bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guidelines for the rational use of paracetamol in febrile paediatric patients
Authors: Spain David J 
Published: August 2010

AbstractFever itself is usually not harmful and may enhance immune function. Paracetamol is widely used as an antipyretic in children. Paracetamol provides little or no benefit to the majority of these children. Significant harm, including death, has been described with paracetamol. This paper examines current understanding of the management of fever, in relation to the role of paracetamol. Recommendations are made for its less frequent use.
A middle aged woman with fluctuating conscious level and unsteady gait ACEM Queensland Faculty Inaugural Clinicopathological Conference
Authors: Sinnott Michael 
Published: August 2010

AbstractThis article is an edited version of a clinicopathological conference held by the Queensland Faculty of the Australasian College for Emergency Medicine. The case discussed by a panel of emergency medicine specialists, advanced trainees and invited guests, is of a 55 year old lady presenting with progressive deterioration in conscious state.A list of important issues that may influence the daily routine of medical staff working in the emergency department is included in the conclusions.
Intermittent subclavian artery occlusion following clavicular fracture
Authors: Williams Sean RW , Pike Ian AH 
Published: August 2010

AbstractAlthough fractures of the clavicle are common, complications are rare. A 41 year old painter developed two uncommon complications of clavicular fracture, mechanical intermittent subclavian artery occlusion and subclavian vein thrombosis. Both conditions were clearly identified on the clinical symptoms and signs and confirmed with dynamic angiography and computerised tomography. Operative intervention led to complete resolution of symptoms.
Acute pulmonary oedema secondary to thromboembolic occlusion of the distal aorta in a patient with hypertrophic cardiomyopathy
Authors: Ardagh Michael 
Published: August 2010

AbstractA 49 year old man with hypertrophic cardiomyopathy and atrial fibrillation presented with bilateral lower limb ischaemia due to embolism of a left ventricular mural thrombus causing occlusion of the distal aorta and common iliac arteries. The patient developed severe pulmonary oedema. This was thought to be caused by the elevated cardiac after‐load imposed by the aortic obstruction.He was successfully treated with continuous positive airway pressure prior to definitive treatment of the obstruction by bilateral aorto‐iliac embolectomies.
Methotrexate poisoning
Authors: Canestra Jane 
Published: August 2010

AbstractThree case studies of accidental methotrexate ingestion in paediatric patients are presented. Two patients had toxic methotrexate levels. Treatment included the administration of charcoal, intravenous hydration, alkalinisation of urine and the administration of the specific antidote folinic acid. All patients made an uneventful recovery. Parenteral folinic acid therapy should be commenced without delay in all cases of suspected methotrexate poisoning in equimolar concentration to the suspected dose of methotrexate. It is recommended that methotrexate tablet packaging be altered to reduce the likelihood of paediatric access.
Size does make a difference in management of spontaneous pneumothoraces
Authors: Aplin Phil 
Published: August 2010

AbstractObjectives: The study looked at the relationship between pneumothorax size and the likelihood of successful microcatheter aspiration, rate of surgical intervention and the rate of recurrence.DesignA retrospective case study analysis of 117 consecutive cases of spontaneous pneumothorax over a four‐year period was undertaken with patient follow up for a minimum of 12 months.Pneumothoraces were classed as small (less than 20% of hemithoracic volume), moderate (between 20% and 60%) and large (greater than 60%).ResultsThe success rate of microcatheter aspiration was significantly higher in moderate sized pneumothoraces compared to large pneumothoraces (82% vs 43%, P<.01). Increasing pneumothorax size was also associated with an increased surgical intervention rate (12.5%, 34% and 50% respectively for small, moderate and large groups, P<.05). Increasing pneumothorax size was not associated with an increased recurrence rate.ConclusionIncreased pneumothorax size is associated with a significantly lower rate of successful management using microcatheter aspiration techniques and an increased rate of thoracic surgical intervention.
Blood volume regulation
Authors: Isbister James P 
Published: August 2010

AbstractThe maintenance of adequate cardiac output and tissue perfusion is dependent on intravascular blood volume and its adequate return to the heart. Considering the numerous functions of the cardiovascular system in providing adequate flow to the peripheral microcirculation, it is not surprising that there may be conflicts of interest when stresses are placed on the system. Of particular importance are the stresses in which there are increased oxygen demands, decreased oxygen availability and concomitant requirements for temperature regulation.In the context of depleted intravascular blood volume, the splanchnic circulation provides an autologous blood bank until transcapillary refill of the circulation occurs. On the other hand centralisation of blood from the venous capacitance compartment, as seen with acute hypoxia, leads to overfilling of the heart, release of atrial natriuretic peptide and subsequent reduction of the plasma volume by transcapillary efflux.In this review the basic physiology of blood volume, red cell mass and plasma volume regulation will be presented, followed by a consideration of the pathophysiological changes occurring in the context of a variety of clinical settings. Recent insights into neurohormonal aspects of blood volume regulation, the role of the spleen, the interstitial compartment, colloid oncotic pressure, vasomotion and red cell function will be presented.
Massive transfusion: a review
Authors: Harvey Michael P 
Published: August 2010

AbstractThe most generally accepted definition of massive transfusion is the replacement of the patient's blood volume in under 24 hours. This corresponds to 3000ml of red cells or approximately 10 units of packed cells in an average weight person. The most frequent reasons for massive transfusion include trauma, GIT bleeding, obstetric bleeding, bleeding abdominal aortic aneurysm, and major elective vascular surgery. Survival in massively transfused patients will vary depending on the underlying disease process. Overall survivals of 45–67% have been reported and of these 90% regain full independence and 75% return to work. Massive transfusion imposes a considerable strain on blood banking resources and in many centres a relatively small number of patients consume 10–15% of the total blood supply annually. Severe coagulopathy (INR and/or APTT double normal) will develop in 40% of patients and severe thrombocytopenia (platelets <50 × 109/L) in 30% of patients between 10 and 20 units of units transfused. Coagulopathy, hypothermia and tissue injury all contribute to the phenomenon of microvascular oozing which develops in approximately 30% of massively transfused patients. There is only a weak correlation between the severity of coagulopathy/thrombocytopoenia and the total units transfused suggesting that factors such as duration of tissue hypoperfusion and consumption are likely to play a more important role than simple haemodilution of coagulation factors. Because of the lack of clear correlation between coagulopathy/thrombocytopenia and the number of units transfused, “formula” replacement with plasma and platelets is not recommended. The approach to blood product support in the massively transfused patient will be discussed.
Fluid resuscitation in children
Authors: Henning Robert 
Published: August 2010

AbstractChildren most often need fluid resuscitation because of fluid loss (especially from diarrhoea), while bleeding and sepsis account for a minority of cases. The child's immature body systems (especially cardiovascular and renal), age‐dependent fluid compartment sizes and lack of degenerative vascular diseases of adulthood affect the child's clinical signs and the response to hypovolaemia and to resuscitation.The issues of what fluid, how much, how fast and by what route are interdependent. In general, aggressive early fluid resuscitation reduces mortality and morbidity in children with burns and sepsis, while slow rehydration over 48 hours is safer in dehydrated children with diarrhoea or diabetic ketoacidosis. There are few specifically paediatric data comparing hyper‐ or isotonic crystalloid with colloid, or the various colloids with each other, so that legends abound in paediatric resuscitation. The empirical basis of these legends will be discussed in this paper.Safe resuscitation requires close observation of the cardiovascular system, conscious state, urine output and blood chemistry. When close biochemical monitoring is not possible, a fluid regime should be chosen which is least likely to cause biochemical changes.
The changing pattern of self‐poisoning in Hong Kong over nine years
Authors: Lau Fei Lung , Liu Rico , Yip Sai Hang 
Published: August 2010

AbstractThree thousand four hundred and twenty poisoned patients presenting to the Accident & Emergency Department of an inner‐city hospital from July 1985 to June 1994 were studied retrospectively. There was a predominance of females (F:M = 7:3) and young adults (45% aged between 21 years and 30 years). Hypnotics and tranquilisers made up more than half of the agents taken. Most of the patients (57%) poisoned themselves deliberately. The majority of patients had taken a single drug (97%). There was a significant drop in poisoning with Mandrax (methaqualone/diphenhydramine), Lendormin (brotizolam) and aspirin (acetylsalicylic acid) after 1990 while poisoning with narcotic analgesics and hallucinogens increased significantly.
Ketamine anaesthesia in Papua New Guinea
Authors: Roberts Penny , Dent Andrew W 
Published: August 2010

AbstractThis study examines the incidence and severity of adverse effects of ketamine anaesthesia used for short outpatient procedures in Papua New Guinea. Nine hundred and twenty consecutive ketamine anaesthetics were observed. Eighty‐two adverse events in 77 anaesthetics (8.4% of anaesthetics) were observed. Twelve anaesthetics (1.3%) were complicated by a severe adverse event. These were severe emergence phenomena (nine cases), seizure (one case) and pain necessitating abandonment of the procedure, which occurred twice with the same patient who also suffered laryngospasm during one of these anaesthetics. There were no deaths. Young adult male patients with painful or prolonged procedures had the highest frequency of hallucinatory adverse effects. This study confirms the safety and efficacy of ketamine anaesthesia.
Practical guidelines for emergency department photography and video recording
Authors: Ryan John M , Gaudry Paul L 
Published: August 2010

AbstractClinical photography and video recording by emergency department staff are important adjuncts to the teaching and practice of emergency medicine. A single‐lens reflex camera with a manual zoom 35–105mm macro lens is the recommended camera for most teaching purposes. A built‐in ringflash mounted around the lens allows for shadowless and uniform illumination. The instant developing camera has some specialised applications in wound care and trauma triage. The digital camera, which captures high resolution colour images that can be individually computer edited and enhanced provides exciting possibilities for photographic presentation in the future. A system for video recording resuscitations can be readily installed and used for quality improvement.
A review of detection techniques for oesophageal intubation
Authors: Ardagh Michael 
Published: August 2010

AbstractInadvertent intubation of the oesophagus is an occasional complication of endotracheal intubation and can be fatal if unrecognised.Visualising the endotracheal tube pass between the vocal cords and capnography are established as the gold standard methods of ensuring tracheal placement, but both may be either impossible or impractical in certain emergency intubations.Colourimetric end tidal CO2 detectors and oesophageal detector devices are alternative techniques. Of these oesophageal detector devices are the more accurate.
A review of ACEM accreditation: 1986–1995
Authors: Yuen Allen 
Published: August 2010

AbstractThis review summarises the findings of all accreditation inspection visits performed by the College from 1986 until 1995. All hospitals in Australia and New Zealand which requested inspection for the purpose of accreditation of training positions for advanced trainees of the College during this period, were inspected. Hospitals which did not fulfil the basic criteria for accreditation were not inspected until these requirements were satisfied.Altogether, 109 inspections have occurred, comprising 76 hospitals and two helicopter retrieval services. Twenty hospitals have been inspected twice, eight have required three inspections. All but one major metropolitan hospitals were included in the first round of inspections.The reasons for success, failure or downgrading of accreditation are analysed. This information may prove useful for hospitals seeking to have training positions approved in their hospital in the next round of inspections.
Usage of alternative medicines by patients presenting to an emergency department
Authors: Way Bruce , Stewart Antony , Croker Bill 
Published: August 2010

AbstractObjectiveTo survey the usage of alternative medicines by emergency department patients.SettingAn adult emergency department of a major teaching hospital in the eastern suburbs of Sydney.MethodOver a five day period, 261 patients responded to a questionnaire examining their use of alternative medicines. Data on the alternative medicines used, details of the prescribers and opinions on safety were collected.ResultsSeventy two percent of respondents had taken some form of alternative medicine before and 48% were currently taking one or more on a regular basis. Alternative medical therapy was most common amongst middle aged, well educated females. Seventy percent were self prescribing and 92% felt that they were completely safe.ConclusionsUse of alternative medicines is common amongst patients presenting to the emergency department. Most are taken without supervision and patients generally feel that they are completely safe.
Boerhaave's syndrome complicated by tension pneumothorax
Authors: Doherty Steven 
Published: August 2010

AbstractTension pneumothorax secondary to oesophageal perforation has only twice been reported in the medical literature, and has never been described in association with Boerhaave's syndrome. A case of tension pneumothorax secondary to spontaneous oesophageal rupture in a 47 year old man is presented.If Boerhaave's syndrome is suspected because of back or abdominal pain, vomiting, dyspnoea and radiological signs, a gastrograffin oesophagram is the imaging procedure of choice. Early surgical drainage and repair produce the best outcome.
Clinical intervention in retrieval medicine
Authors: Merchant John , Tall Gary , Manning Ron 
Published: August 2010

AbstractObjectiveTo describe the clinical interventions undertaken by retrieval physicians during interhospital transfer between different hospital types and discuss the implications for staff training.MethodCase sheets from all interhospital transfers undertaken by the Sydney Aeromedical Retrieval Service for the 1995 calendar year were analysed retrospectively. Clinical interventions were categorised into airway management, invasive procedures, fluid resuscitation and drug therapy. Each category was then reviewed according to the functional level of the referring hospital.ResultsA total of 577 interhospital transfers occurred during this period. Two hundred and fifty eight (44.7%) patients transported required at least one clinical intervention. A total of 421 interventions were made. Of the 421 interventions performed 43% were classified as drug therapy, 34.4% as invasive procedures, 13.3% as fluid resuscitation and 9.3% as airway management. The overall intervention rate for those patients transported from tertiary hospitals was 0.31, for other metropolitan hospitals 0.78, for rural base hospitals 0.70 and for other rural hospitals 1.06.ConclusionThose physicians with advanced training in critical care medicine are most suited to the requirements of retrieval medicine. Patients from smaller hospitals have a greater likelihood of requiring intervention by the retrieval physician.
Attitudes and beliefs of emergency department doctors towards domestic violence in Hong Kong
Authors: Wong Tai‐wai , Chung Mimie MY , Yiu Jackson JK 
Published: August 2010

AbstractA questionnaire was sent to all doctors working in emergency departments in Hong Kong to survey their attitudes and beliefs towards domestic violence. Beliefs concerning privacy and traditional cultural values were found to be important factors affecting the doctor's ability to identify cases of wife abuse. Most respondents had no formal training in this area and felt inadequate in the handling of domestic violence cases. Ways to improve training and identification of at risk cases are discussed.
Never eat an ugly fish: three cases of tetrodotoxin poisoning from Western Australia
Authors: Ellis Rodney , Jelinek George A 
Published: August 2010

AbstractTetrodotoxin is a powerful axonal blocking agent found in a number of marine creatures, including puffer fish. Fatal and near fatal poisonings due to puffer fish ingestion have been described in the medical literature, but few reports are from Australia.Three adults from the same family (two men aged 40 and 24 years and one woman aged 47 years) presented to the Fremantle Hospital Emergency Department six hours after catching and eating an unknown fish. Two developed typical symptoms of tetrodotoxin poisoning including tongue and lip paraesthesiae, blurred vision, ataxia, vomiting and progressive muscular paralysis with inability to stand. They were admitted to the intensive care unit although neither required mechanical ventilation. The third had minimal signs and was observed in the emergency medicine observation ward overnight. All were discharged the next day with some residual ataxia.Clinically significant tetrodotoxin poisoning may culminate in respiratory failure and death if untreated. There is no specific antidote and treatment is supportive. The literature on this unusual poisoning is reviewed.
The serotonin syndrome
Authors: Williams Aled 
Published: August 2010

AbstractThe serotonin syndrome is an increasingly recognised clinical condition characterised by a triad of motor, mental status and autonomic changes. In most cases it is mild and self limiting. In severe cases it can progress to rhabdomyolysis, disseminated intravascular coagulation and death.The syndrome is caused by an increased level of serotonin in the central nervous system. This is usually the result of the administration of combinations of serotinergic agents.This article describes two cases of the syndrome where the diagnosis was not immediately apparent. The pathophysiology, clinical course and treatment are then discussed. Serotonin syndrome is also compared to neuroleptic malignant syndrome. This is a disorder with similar signs and symptoms and may have a similar pathophysiological basis.Serotinergic agents are commonly prescribed. Emergency physicians must be vigilant for this easily overlooked, potentially fatal but treatable disorder.
New drugs in the treatment of depression and schizophrenia
Authors: Gowardman John 
Published: August 2010

AbstractPharmacological agents are important in the treatment of many patients with major depression or psychotic illness. Antidepressant drugs such as the tricyclic antidepressants and non‐selective monoamine oxidase inhibitors are associated with significant adverse effects, especially in overdose. Newer antidepressants include selective serotonin reuptake inhibitors and reversible, selective monoamine oxidase inhibitors. These new drugs are clinically effective and have greatly improved side effect profiles, being considerably safer in overdose than older agents. In the treatment of psychosis, risperidone and clozapine represent clinical advances and are less likely to induce adverse neurological effects than existing neuroleptic agents.
Intrathecal baclofen overdose
Authors: Merchant John , Hollis Gregory 
Published: August 2010

AbstractIntrathecal baclofen administered by bolus or continuous infusion has been shown to be of benefit in the treatment of spinal spasticity.Reporting of complications has been limited, particularly in the emergency medicine literature. Reports have been primarily associated with clinical trials.We report a case of intrathecal baclofen overdose in a patient presenting to the emergency department with an altered level of consciousness and cardiorespiratory depression, who required mechanical ventilation, fluid resuscitation and intensive care admission.The literature is reviewed with respect to the action and effectiveness of intrathecal baclofen, use of the relevant implantable devices, suggested methods of management in overdose and the other reported complications from this treatment modality.
Mild traumatic brain injury
Authors: Cameron Peter A , Ponsford Jennie L 
Published: August 2010

AbstractMild head injury is a common emergency presentation. Previously medical attention has focused on risk of injury requiring surgical intervention. The importance of long term sequelae in patients not requiring surgical intervention has now been recognised. It is not clear, however, how frequently this occurs, which patients are at risk and whether interventions improve outcome. The symptoms associated with mild traumatic brain injury have an organic basis. Some people will be helped by strategies to deal with these symptoms. Emergency physicians should develop better methods to ensure adequate screening in the emergency department to target at risk groups and introduce interventions which are proven to be effective.
Outcome from prehospital cardiac arrest in Melbourne, Australia
Authors: Bernard Stephen 
Published: August 2010

AbstractAlthough the incidence and outcome of prehospital cardiac arrest have been reported for many cities, relatively few have originated from Australia. This study reviewed ambulance and hospital records of all patients who were in cardiac arrest when first attended by ambulance officers in metropolitan Melbourne between 1 February and 31 July 1995. Of 361 patients with a presumed primary cardiac cause of arrest, 113 (31%) were initially in ventricular fibrillation. The average ambulance response time was 9.4 minutes. Bystander cardiopulmonary resuscitation was performed on 22% of patients. Ten patients (3%) were discharged alive from hospital of whom eight (2%) were to independent living at home. All survivors were in ventricular fibrillation when first seen. It is concluded that survival from prehospital cardiac arrest in Melbourne is low. Strategies to improve outcome are suggested.