bluuebunny/crossref_metadata_2025_split huggingface dataset:
The acute effects of magnesium in atrial fibrillation and flutter with a rapid ventricular rate
Authors: Walker Steve , Taylor James , Harrod Richard 
Published: August 2010

AbstractA prospective, randomised, placebo controlled, double blinded trial to assess the efficacy of intravenous magnesium sulphate (20mmol over 30 minutes) versus placebo in patients presenting to the emergency department with rapid atrial fibrillation and flutter. The end points were slowing of the ventricular rate and reversion to sinus rhythm. A total of 41 patients were enrolled. The mean decrease in heart rate 30 minutes after commencing the infusion was 24.1/min for the magnesium group compared to 11.0/min for the placebo group (different at the 95% level of significance). The mean decrease in heart rate and the reversion rate four hours after commencing the infusion were the same at the 95% level of significance for the two groups. We conclude that magnesium has a significant effect in the acute slowing of ventricular rate but no effect in achieving reversion to sinus rhythm.
Critical incident monitoring is a useful quality improvement tool for the emergency department
Authors: Stella Damien , Hendrie James , Smythe James , Graham Ian 
Published: August 2010

AbstractObjectivesTo describe and evaluate the critical incident methodology as a quality improvement tool in the emergency department.MethodAn audit of Emergency Department Incident Reports over a five‐month period. The main outcome measures used were aetiology, factors which may have minimised the incident, the outcome and any suggested corrective strategies. The result was a 230 point questionnaire. This tool was called the Emergency Department Incident Monitoring System. Despite the number of questions, the circling of responses allowed the form to be completed in under five minutes.ResultsIn the 112 incidents analysed, there were 46 patient factors, 92 human factors and 33 diagnostic factors identified. Skilled assistance and supervision minimised the incidents in 44% of cases. In 86% of incidents, patients suffered minor or no physiological change. In 8% of incidents, patients suffered major morbidity. There was one death in the series. Improved communication was identified as the most important corrective strategy in 21% of incidents. Further training and education were felt to be important in 20% of incidents and improved supervision in 16% of incidents.ConclusionThe critical incident technique provides a practical and effective framework for analysing incidents. It is an inexpensive, easily implemented adjunct to traditional quality improvement programs and provides useful clinical and administrative information. Sampling error does limit the value of the technique.
Reliability of the National Triage Scale with changes in emergency department activity level
Authors: Hollis Gregory , Sprivulis Peter 
Published: August 2010

AbstractAimTo assess the reliability of the National Triage Scale (NTS) by determining whether the activity level of an emergency department influences triage category assignment.SettingEmergency Department, The St George Hospital, a Sydney metropolitan teaching hospital emergency department.MethodsA prospective study of all patients presenting over a six‐month period. Triage category (TC) assignment distribution and admission rate in each TC was determined for three levels of departmental activity (Quiet, Normal, Busy) defined by the number of presentations to the department in the previous two hours.ResultsOf 17,561 presentations examined, the proportion of patients assigned to each TC did not significantly differ for NTS1,2,3 or 4. The percentage of patients assigned to NTS5 for Quiet periods was 9.0% (95%CI 7.9–10.0%), Normal 7.0% (6.5–7.6%) and Busy 6.6% (6.0–7.2%) (p<0.001). The admission rate for NTS4 for all levels of activity was 36% (35–37%) and exceeded the NTS guideline of 20–30%. Busy 16% (13–20%) and Normal 16% (13–19%) NTS5 patients had a slightly higher admission rate than Quiet NTS5 patients 10% (6–14%) (p=0.049) and exceeded the NTS guideline of 5–10%. Admission rates for NTS1,2 and 3 were within NTS guidelines for all activity levels.ConclusionThe NTS can be applied consistently, independent of the emergency department activity level. Admission rate analysis indicates that the slightly higher proportion of NTS5 patients presenting during Quiet periods were of genuine low acuity. NTS guideline comparison suggests either 10% of NTS4 and 5% of NTS5 patients at this hospital should have been triaged to a higher TC or that the NTS admission rate guidelines may need revision.
Acute fulminant viral myocarditis
Authors: Raftos John R 
Published: August 2010

AbstractTwo cases of viral myocarditis resulting in early death are presented. The acute fulminant form of viral myocarditis occurs infrequently but is significant as it often involves neonates, adolescents and young adults, frequently with poor outcome. Prompt diagnosis is based on a high index of suspicion and is essential for optimal recovery. However the presence of abdominal pain as a major symptom may delay diagnosis. The clinical course and management of this form of viral myocarditis is discussed.
Massive European wasp envenomation of a child
Authors: Levick Nadine , Braitberg George 
Published: August 2010

AbstractEnvenomation is a unique area of emergency medicine which interfaces acute emergency care with zoological research and public education. A considerable amount is known about envenomation by the snakes and spiders of Australia, which are among the most venomous in the world. There is little known, however, about massive envenomation by the European wasp (species Vespula germanica, family Vespidae), a recently introduced, aggressive and venomous vespid wasp. Allergy to bee, wasp and ant venom (order Hymenoptera) is well reported in the literature but there has been no documentation of systemic allergic reactions following massive vespid envenomation. Massive envenomation by vespid wasps in Australia has not been reported, although there are international reports of serious morbidity and a number of fatalities. This paper reports a massive European wasp envenomation in Melbourne and reviews the international literature. In this case, in contrast to the literature on massive vespid wasp envenomation, there is predominance of central nervous system toxicity with no major metabolic disturbance. The management of massive vespid envenomation includes standard supportive care and close laboratory monitoring for early evidence of haemolysis, rhabdomyolysis and metabolic derangement, which may significantly precede any clinical deterioration. Serious complications may be delayed and it is advised to follow up patients for 72 hours. There is potential for further research into vespid wasp venom and a need for increased public awareness of preventative strategies in Australia.
Right ventricular infarction
Authors: Page Colin B , Wilkes Garry J 
Published: August 2010

AbstractRight ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio‐ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30–50%. Kussmaul‘s sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient.Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarchon is increased by right ventricular infarction, but may be lessened by thrombolytic therapy in eligible patients.
Rapid transfusion systems
Authors: Gibbs Neville M , Thackray Mark 
Published: August 2010

AbstractFactors influencing the rate of infusion include the size of the venous access, the diameter and length of infusion tubing, the viscosity and density of the fluid infused, and the pressure gradient between the infusion bag and vein. Narrow gauge intravenous catheters and other restrictions reduce flow by increasing resistance, and by encouraging turbulent flow. Currently available rapid infusion systems provide efficient warming of fluids, and promote rapid flow by having low resistance and high driving pressures. The high driving pressures are achieved by applying external pressure to infusion bags, or by using a reservoir and roller pump. Given adequate intravenous access, both methods are capable of flow rates over 1000ml/min. At high flows, air eliminators are required to reduce the risk of air embolism. Open reservoir systems require additional monitors to avoid the infusion of air. Other potential complications of rapid transfusion include fluid overload, hyperkalemia and citrate toxicity.
Minimal volume, hypotense resuscitation
Authors: Myers Colin T 
Published: August 2010

AbstractLarge volume fluid resuscitation attempting to normalise physiological parameters in hypovolaemic shock has become the accepted management practice during the last 30 years.This doctrine, based on research in the 1950s, teaches that shock increases mortality, aggressive resuscitation improves outcome and normalisation of vital signs protects against multiple organ dysfunction. The wide acceptance of this doctrine is demonstrated by the central role it plays in the American College of Surgeons Advanced Trauma Life Support (ATLS) course and its Australian equivalent the Early Management of Severe Trauma (EMST) course.During the late 1980s, a number of animal research papers demonstrated severe limitations to the earlier work performed in the 1950s and proposed an alternative approach using hypotense or minimal fluid resuscitation.Controlled haemorrhagic shock is hypovolaemic shock in which the source of the bleeding is easily controlled without operation and hence aggressive fluid resuscitation can be pursued with minimum risk.Uncontrolled haemorrhagic shock is hypovolaemic shock due to bleeding which cannot be controlled without surgery. The restoration of blood pressure towards normal levels may lead to dislodgement of thrombus and loss of vascular spasm in damaged vessels, with a subsequent increase in blood loss. It is in this situation that hypotense resuscitation is thought to be of most value.Hypotense resuscitation is defined as the use of fluid resuscitation to maintain blood pressure at lower than normal levels which are sufficient to maintain life, but minimise the risk of exacerbating internal bleeding.Prompted by animal research a number of human studies have been undertaken to clarify the role of fluid resuscitation in uncontrolled haemorrhage.At present, there is wide acceptance of the use of hypotense or minimal volume resuscitation for ruptured abdominal aortic aneurysm and a recent demonstration that morbidity and mortality are decreased by the use of hypotense resuscitation in penetrating truncal trauma. There are however many other clinical situations that may produce uncontrolled haemorrhagic shock about which we have little clinical data to predict appropriate levels of fluid resuscitation. These include ectopic pregnancy, gastro‐intestinal haemorrhage and blunt multi‐system trauma.This paper will analyse the animal studies that demonstrate the physiological effects of the various fluid resuscitation regimes and discuss all the clinical papers on the subject of hypotense resuscitation. An attempt will then be made to integrate this data into current Australian practice and give broad guidelines on the modern management of uncontrolled haemorrhagic shock, based on minimal volume or hypotense resuscitation.
Intravenous fluid administration in pregnancy: maintenance and acute hydration
Authors: Crowhurst John A 
Published: August 2010

AbstractPregnancy is characterised by a hyperdynamic output state, low blood viscosity and haematocrit, reduced blood and tissue buffering capacity, increased tendency to both sodium and water retention, an exaggerated ketotic and hypoglycaemic response to dehydration and increased insensible losses and decreased heat tolerance. These changes are relevant to anaesthetists attempting to restore and maintain fluid, electrolyte, glucose and metabolic balance in labour and during anaesthesia, resuscitation and critical care.Fluid maintenance and replacement in pregnancy follow the basic principle of replacing what is lost in both quantity and quality, remembering the specific requirements of the individual patient and situation.The altered milieu of pregnancy makes the use of most crystalloid containing fluids somewhat controversial particularly for acute hydration (fluid loading) in association with central neural blockage or resuscitation. Normal saline and lactate tend to worsen reduced buffer base capacity and cause further dilution of plasma proteins in an already low blood glucose level, so potentiating the efforts of highlevel epidural or spinal sympathetic blockade. Glucose loads can cause fetal hyperinsulinaemia, rapid‐onset neonatal hypoglycaemia and jaundice. A balanced approach of fluid administration using colloids, crystalloids and vasopressors will be discussed.
Mammographic techniques for imaging subcutaneous foreign bodies in the extremities
Authors: Lim Kim , Blecher Carl 
Published: August 2010

AbstractConventional soft tissue radiography using specialised high definition film is at present the standard for screening for subcutaneous foreign bodies in the extremities. While this is usually sufficiently sensitive for large (greater than 1mm) or radio‐opaque objects, finer splinters particularly of plant origin are less readily demonstrated. Current mammographic technology may become another imaging option in such cases.
Emergency medicine in Antarctica
Authors: Taylor David McD , Gormly Peter J 
Published: August 2010

AbstractAntarctica provides immense and varied challenges, not least of which is the provision of adequate health care for expedition personnel. Although expeditioners must be healthy and not reliant upon medication for the maintenance of health, unexpected illness and accidents are always a possibility. An Antarctic health facility must be well organised, able to accommodate almost every contingency and be provided with adequate equipment, medication and medical expertise. This paper describes the provision of emergency health care at Australian Antarctic stations and discusses the climate and environment, medical practitioner selection and training, equipment and facilities, medical conditions expected, evacuation and aspects of Antarctic telemedicine. Some illustrative cases are presented.
Head injury and the time interval to computerised tomography scan
Authors: Kijvanit Patricia K , Gaudry Paul L 
Published: August 2010

AbstractObjectivesTo audit the time interval from arrival at the emergency department to computerised tomography scan in patients with head injury undergoing neurosurgery and to evaluate the circumstances when this time interval exceeded two hours.SettingMajor trauma service.DesignDescriptive retrospective review.ResultsThere were no statistically significant relationships between time to computerised tomography scan and initial Glasgow Coma Scale score, Abbreviated Injury Scale, Injury Severity Score, arrival during normal hours versus after hours type or type of neurosurgical procedure performed. Time to scan was significantly shorter for interhospital transfers than direct admissions. The time interval exceeded two hours in 29 of 115 patients (25%). This was considered avoidable in 20 patients (69%), including six with documented alcohol ingestion.ConclusionAudit identified a need to focus clinical staff on earlier decision making. Specific clinical guidelines have been implemented for intoxicated patients with head injury.
Pneumorrhachis following head trauma
Authors: White Paul , King Michael , Civil Ian 
Published: August 2010

AbstractPneumorrhachis or air within the spinal canal is an extremely rare complication of skull fracture. We report a case of pneumorrhachis following head trauma, and review the other two documented cases. Although rare, the finding of air within the spinal cord on lateral cervical radiographs of a trauma patient is important. As these films are done early in the assessment of the trauma patient, this finding provides early indication of skull fracture and should direct the treating team to carefully evaluate for cerebral injury.
Herpes simplex virus infection is another risk from needlestick injury
Authors: Sinnott Michael J , Thomas Peter P , Whitby R Michael 
Published: August 2010

AbstractThis is the first case report in the literature of herpes simplex virus type 1 infection resulting from a needlestick injury. The case highlights the need to observe Standard Precautions to prevent sharps injury and the need for prophylactic treatment, for instance in this case with acyclovir, is emphasised.
Helical CT aids in the emergency department diagnosis of pulmonary thromboembolism
Authors: Small Niall 
Published: August 2010

AbstractPulmonary thromboembolism remains a diagnostic challenge for emergency physicians. There is a high mortality from failed diagnosis.Rapid and accurate diagnosis by a readily accessible and minimally invasive technique such as helical computerised tomography (CT) has the potential to reduce mortality and allow early consideration of new treatments such as thrombolysis. There is also potential to reduce the number of procedures required to reach a diagnosis. Current published material is reviewed and a suggested role for helical CT in the emergency department diagnosis of pulmonary thromboembolism is outlined. Three case reports are presented where CT has been utilised in the diagnosis of pulmonary thromboembolism in patients presenting to an emergency department.
Nicotiana glauca toxicity
Authors: Webb Mark , Dalzell Shona 
Published: August 2010

AbstractA case of nicotine toxicity in a 50 year old woman who presented with persistent neurological symptoms is described. This followed the ingestion of leaves from the plant Nicotiana glauca. The active substance was a nicotine‐like alkaloid, anabasine. Only a few cases of this ingestion have been documented in the medical literature and the lay press, with two fatalities resulting from ingestion of a similar quantity of plant to that ingested by the patient described here. A description of nicotine toxicity and its management is presented.
Aboriginal utilisation of an urban emergency department
Authors: Green Tim 
Published: August 2010

AbstractObjectiveTo profile the use of an urban emergency department by Australian Aborigines.SettingA large inner city adult and paediatric hospital with a significant local Aboriginal community.MethodAboriginal attendances were retrospectively identified for a six month study period by a search of the emergency department database. All patient charts were reviewed and data compared with that of non‐Aboriginal patients for the same period and the Australian Bureau of Statistics data on the catchment area of the hospital.ResultsThere were 338 Aboriginal presentations during the study period, representing 1.7% of the total emergency department caseload. This was 27% more presentations than would be predicted from the size of the Aboriginal population in the local area as assessed by Australian Bureau of Statistics census data. Patients in the Aboriginal cohort tended to be young and female reflecting the demographic profile of the Aboriginal community. The number of Aboriginal men over the age of 45 who presented to the emergency department was 33% less than predicted. Aboriginal patients were more likely to have been referred to the emergency department by a GP and these patients had a higher admission rate than those who were self referred. There was no significant difference in the rate of ambulance use, rate of arrival with police, time of triage or disposition status between the Aboriginal and non‐Aboriginal patient groups. Aborigines had significantly lower National Triage Scale scores than non‐Aborigines but the admission rate for Aborigines was higher in categories two, three and four. The contribution of the local Aboriginal Medical Service and the incidence of trauma and substance abuse are described and discussed.ConclusionsThis study is the first to describe the characteristics of emergency department use by urban Australian Aborigines. The under representation of older Aboriginal men and the lower triage categories of Aboriginal patients demonstrated in this study warrant further prospective evaluation.
Dissection of the subclavian artery with mediastinal haemorrhage – an unusual complication of central venous catheterisation
Authors: Burke Michael P , Opeskin Ken 
Published: August 2010

AbstractArterial cannulation is a recognised complication of attempted central venous cannulation. Arterial cannulation may cause haemorrhage, thrombosis, pseudoaneurysm formation, mycotic and true aneurysm formation and air embolism. We describe a case of subclavian artery dissection during attempted subclavian vein catheter placement resulting in a mediastinal haematoma and cardiac tamponade contributing to death. Inadvertent arterial cannulation may be difficult to diagnose in the hypoxic, hypotensive patient. The complications of arterial cannulation during attempted subclavian central venous catheter placement may be minimised by careful positioning, meticulous attention to technique and avoiding the use of large bore central venous catheters in unstable patients.
Non‐traumatic fracture of the first rib
Authors: Steele Donna , Bergman Jack 
Published: August 2010

AbstractA 25 year old man presented to the emergency department complaining of severe left chest pain associated with shortness of breath on waking. A chest radiograph showed a fracture of the left first rib. There was no history of recent direct trauma, although a minor injury to the left shoulder girdle had occurred three weeks earlier. Current theories on mechanism of injury in fractures of the first rib with both direct and indirect trauma are discussed and clinical management outlined.
Infrared tympanic thermometers are unreliable in low ambient temperatures
Authors: O'Brien Debra , Rogers Ian , Smith Alison , Lopez Derrick 
Published: August 2010

AbstractStudy objective To assess the accuracy of infrared emission detection tympanic thermometers at ambient temperatures near and below their specified operating ambient temperature range.Methods In a pilot and subsequent study, two operators, using two brands of infrared emission detection thermometers in ambient temperatures ranging from 24.6°C to −22.1°C measured tympanic temperatures of five healthy male volunteers. Each tympanic temperature measurement was taken twice by each operator, with both thermometers, in both ears of each subject. Results were compared with the subjects’ rectal temperatures taken simultaneously.Results A total of 240 tympanic temperature readings were made. In all ambient temperatures there was close agreement between operators and between left and right ears. With decreasing ambient temperatures there was an increasing and significant difference between rectal and tympanic temperatures. Tympanic temperatures were always lower than rectal readings. Both thermometers only gave warning displays of low ambient temperature when used in ambient temperatures well below their specified operating range. Only one brand continued to give readings at very low ambient temperatures and these were substantially inaccurate.Conclusions Infrared emission detection thermometers have limitations in low ambient temperatures. Operators should be aware of these limitations. Development of models of infrared emission detection devices with a wider operating ambient temperature range may be appropriate for use in the field.