bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community‐acquired Aeromonas hydrophila meningitis
Authors: FRATZIA JAMES D 
Published: August 2010

ABSTRACTObjectives: To present a unique case of pyogenic meningitis due to Aeromonas hydrophila.Clinical features: A previously healthy 66 year old man presented with fever, tachypnoea, back ache and delirium the day after he had been turning compost. Diagnoses of bronchopneumonia, septicaemia and meningitis were made on clinical, radiological and microbiological laboratory assessments.Intervention: He was treated with IV cefotaxime for three weeks. He required ventilation for eight days.Outcome: Recovery was complicated by persisting unilateral deafness and urinary retention secondary to prostatomegaly.Conclusion: Previous reported cases of Aeromonas hydrophila meningitis have occurred in neonates or in adult hosts with compromised immunity. A single case of an immunocompetent adult who developed Aeromonas hydrophila meningitis three days after craniotomy has been reported. However, there have been no community‐acquired cases described in immunocompetent adults. Circumstantial evidence suggested that the organism had been inhaled while working with a compost heap. There have been no previous reports of acquisition of the organism in this manner.
Does undergraduate emergency medicine teaching equip junior doctors for ward emergencies?
Authors: ARDAGH MICHAEL , KELLY ANNE‐MAREE 
Published: August 2010

ABSTRACTObjectives:

To assess the competence of junior doctors in recognising and managing life‐threatening ward emergencies.
To compare the competence of a group which had received emergency medicine teaching with one which had not.

Method:Sixty seven final year medical students participated in a structured written clinical examination designed to test their competence in recognising and managing four life threatening ward emergencies.Papers were marked numerically against a pre‐determined marking schedule and were also reviewed for the presence of fatal management errors.Comparisons were made between the group which had received emergency medicine teaching and the group which had not.Results:

For the group which had not received emergency medicine teaching (n = 15) the average total score was 218/400. The group which had received emergency medicine teaching (n = 52) had an average score of 290/400. There was a significant difference between these groups (p<0.0001).
The group which had not received emergency medicine teaching committed 0.28 fatal errors per student per case. The group which had received emergency medicine teaching committed 0.07 fatal errors per student per case. This difference was significant (p<0.001).

Conclusions:

There is considerable scope to improve the competence of junior doctors for dealing with life‐threatening ward emergencies.
Junior doctors who received emergency medicine teaching scored significantly better than those who did not.
Emergency medicine teaching is a suitable tool to help equip junior doctors to deal with life threatening ward emergencies.
Factors affecting entry into prospective research in the emergency department
Authors: RICHARDSON DREW B 
Published: August 2010

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

ABSTRACTObjectives: To evaluate the usefulness and practicality of clinicians performing rapid whole blood agglutination tests for the detection of HIV antibodies in a busy emergency department.Methods:: Seventy seven patients agreed to participate in the study. Specimens from each were tested separately in the reference laboratory as well as in the Emergency Department. A different clinician performed the rapid test from the one who had collected the specimen. No investigator knew the status of the serum tested.Results:: Seventy of those tested were negative on both series of tests. Seven tested positive on both the rapid and laboratory tests.Conclusion: The rapid testing of blood for HIV antibodies within the emergency department is an essential diagnostic tool which easily and reliably determines the need for specific therapies in acutely ill patients.
Postgraduate emergency medicine training in the United States of America
Authors: TOTTEN VICKEN Y 
Published: August 2010

ABSTRACTObjectives: To describe the structure of emergency medicine residency training to Australasian emergency physicians and emergency medicine educators.Method: This paper begins with an overview of general education, traditional medical education and residency training in the United States. Postgraduate emergency medicine training is covered in detail. Fellowships and the status of sub‐specialty training is discussed.The Residency Review Committee mandates certain structural aspects of a postgraduate training program, including the Core Content and Core Curriculum. Criteria are being developed for sub‐specialty certification fellowships. Fellowships in emergency medicine remain mostly informal.The scope of practice of emergency medicine in the United States is described, along with the interim compromises made necessary because of the shortage of trained emergency physicians.Summary: Emergency medicine as a medical specialty is gaining recognition. An international exchange of information about training programs should improve emergency medicine everywhere.
Organochlorine ingestion
Authors: HORE CRAIG , GEORGE TERRY 
Published: August 2010

ABSTRACTA 48 year old man rapidly deteriorated and died following the intentional ingestion of a commercial pesticide mixture containing chlordane and dichloroethyl ether with kerosene as the solvent vehicle.After oral ingestion, chlordane is primarily a neurotoxin. Dichloroethyl ether is a respiratory tract irritant. Both have effects on several other systems. Kerosene is a potent cause of aspiration pneumonitis when inhaled and gastric emptying is not recommended unless it is the vehicle for other, more toxic substances, as in this case.Management for both chlordane and dichloroethyl ether ingestion is supportive, involving airway maintenance, decontamination, and gastric lavage and charcoal administration.
Measuring capillary refill time is useless
Authors: WATSON ADAM , KELLY ANNE‐MAREE 
Published: August 2010

ABSTRACTThe objectives of this study were to define the range of normal capillary refill times for an adult population and to assess the contribution of age, gender and environmental temperature to any variability shown.Data from 331 healthy adult volunteers were collected including age, gender, environmental temperature and capillary refill time by a standard method. Multiple regression analyses were used to assess the contribution of temperature, age and gender to the variation in capillary refill times.A wide range of capillary refill times were found. Taking the 95th centile as the upper limit of normal, the upper limit of normal for males aged 14–65 years was 2.2 seconds, for females in the same age group 3.0 seconds; for males over 65 years 3.6 seconds and for females over 65,3.8 seconds. Capillary refill times varied significantly with age, gender and environmental temperature (p<0.01), however, taken together, these factors accounted for only 20% of the observed variance.From this study and a review of the available literature it is concluded that measurement of capillary refill time does not perform satisfactorily as a test nor does it give useful information about the patient's circulatory status. Its use as an assessment tool in trauma should be discontinued.
Australian emergency departments and hospital‐acquired needlestick injuries
Authors: ROGERS IAN R , DUNN ROBERT , BRENTNALL EDWARD 
Published: August 2010

ABSTRACTHospital‐acquired needlestick injuries are frequently managed in Australian emergency departments. In July 1992 a survey was conducted of all Australian emergency departments accredited by the Australasian College for Emergency Medicine in order to quantify the problem and identify common themes or deficiencies in management. The average rate of reported needlesticks was 2.9 per 100 hospital beds per month. At least 350 initial needlestick consultations occur per month in ACEM‐accredited EDs Australia‐wide or 4,200 per year.More than two thirds of initial consultations for such injuries were in emergency departments but the majority of continuing care was provided in other sites. Over one third (37%) of emergency departments had inadequate or absent needlestick reporting sheets and three quarters failed to provide exposed workers with written information sheets. Zidovudine (AZT) was frequently unavailable or delayed in availability. Control of providing AZT was often vested in non‐emergency department clinicians. These problems are discussed together with suggestions for the format of an ideal needlestick protocol.
Profile of emergency department attendances
Authors: COLERIDGE JOHN T , CAMERON PETER A , WHITE JAMES B , EPSTEIN JOSEPH 
Published: August 2010

ABSTRACTFollowing the implementation of a computerised Emergency Department (ED) attendance record, the data collected were analysed to describe the profile of ED attendances. A McDonnell Douglas ED module (1988 version) upgraded at Western Hospital was installed one year prior to the study period. Data entry was performed by clerical staff at the time of attendance. Diagnostic coding was performed by hospital medical officers. Introduction of the computerised attendance record was associated with no increase in staffing and was accepted by the staff with minimum difficulty.From 1 March 1989 to 28 February 1990, 48,748 attendances to the ED were documented at Western Hospital, Melbourne, Victoria, a 305 bed metropolitan hospital situated in the mixed residential and industrial western suburb of Footscray in Melbourne. Males predominated (55% of attendances overall), especially in the 16–25 year age group. Peak attendances were in the very young and young adult age groups. There was little seasonal variation in the number of attendances.Just under 30% of attendances were due to trauma. This percentage is considerably lower than that reported by comparable overseas studies. Upper respiratory tract infections, asthma and other respiratory disorders made up 8.1% of all attendances, and gastroenteritis and non‐specific gastrointestinal disorders made up a further 4.6%.It is essential that all Australasian EDs develop a computerised attendance record with data which are comparable between hospitals.
Australasian College for Emergency Medicine: Fellowship Examination 1986 to 1992
Authors: GAUDRY PAUL L 
Published: August 2010

ABSTRACTStudy objectives: To determine the pass rate to the Fellowship Examination of the Australasian College for Emergency Medicine (ACEM) in 1986 to 1992, in relation to age and sex of candidates, the entry criteria to sit the examination and the number of attempts by candidates.Design: Retrospective review of application forms, mark sheets and examination results of all attempts by candidates in the first 10 administrations of the examination.Main results: One hundred and forty six candidates (124 male and 22 female) made 245 attempts at the examination. One hundred and eight candidates were successful. Pass rate among male candidates was 43% of attempts and among female candidates was 52% of attempts. Pass rate among candidates who had passed the ACEM Primary Examination was 52% of attempts and among candidates who had passed the Primary Examination of another College was 41% of attempts. The pass rate was 50% at the first attempt, 38% at the second attempt and 32% at the third or more attempts. The pass rate at repeat attempts was significantly related to the number of sections passed at the last previous attempt. The pass rates in the five clinical and oral sections (66%) was significantly lower compared with the pass rates in the three written sections (74%). The pass rates in the two sections of short cases (59%) was significantly lower compared with the pass rates in the six other sections (73%).Conclusion: Candidates need to be better trained and better prepared for the examination and a programme of examiner training and monitoring is needed, so that the examination process is appropriate for the needs of ACEM.
The Royal Melbourne Hospital Emergency Department twenty years on
Authors: Waller Richard H 
Published: August 2010

AbstractIntroduction:This study compared the patients who chose to attend the Royal Melbourne Hospital Emergency Department (RMH ED) for an arbitrary week in 1993 to those from a similar study completed 20 years before.Method:Of all patients presenting to the RMH ED over the week, those that chose to attend were entered into the survey.Results:The survey population was predominantly male, spoke English, was aged less than 45 years, had a relatively stable place of abode, and received an after tax income of less than $200 per week. Patients were less likely to be of Anglo‐Celtic descent than in 1973 and were unlikely to have attempted tertiary studies unless of Asian descent. The day of highest attendance had changed from Monday to Sunday. Although patients were likely to have a local doctor, they were unlikely to have seen him or her for the complaint. Patients stated that they were prepared to pay $10‐$20 for the ED consultation. As in 1973, most patients chose RMH ED for reasons of convenience, though more patients had attended the hospital before. In this study less patients were privately insured and more were pensioners, although more patients used private transport to come to hospital.Conclusions:Times have changed. If we are to provide optimal service to our patients we need knowledge of their background, social circumstances, and expectations as we provide emergency services into the 21st century.
Fatal fluoride toxicity from silver brazing flux ingestion
Authors: TILLEARD JAMES 
Published: August 2010

ABSTRACTAim:To describe a case of fluoride poisoning due to ingestion of silver brazing flux and review the pathophysiology and treatment of such ingestions.Introduction:The dominant hazardous constituent of silver brazing flux is KHF2 (potassium hydrogen fluoride). This compound is toxic, corrosive and rapidly absorbed from the gastrointestinal tract to produce systemic fluoride toxicity.Case report:A woman ingested an unknown amount of silver brazing flux and was brought to the Emergency Department hypotensive and obtunded. Despite vigorous resuscitation and electrolyte replacement she developed refractory ventricular fibrillation and died eight hours later in intensive care.Discussion:Hydrogen fluoride and its salts are widely used in industrial and domestic products but poisoning by these agents is uncommon. Rapid absorption produces systemic fluoride toxicity. This generates hypocalcaemia, hypomagnesaemia and hyperkalaemia with death resulting from refractory ventricular arrhythmias. These chemicals are corrosive and may cause haemorrhage or perforation of the gastrointestinal tract.Conclusion:Survival from such ingestions is rare. Early recognition and appropriate treatment are essential to optimise outcome.
The incidence and implications of haematuria in renal colic
Authors: LAU HC , SYME RRA 
Published: August 2010

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

ABSTRACTAnalysis of 3,046 consecutive admissions through the Emergency Department at Flinders Medical Centre was performed to determine whether they were valid acute admissions. The study period was 15th December, 1992 to 28th February, 1993. There was an average of 40.1 admissions from just over 140 presentations per day during this period.The admissions were reviewed against a modification of the Appropriateness Evaluation Protocol (AEP). This Protocol had been evaluated in a study for the Clinical Advisory Committee of the South Australian Health Commission. The modifications involved adding to the survey form criteria which had been accepted as overriding clinical reasons for admission in the Evaluation of the AEP report and conducting the survey prospectively as patients were admitted, rather than in a retrospective manner.Analyses were made of the day and time of day of admission. A separate analysis was conducted of patients referred by general practitioners (GPs). The busiest days were Sunday, Tuesday and Thursday, the busiest time for admission was 1600 to 2000 hours. For GP referred patients the quietest day was Sunday.Particular analyses were conducted on those criteria which had been added to the original AEP and on those patients who met none of the criteria, by definition, non acute admissions.There were very few non acute admissions through the emergency department. Only 83 patients (2.72%), met none of the 24 criteria, although many of these admissions could be justified on the basis that there were no viable alternatives to admission.If the AEP is to be used, the method chosen consumed fewer resources and provided the opportunity for more immediate analysis and feedback than the previous study.
Missed fractures in the emergency department
Authors: CAMERON MG 
Published: August 2010

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

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

ABSTRACTStatus epilepticus (SE) may be defined as two or more seizures without full recovery of consciousness between seizures, or recurrent epileptic seizures for more than 30 minutes. Generalised convulsive, tonic‐clonic status epilepticus is the form of SE with the greatest immediate threat to life, and is a medical emergency with morbidity and mortality related to duration of seizure activity.This article reviews the pathophysiology and management of SE with particular emphasis on the pharmacotherapy of generalised convulsive SE.
Post‐transportation mortality following acute traumatic spinal cord injury
Authors: Sansom Guy W , Brown Douglas J , Imran Bakht 
Published: August 2010

AbstractObjective: To identify the mortality rate and cause of death from traumatic spinal cord injury following transfer to an acute spinal injuries unit.Design: A five year retrospective analysis of mortality in adults admitted with suspected traumatic spinal cord injury to a specialised acute spinal injuries unit.Setting: Spinal Injuries Unit, Austin Hospital, Melbourne. The sole acute adult unit in a catchment area of 5 million people.Patients: Three hundred and ninety‐two patients admitted to the unit from 1 January 1988 to 31 December 1992.Results: Twenty‐six patients died during their admission (6.6%), they had a mean age of 52.3 years, and death occurred a mean 35.6 days after admission. The common causes of death were pneumonia, pulmonary embolus, and multiple trauma. The highest mortality rate was during the first 24 hours following arrival at the unit.Conclusion: There were no deaths attributable to inadequate stabilisation prior to transfer. Leading causes of death were pneumonia, pulmonary embolus, and multiple‐trauma. Comparison with previous studies is difficult due to wide variations in the selected study population.
Anaphylactic shock: mechanisms and treatment
Authors: Brown Anthony FT 
Published: August 2010

AbstractThis paper reviews the mechanisms of anaphylactic shock in terms of the immunoglobulin and non‐immunoglobulin triggering events; and the cellular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule associated mediators and the rapidly formed, newly synthesised mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately curtail the anaphylactic reaction. The roles of these mediators in the various causes of cardiovascular collapse are examined.The treatment of anaphylactic shock involves oxygen, adrenaline and fluids. The importance and safety of intravenous adrenaline are discussed. Combined H1 and H2 blocking antihistamines and steroids have a limited role. Glucagon and other adrenergic drugs are occasionally used, and there are several new experimental drugs.
Does alcoholic ketoacidosis go undetected?
Authors: Ragg Michael , Eddey David 
Published: August 2010

AbstractObjectiveTo review the condition of alcoholic ketoacidosis.Data sourcesEnglish language literature search using Medline® for the period 1973 to 1993. A total of 34 articles, abstracts and book chapters were used.Data synthesisAlcoholic ketoacidosis has been recognised for over 50 years yet there seems to be a lack of knowledge about this condition. The patient usually abuses alcohol, and presents with nausea, vomiting and abdominal pain. Laboratory tests show an increased anion gap metabolic acidosis and electrolyte changes secondary to vomiting and dehydration. Urinalysis may be negative for ketones. The differential diagnosis is that of a raised anion gap metabolic acidosis in the setting of chronic alcohol consumption. Intravenous fluids and glucose are the mainstays of treatment.ConclusionAcutely unwell patients who abuse alcohol commonly present to the emergency department. Failure to consider alcoholic ketoacidosis may lead to inappropriate discharge.