bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial function and haemodynamics in extensive burn trauma: evaluation by clinical signs, invasive monitoring, echocardiography and cytokine concentrations. A prospective clinical study
Authors: Papp A. , Uusaro A. , Parviainen I. , Hartikainen J. , Ruokonen E. 
Published: November 2003

Background:  The objectives of this study were to (1) describe the haemodynamic profile of patients with extensive burns during the early fluid resuscitation phase, (2) evaluate myocardial performance by invasive monitoring and echocardiography and (3) analyze the relations between serum cytokine (IL‐6, IL‐8, TNF) and natriuretic peptide (ANP, BNP) concentrations and myocardial function in these patients.Methods:  Prospective, clinical study in a tertiary care burn centre. Invasive haemodynamic measurements including a pulmonary artery catheter, echocardiography, blood samples for cytokine and atriopeptide analyses. The follow‐up time was up to 72 h postinjury.Results:  According to echocardiography, patients were hypovolaemic despite aggressive (median 7,9 ml kg−1 h−1, range 3.3–11.7) fluid resuscitation and adequate urine output (median 0.9 ml kg−1 h−1, range 0.46–1.35) during the first day postinjury. There were no consistent findings of hyperlactatemia, metabolic acidosis or low mixed venous oxygen saturations. Daily highest and lowest values of cardiac index and stroke volume index increased and the lowest and highest values of systemic vascular resistance decreased. Cardiac performance (stroke volume index) improved during the study period even though there were no initial signs of myocardial depression in echocardiography. Three patients received a dobutamine infusion based on clinical judgement. There was no consistent association between haemodynamic changes and plasma cytokine concentrations.Conclusion:  Persisting hypovolaemia is evident in the resuscitation phase of extensive burns despite aggressive fluid therapy and the lack of classic signs of hypoperfusion. Cardiac performance improves during the first days after extensive burn injury without association with plasma cytokine profile.
Prevalence and predictive value of ionized hypocalcemia among critically ill patients
Authors: Hästbacka J. , Pettilä V. 
Published: November 2003

Background:  Ionized hypocalcemia is common among critically ill patients, and it has been shown to correlate with increased mortality. The purpose of this study was to examine the performance and independence of ionized calcium (Ca2+) in prediction of all‐cause day‐30 mortality among critically ill adult patients.Methods:  Of 993 critically ill patients treated in the Helsinki University Hospital during a 24‐month period, the study comprised 941 patients without calcium supplementation. Patient and laboratory data were obtained retrospectively from an intensive care database. The discriminative powers of admission and lowest Ca2+ values regarding day‐30 mortality were evaluated by producing receiver operating curves (ROC). Hazard ratios for death of severe and mild hypocalcemia were calculated by Cox regression model.Results:  The prevalence of ionized hypocalcemia (Ca2+  <1.16 mmol l−1) was 85%. Of 941 patients, 45 (4.7%) had ionized calcium >1.3 mmol l−1 and were excluded from mortality analysis. Univariate Cox regression model revealed hazard ratios of 5.1 (95% confidence interval, CI 2.9–9.0) for severe (<0.90 mmol l−1) and 1.8 (95% CI 1.3–2.4) for mild ionized hypocalcemia (0.90–1.15 mmol l−1) on admission, but hypocalcemia was not shown to be independently associated with mortality by multivariate Cox regression model. In prediction of day‐30 mortality admission and lowest Ca2+, levels had areas under curves of 0.636 and 0.671, respectively.Conclusion:  Ionized hypocalcemia is common among critically ill adults and it is associated with increased mortality. Although non‐survivors and survivors differ significantly in admission Ca2+, hypocalcemia is not independently associated with day‐30 mortality.
Positioning internal jugular venous catheters using the right third intercostal space in children
Authors: Kim K. O. , Jo J. O. , Kim H. S. , Kim C. S. 
Published: November 2003

Background:  Central venous catheters are used for pressure measurement, and drug and fluid therapy in children. Several reports have described serious complications related to catheter positioning. We evaluated the possibility of using the right third intercostal space as an anatomic landmark for determining the optimal insertion depth of a central venous catheter from the right internal jugular vein.Methods:  The distance between the skin puncture site and the right third intercostal space (SK‐ICS) was measured in 83 children. The catheter was inserted to a depth equal to the measured distance. Postoperatively, the distance between the catheter tip and the radiographic junction of the superior vena cava and the right atrium was measured. This was defined as the optimal catheter length, which placed the catheter tip at the SVC/RA junction (SK‐SVC/RA).Results:  A significant correlation was found between the SK‐ICS and SK‐SVC/RA (regression equation: SK‐SVC/RA = 0.35 + 0.98 × SK‐ICS, r2 = 0.8554). Based on the data obtained, a simple formula, SK‐ICS−1 (cm), predicted that a CVC would be positioned above the RA in 98.8% of patients.Conclusions:  Using the right third intercostal space as an anatomic landmark allows positioning of the catheter tip in the SVC near to but not in the RA in children.
Impact of SARS on an emergency department in Hong Kong
Authors: Man Chi Yin , Yeung Richard SD , Chung Josephine YM , Cameron Peter A 
Published: November 2003

AbstractObjective: To report on the impact of a Severe Acute Respiratory Syndrome (SARS) outbreak on the attendances of a major teaching hospital ED.Methods: Two periods were studied. The first was prior to the closure of the ED due to SARS and the second was after re‐opening of the ED. Data on attendances, discharge against medical advice, triage categories, trauma and ambulance cases were retrieved from the computer and compared with the data in the same periods in 2002.Results: In the first period, when compared with 2002 there was a significant decrease in the mean daily attendance (397 vs 524), trauma cases (68 vs 111), minor cases (category 4: 283 vs 361, and category 5: 20 vs 43). In the second period, there was a significant decrease in the mean daily attendance (265 vs 545), trauma cases (40 vs 111), minor cases (category 4: 181 vs 376, and category 5: 12 vs 45), discharge against medical advice (4 vs 6 daily) and ambulance cases (70 vs 86 daily). Patients requiring immediate care however, remained similar.Conclusion: There was a significant drop in the overall ED attendance, trauma cases and minor cases after the outbreak of SARS. Possible causes include changes in community behaviour, resulting in a lower incidence of trauma and disease and fear of presenting to hospital and contracting SARS.
Is mediastinal shift on chest X‐ray of pneumothorax always an emergency?
Authors: Clark Sean , Ragg Michael , Stella Julian 
Published: November 2003

AbstractObjective: To determine the incidence of mediastinal shift on chest X‐ray due to pneumothorax.Methods: A retrospective chart review was undertaken of all patients with pneumothorax presenting to the ED over the period 1 January 1995 to 31 December 1999. The primary outcome was mediastinal shift on initial CXR. The incidence of clinical tension pneumothorax was noted.Results: There were 176 presentations with pneumothorax in the study period. Two cases of clinical tension pneumothorax were identified and treated prior to CXR. Thirty patients with mediastinal shift on initial CXR, none of which clinically merited emergency needle decompression, were all managed with intercostal catheter (ICC) insertion. Overall, 141 of 176 (80.1%) had an ICC inserted as part of their management. Mean pulse rate (91.8 SD 29.5 vs 86.7 SD 23.6, P = 0.02) and respiratory rate (21.9 SD 14.4 vs 15.1 SD 11.5, P = 0.03) were greater in patients with mediastinal shift on CXR.Conclusion: True clinical tension pneumothorax is an uncommon condition. Radiological evidence of mediastinal shift is more common. No patient in this latter group deteriorated while awaiting X‐ray.
Community acquired needlestick injuries in non‐health care workers presenting to an urban emergency department
Authors: O'Leary Fenton M , Green Timothy C 
Published: November 2003

AbstractObjectives: To review the epidemiology and demographics of community acquired needlestick injuries in non‐health care workers attending an urban ED.Methods: A retrospective analysis of patients with needlestick injuries attending the Royal Prince Alfred Hospital from 1996 to 2001.Results: One hundred and twenty cases were reviewed. The most common mechanism of injury was exposure to discarded syringes (68%). Forty three (36%) injuries were work related. Twenty four (20%) were non‐accidental. Ten (8%) patients received human immunodeficiency virus post exposure prophylaxis. There were no viral seroconversions in the patients with data available.Conclusions: We have identified three groups, males, cleaners and police officers, who are at particular risk of injury. Community education is required so that medical assessment is sought early and to increase awareness of these injuries. The provision of post exposure prophylaxis requires individualized risk assessment, as only in a minority of cases is the source available for testing.
Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain
Authors: Holdgate Anna , Asha Stephen , Craig Jonathan , Thompson Jennifer 
Published: November 2003

AbstractObjectives: To test the agreement between the visual analogue scale (VAS) and a verbal numeric rating scale (VNRS) in measuring acute pain, and measure the minimum clinically significant change in VNRS.Methods: Patients scored their pain by the VAS and the VNRS, then re‐scored their pain every 30 min for up to 2 h. Patients also recorded whether their pain had improved or worsened. Agreement between scores was evaluated, and where patients scored their pain as ‘a bit worse’ or ‘a bit better’ the mean change in VNRS was calculated.Results: A total of 309 paired observations were obtained from 79 patients. The VAS and VNRS were highly correlated (r = 0.95, 95% CI 0.94–0.96). The VNRS was significantly higher than the VAS for the paired observations, with 95% of the differences between VAS and VNRS lying between −2.3 and 1.3 cm. The minimum clinically significant difference in VNRS was 1.4 cm (95% CI 1.2–1.6).Conclusions: The VNRS performs as well as the VAS in assessing changes in pain. However, although the VAS and VNRS are well correlated, patients systematically score their pain higher on the VNRS, with an unacceptably wide distribution of the differences.
Traction splinting of femoral shaft fractures in a paediatric emergency department: Time is of the essence?
Authors: Chu Robert SL , Browne Gary J , Lam Lawrence T 
Published: November 2003

AbstractObjective: To describe the use of traction splinting in children with femoral shaft fracture and to determine if timing of traction splinting application effects outcome.Methods: A retrospective descriptive study conducted over a five and a half year period (1 January 1996 to 1 July 2001) on children presenting with femoral shaft fracture to a Paediatric trauma centre. Data were collected on all children with a radiological diagnosis of fracture to the femoral shaft. Evidence for hypovolaemic shock and neurovascular compromise was sought. The administration of parenteral analgesia and whether a validated pain scale was employed to monitor pain relief was documented. The use of a traction splint or other leg splint device before arrival in the ED and subsequent changes to splinting in hospital were noted. Times to perform radiographic examination and femoral nerve block were also recorded.Results: Ninety‐five (95) patients met the study inclusion criteria with 66.3% having some form of immobilization and 70% administered parenteral analgesia in the pre‐hospital setting. In only 7.3% of patients was a Thomas splint traction applied within 2 h of arrival. Adverse clinical outcome was not reported in any patient regardless of time to application of Thomas splint traction. The application of Thomas splint traction in the ED resulted in a significant delay in the performance of diagnostic radiographs and femoral nerve block.Conclusions: The timing of traction splinting is not associated with poor outcome in isolated paediatric femoral shaft fracture provided effective analgesia has been administered in a timely fashion.
Are children with femoral fracture haemodynamically unstable?
Authors: Chu Robert SL , Browne Gary J , Lam Lawrence T 
Published: November 2003

AbstractObjective: To assess the occurrence of hypovolaemic shock in children who have sustained traumatic femoral fracture.Methods: A retrospective descriptive study was performed on a cohort of children with traumatic femoral fracture presenting over a five and a half year period from 1 January 1996 to 1 July 2001. Selected parameters for analysis included administration of a fluid bolus, as well as all available vital signs within 4 h following injury relating to pulse, systolic blood pressure, respiratory rate, skin capillary refill time and mental status. Fluid and blood transfusion records were examined, as was the need for intraosseous access. Initial haemoglobin and haematocrit results were also obtained.Results: There was no evidence for haemodynamic instability in the 100 patients who met the selection criteria when compared with internationally accepted normal vital sign parameters. No significant difference was found in the initial vital signs between patients who received fluid bolus and those that didn’t. No patient needed intraosseous access or fluid resuscitation. One patient received blood transfusion without evidence of haemodynamic instability. Haemoglobin and haematocrit values were not significantly decreased. Ninety‐two percent of patients in this study had isolated femoral fracture.Conclusions: No evidence for haemodynamic instability was found in a cohort of children with traumatic femoral fracture.
Skills retention for insertion of the Combitube and laryngeal mask airway
Authors: Vertongen Vicki M , Ramsay Mace P , Herbison Peter 
Published: November 2003

AbstractObjective: To determine if the skills to successfully ventilate using the laryngeal mask (The Laryngeal Mask Company Limited, Henley on Thames, United Kingdom) and Combitube (The Kendall Company, Mansfield, USA) can be retained after seven months.Methods: Nursing, medical and theatre staff from Dunedin Hospital were recruited in a prospective study. Subjects were taught to insert and ventilate an Ambuman manikin using both devices. Subjects were tested on their ability to ventilate the manikin with both devices within one month then following a six‐month period.Results: A total of 101 subjects were recruited with 86 subjects retested at least six months later. Initial testing resulted in subjects successfully ventilating the manikin in 90% (laryngeal mask) and 92% (Combitube) of attempts. At retesting, successful ventilation was achieved in 85% (laryngeal mask) and 77% (Combitube) of attempts. The decline in skills level was significant for the Combitube only (95% CI 4% to 26%).Conclusion: The ability to successfully ventilate is better maintained with the laryngeal mask than the Combitube after seven months.
The Communication Clerk role in the emergency department
Authors: King Diane 
Published: November 2003

AbstractObjective: Analyse the clinical hours saved by the introduction of a dedicated Communications Clerk to the ED.Methods: A Communications Clerk role was introduced at Flinders Medical Centre during 2002. Over a seven‐week period the number of telephone calls taken and paging performed was logged. This function had previously been performed purely by clinical staff, and the number of clinical hours saved was evaluated.Results: Over the study period the Communication Clerks worked for 509 h. A total of 7302 telephone calls were answered or made, and 924 pages made. The clinical hours saved was calculated at 243.3. The ratio of hours worked by the Communication Clerk to clinical hours saved overall was 2.1.Conclusion: The role of a Communication Clerk in a busy ED is an effective work practice change, particularly in relation to clinical hours saved.
Documentation and tagging of casualties in multiple casualty incidents
Authors: Garner Alan 
Published: November 2003

AbstractThe use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags. Documentation cards attached to casualties may be of use in situations where casualties will pass through an extended evacuation chain, and clear labels for deceased casualties are of benefit as they discourage repeat assessments. Adoption of an evidence‐based approach to multiple casualty incident scene management will require a paradigm shift in the thinking of ambulance services. A broad‐based educational approach that encourages critical reappraisal of existing procedures is recommended.
Paracetamol poisoning: Which nomogram should we use?
Authors: Reid Duncan , Hazell Wayne 
Published: November 2003

AbstractObjectives: To determine the type of paracetamol nomograms used in Australasian EDs. To review the literature to determine the evidence base for existing nomograms.Methods: A cross sectional descriptive study via postal survey of all Australasian EDs accredited for specialist emergency medicine training by the Australasian College for Emergency Medicine (ACEM). A literature review using Knowledge Finder search engine was employed.Results: The response rate was 87%. The most commonly used nomogram had a four‐hour treatment level of 1300 µmol/L (69%). A total of 22% of respondents used a four‐hour treatment level of 1000 µmol/L. Two departments (3%) treated all patients above the 660 µmol/L line. Eleven departments (15%) did not have a treatment line below 1300 µmol/L.Conclusion: Practice varies in Australasian EDs. Patients with paracetamol levels below the 1300 µmol/L have been reported in the literature to develop hepatotoxicity, and deaths have been documented. N‐acetylcysteine is extremely safe when used in the recommended dosages.
Five years of snake envenoming in far north Queensland
Authors: Barrett Robyn , Little Mark 
Published: November 2003

AbstractObjective: To describe the epidemiology, clinical features, treatment and outcomes of patients with elapid snake envenoming in far north Queensland.Methods: Review of patients admitted with snake envenoming to Cairns Base Hospital, Queensland, from 1 January 1996–31 December 2000.Results: A total of 264 patients presented to the hospital with a diagnosis of snakebite. Of these, 27 (10%) had clinical evidence of envenoming, including seven children. All envenomed patients had been bitten on a limb. Two patients had correct initial first aid applied. Commercially available venom detection kits were used in 23 patients; 14 (61%) bite site swabs were positive, but only four (23%) of 17 urine Venom Detection Kits were positive. Antivenom was administered to 20 envenomed patients. The five brown snake envenomed patients required a median of 9 ampoules of antivenom to treat their coagulopathy. Sixteen patients were admitted to the ICU, with six requiring ventilation. Six patients were successfully managed in the ED observation ward. Three patients envenomed by a taipan, and one by a death adder were discharged with ongoing neurological symptoms. There was one death from brown snake envenoming.Conclusions: The incidence of snakebite and envenoming in far north Queensland is higher than reported from hospitals in capital cities and is a significant health issue.
Observation of snakebite victims: Is twelve hours still necessary?
Authors: Hughes Andrew 
Published: November 2003

AbstractObjective: To determine the period of observation required to exclude elapid envenoming following presentation with suspected or definite snakebite in South‐east Queensland.Methods: Two part case series of patients presenting with a snakebite to a regional hospital in South‐east Queensland. A snakebite assessment protocol was established for a prospective phase with the same data collection tool used for retrospective cases. The time of onset of clinical features, and abnormal investigations consistent with envenoming were recorded for each feature. ‘Time zero’ was set at the time of removal of effective first aid or, time of presentation in the absence of effective first aid.Results: A total of 360 presentations of snakebite were identified with envenoming diagnosed in 34 cases (9%). Seventy‐three percent of clinical features and investigation abnormalities were present at, or before, time zero with 95% present within 6 h. All abnormalities, which commenced beyond 6 h, occurred in patients where the diagnosis of envenoming had already been established.Conclusions: Six hours of assessment appears adequate to exclude elapid envenoming in asymptomatic patients in South‐east Queensland. Evidence in the literature of delayed onset of envenoming in completely asymptomatic patients is difficult to find.
Lead poisoning after ingestion of home‐made Chinese medicines
Authors: Fung Hin Tat , Fung Chi Wah , Kam Chak Wah 
Published: November 2003

AbstractA young woman presented with non‐specific generalized musculoskeletal pain. Investigations revealed anaemia, raised reticulocyte count, basophilic stippling and erythroid hyperplasia of the bone marrow. Further history showed that she had been taking home‐made Chinese medicines for acne for two months and the blood lead level confirmed the diagnosis of lead poisoning. The medications were stopped and her condition gradually improved. Incorporating the use of herbal medicines into the routine medical history is important in early identification of herbal poisoning.
A new drug free technique for reducing anterior shoulder dislocations
Authors: Cunningham Neil 
Published: November 2003

AbstractFive cases of anterior shoulder dislocation are reported. The dislocations were reduced quickly, painlessly and without the use of drugs using the ‘Cunningham technique.’ The practice and theory of the technique are described. The ‘Cunningham technique’ is a useful single operator method of reducing anterior shoulder dislocations. Further research is being undertaken to reproduce the results in a larger patient group and also to examine how easily the technique can be taught.