the effectiveness of ambulance treatment for patients with abnormal temperatures, and provide a starting point for further research into improving the ambulance management of hypothermia and fever.
Childhood meningitis and Haemophilus influenzae type b vaccines
Authors: MCINTOSH E DAVID G , ISAACS DAVID 
Published: August 2010

ABSTRACTEffective vaccines against Haemophilus influenzae type b (Hib) disease in children are available. If overseas experience is any indication, the incidence of invasive Hib disease in infants and children will fall substantially over the next few years. In the absence of signs of raised intracranial pressure, lumbar puncture is generally indicated in children with suspected meningitis prior to therapy. Infants and children with suspected meningitis should be given dexamethasone preferably before or within twenty minutes of the first dose of antibiotics in order to prevent the sequelae of deafness and neurological damage. The treatment of choice for neonatal meningitis is ampicillin and cefotaxime, but the efficacy of dexamethasone in preventing long‐term sequelae in neonates is not yet established. The treatment of choice in older infants and children is cefotaxime or ceftriaxone. Antibiotic therapy should be continued for seven days for uncomplicated meningococcal meningitis and 10 days for Hib and pneumococcus in infants and children, and for 14 to 21 days for neonatal meningitis. Chemoprophylaxis of selected contacts with rifampicin is recommended.
Has Gallo proven the role of HIV in AIDS?
Authors: PAPADOPULOS‐ELEOPULOS ELENI , TURNER VALENDAR F , PAPADIMITRIOU JOHN M 
Published: August 2010

ABSTRACTThe evidence that Robert Gallo and his colleagues presented on 4th May 1984 regarding HTLV‐III (HIV) isolation and the role of HIV in the pathogenesis of AIDS is critically analysed. It is concluded that the evidence does not constitute proof of the isolation of a retrovirus, that the virus is exogenous, or that the virus is causally related to AIDS.
Traumatic coronary artery fistula
Authors: CHAN BETTY S H , DOOHAN MELISSA M 
Published: August 2010

ABSTRACTObjective: To present a case of traumatic coronary artery fistula caused by blunt injury.Clinical features: A previously healthy 20‐year‐old motor cyclist was involved in a motor vehicle accident. He suffered acute myocardial infarction secondary to a traumatic coronary artery fistula (CAF). His other injuries included a fractured left clavicle, bilateral small pulmonary contusions and pneumothoraces, pneum‐omediastinum and a small subcapsular haematoma of the liver.Intervention and outcome: He was managed conservatively. Recovery was complicated only by pericarditis and he was well one year after the injury.Conclusion: Traumatic CAF may result from blunt chest trauma and may be diagnosed from history, physical examination, and ECG changes. An echocardiogram should be performed in patients with positive ECG findings or the development of a new continuous murmur. Coronary angiography remains the gold standard but is rarely indicated in the acute situation. Regular follow up is required as traumatic CAF has a high incidence of late complications. With symptomatic CAF, the recommended treatment of surgical repair has a high success rate with few complications.
Trauma teams: order from chaos
Authors: MYERS COLIN T , BROWN ANTHONY F T , DUNJEY STEPHEN J , O'BRIEN DELIA A 
Published: August 2010

ABSTRACTIntroduction: Trauma systems based on trauma centres have become the gold standard for trauma care in North America. The epidemiology of trauma in the United Kingdom and Australasia is significantly different. The standard of care of patients with blunt injuries in British hospitals may not be as high as in North America. There is ongoing research into the best system of care. Until convincing results are available, adoption of a trauma team approach by all hospitals receiving major trauma would be appropriate. The purpose of this paper is to provide sufficient detail of an operational trauma team to allow others to develop a similar system.Methods: We introduced a trauma team approach in the Emergency Department of the Royal Brisbane Hospital, a tertiary referral teaching hospital. Laminated action cards detailed precise task allocation to four doctor‐nurse pairs working simultaneously. Equipment, procedures, pathology requests, radiology and clerical duties were standardised in advance. An audit form was completed after each resuscitation.Results: In an initial review, 108 patients admitted with trauma met criteria for activation of the trauma team. Time of arrival to completion of initial resuscitation was reduced by 63 per cent and time in the department by 51 per cent.Conclusion: A major component of the success of the best American trauma systems lies in organisation. By contrast, many hospitals in the United Kingdom and Australasia still have no organised response to trauma and where trauma teams do exist, they are often ad hoc and disorganised. The absence of a defined team leader and precise task allocation leads to confusion and delay even when individual team members are highly skilled. We describe a trauma team approach to overcome these problems which could be utilised by any hospital using existing staff and resources.
Ectopic pregnancy with shock and negative qualitative B Human Chorionic Gonadotropin
Authors: Hertzberg Susan , Van Der Griend Michael 
Published: August 2010

AbstractObjectives:

To present a case of ruptured ectopic pregnancy with hypotension, shock and a negative qualitative BhCG.
To retrospectively review patients admitted to a Sydney teaching hospital with ruptured ectopic pregnancy over a two year period.

Clinical features:A 30 year old woman presented to the emergency department with severe abdominal pain. On arrival she was shocked, with tachycardia and hypotension. Qualitative BhCG was negative. Laparotomy revealed 2.5L of blood in the peritoneal cavity and a bleeding mass in the right fallopian tube. Pathology reported trophoblastic tissue in the wall of the tube.Review of cases:Of 180 patients admitted to Royal Prince Alfred Hospital with ectopic pregnancy, 37 were found to have ruptured at operation. No cases of ruptured ectopic pregnancy with a negative BhCG were found.Conclusion:This case, though rare, illustrates the fact that a negative serum BhCG neither excludes the diagnosis of ectopic pregnancy nor the possibility of life‐threatening tubal destruction and haemorrhage.
Adverse reactions to flumazenil in mixed drug overdose involving tricyclic antidepressants
Authors: Gray Tim 
Published: August 2010

AbstractObjectives

To describe two cases of status epilepticus and major cardiac toxicity following flumazenil administration in mixed benzodiazepine and tricyclic antidepressant overdose.
To review the reported major adverse reactions to flumazenil.
To suggest guidelines for flumazenil use in the management of overdose.

Clinical featuresFlumazenil was administered to two patients who were comatose following ingestion of benzodiazepines and tricyclic antidepressants. Both suffered immediate convulsions and major cardiac toxicity.InterventionsOne patient received DC defibrillation and respiratory support, the other respiratory support and cardiopulmonary bypass.OutcomesBoth patients required admission to the Intensive Care Unit. The patient requiring cardiopulmonary bypass died of multi‐system failure, the other survived.ConclusionsFlumazenil should not be used to reverse coma due to coingestion of benzodiazepines and tricyclic antidepressants, or undifferentiated coma in which tricyclic antidepressant intoxication may be present.
Cimetidine as an alternative to N‐acetylcysteine in patients with paracetamol poisoning
Authors: Smith Peter B , Ryan Damian 
Published: August 2010

AbstractA 20 year old woman attended the emergency department of Wollongong Hospital 11 hours after a toxic ingestion of paracetamol. After developing a significant anaphylactoid reaction to N‐acetylcysteine (NAC), she was treated with cimetidine 40mg/kg intravenously as an alternative. This therapy may be an option when NAC cannot be used.
The laryngeal mask in pre‐hospital emergency care
Authors: Grantham Hugh , Phillips Garry , Gilligan J Edward 
Published: August 2010

AbstractThe role of the laryngeal mask airway (LMA) in pre‐hospital emergency care was studied prospectively.Method:Thirty ambulance officers were trained in the use of the LMA and attempted 233 insertions in the field over a 12 month period. The majority of the patients (156) had suffered cardiac arrests. The overall insertion success rate was 81%, with half the failures due to rejection of the airway by insufficiently comatose patients, and half due to other causes.Conclusion:The laryngeal mask offers an alternative to the Guedel airway and face mask and has some advantages.
Ovarian hyperstimulation syndrome
Authors: NIEUWKAMP G A 
Published: August 2010

ABSTRACTA 35 year old woman on the IVF program presented with ovarian hyperstimulation syndrome after induction of ovulation with human chorionic gonadotropin. This syndrome is a potentially lethal complication of ovarian stimulation with enlargement of the ovaries and transcapillary fluid shifts. This may result in third space collections in the form of ascites, hydrothorax and rarely pericardial effusions, and haemoconcentration with the attendant risks of volume depletion, renal failure and thromboembolic complications. In this patient there was also a unilateral pleural effusion and coexistent supraventricular tachycardia which has not been previously reported. The management is based on pathophysiological considerations.
CPAP apparatus: an inexpensive alternative
Authors: DINGLE KAELEEN , TAYLOR JAMES 
Published: August 2010

ABSTRACTObjective: To describe an effective and inexpensive CPAP‐mask apparatus for use in the emergency department.Conclusion: CPAP is an effective tool in the treatment of acute pulmonary oedema in the emergency department. The mask apparatus described is an inexpensive alternative to the commercially produced machines.
Acute spontaneous subdural haematoma
Authors: Ng Man Ho 
Published: August 2010

AbstractThe case of a patient with acute spontaneous subdural haematoma is presented. This occurred in the absence of head injury and predisposing conditions such as bleeding diathesis, tumour, arterial aneurysm or arterio‐venous malformation. The true incidence and pathogenesis of this condition is not known. Management includes CT scanning of the head, emergency drainage of the haematoma and post‐operative angiography to rule out aneurysm or arterio‐venous malformation. Preoperative conscious level is the most important prognostic factor.
Resistance to flow through a needle‐free injection port
Authors: Holdgate Anna , Morris Richard W 
Published: August 2010

AbstractAimTo examine the effect of the Braun Reflux valve on flow rates of crystalloid and colloid solutions with different size cannulae.Method100ml aliquots of normal saline and Haemaccel were run through both 14 and 18 gauge cannulae from a fixed height of 1 metre. Ten measurements were made for each fluid with each cannula size then repeated with the Reflux valve interposed between the giving set and cannula for a further 10 measurements.ResultsThe Reflux valve increased the resistance to flow under all conditions examined (p<0.0001). However, the actual changes in flow rates were relatively small, maximum being 12% (9.9 L/hr without valve, 8.7 L/hr with valve).ConclusionsThis study found that the valve caused a statistically significant reduction in flow rates under a variety of conditions, but the clinical significance of this reduction is important only under the most extreme circumstances. Because it has only a minor effect on resistance to flow, the authors recommend the routine use of this valve on peripheral cannulae to reduce the risk of needlestick injury and blood spillage.
Emergency department utilisation by the elderly
Authors: Lamb Ian , Eddey David , Cameron Peter 
Published: August 2010

AbstractObjectiveTo assess the present utilisation of emergency services by the elderly in Geelong and to estimate the impact on these services of the projected increase in the elderly population.SettingThe Geelong Hospital is a 450 bed community teaching hospital incorporating paediatric and obstetric units. It serves a population of approximately 250,000 residents covering urban and rural areas.MethodsAnalysis of computerised emergency department attendance records was undertaken covering a two year period from 1 August 1992 until 31 July 1994. Comparison with Australian Bureau of Statistics data for the region was made. For the purpose of this study “elderly” refers to 65 years and over. This group was compared with the younger population of patients including children.ResultsOf all emergency department visits 16.8% are accounted for by the 65 and over age group (Confidence interval 16.4–17.2% p<0.01). This group makes up 13% of the catchment area population. Of elderly patients attending the emergency department 59% are admitted as opposed to 19.7% of the younger group (odds ratio 3.79 Confidence interval 3.64–3.96 p<0.05). Of elderly patients admitted, 5.3% were admitted to the coronary care unit and 1.2% to the intensive care unit. This compares with 1.1% (odds ratio 5.03 Confidence interval 4.49–5.64 p<0.05) and 0.6% respectively (odds ratio 2.01 Confidence interval 1.64–2.45 p<0.05) for the younger group. The elderly patient is five times more likely to arrive by ambulance than the younger patient.ConclusionsThe elderly population are more likely to use ambulance services, more likely to attend the emergency department, more likely to require admission and more likely to require admission to a critical care area than the younger population. As the number of people over 65 increases, the consequent increase in workload will need to be addressed.
Triage nurse‐initiated X‐rays for limb injuries are accurate and efficient
Authors: Kelly Anne‐Maree , McCarthy Sandy , Richardson Sally , Parris Wendy , Kerr Anne‐Marie 
Published: August 2010

AbstractObjectivesTo estimate the potential reduction in waiting times for patients resulting from triage nurse‐initiated X‐rays.To compare the pattern of X‐ray ordering by triage nurses and medical staff.To estimate the accuracy of triage nurse‐initiated X‐rays.MethodProspective, blinded descriptive/comparative study with nursing intervention on an ‘intention to treat’ basis.ResultsTriage nurse‐initiated X‐rays would have identified 96% of fractures. Nurses would have ordered fewer X‐rays than doctors with an efficiency rate (number of fractures/number of X‐rays) of 41% compared with 36% for doctors. A conservative estimate of the potential time saving for patients is an average of 46 minutes.ConclusionTriage nurse‐initiated X‐rays should result in reduced waiting times for patients and increased efficiency of medical staff. This study suggests that this procedure would be accurate and efficient.
Trauma triggered migrainous coma
Authors: Craft Philip , Kennedy Marcus P 
Published: August 2010

AbstractPatients presenting in coma often present a diagnostic problem. In this case, a young man was brought by ambulance to the Nambour Hospital Emergency Department with sudden onset of coma following minor head injury. Laboratory and radiological investigations revealed no apparent cause. It was not until the patient roused spontaneously and a history of migraine was revealed that a possible aetiology was found.Trauma precipitated migrainous coma is a diagnosis of exclusion but should be considered in the evaluation of the unconscious patient.
The emergency department management of migraine
Authors: Kelly Anne‐Maree , Bryant Michael G , Zebic Steven 
Published: August 2010

AbstractDisabling migraine headache is an uncommon but important reason for presentation to emergency departments. Although not life‐threatening, migraine causes considerable distress for those affected. This article reviews the currently available parenteral agents used to treat this condition, comparing efficacy, the need for additional medication and the incidence of “rebound” headache.Ketorolac and lignocaine fail to reach acceptable efficacy standards and are not recommended for use in acute migraine. Metoclopramide and pethidine perform a little better but each has been shown to be inferior to other treatments.Dihydroergotamine is less effective than chlorpromazine and has a high rate of unpleasant side effects. Haloperidol needs to be studied in appropriate trials before conclusions can be drawn. The most effective agents seem to be chlorpromazine and sumatriptan, each of which has achieved greater than 70% efficacy in a number of studies. Prochlorperazine achieves this level in some studies but numbers are too small to be conclusive. Further research should concentrate on comparison of chlorpromazine, sumatriptan, prochlorperazine and haloperidol in order to clarify their relative effectiveness in the management of migraine.