bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of management of fever without source in young children in Australasian emergency departments
Authors: Smith Brendon 
Published: March 2003

Objective: To document the management of young children with fever without source presenting to emergency departments in Australia and New Zealand, and to document to what extent published guidelines are followed. Method: A questionnaire survey was mailed to Directors of emergency departments. Results: Variation in practice, by a number of measures including age ranges used, threshold temperature, investigations performed, antibiotic use and admission criteria was found. Half the departments did not have written management protocols which correlated with greater variation in practice within a department, compared with those that did have written management protocols. For children 3 to 36 months of age, in three of 23 departments (13%) antibiotics were routinely prescribed for fever without source. Conclusions: Among emergency departments, there is variation in practice in the management of fever without source in infants and young children. Variation within departments is correlated with lack of written management guidelines. Antibiotic use is markedly less than recommended in published guidelines and clinical assessment is emphasized. It is proposed that published guidelines have not been incorporated into routine practice because evidence from clinical trials does not support the guidelines.
Near hanging
Authors: Adams Nick 
Published: March 2003

AbstractObjectives: To review the literature on near hanging, focusing on the pathophysiology, and relating this to the clinical features and management.Methods: English language articles published in the past 15 years and major textbooks of emergency and forensic medicine were searched. Eight case series and six relevant single case reports were identified. Only articles concerned with non‐judicial near hanging were reviewed. Data concerning the incidence of cervical spine injury, laryngeal injury, pulmonary complications and mortality were extracted. Not the case series documented the presence or absence of all these factors, resulting in differing total patient numbers in each category. Unusual complications of near hanging were documented from case reports.Results: Cervical spine injury occurred in four of 689 patients (0.6%). Pulmonary complications occurred in 15 of 133 patients (11%). The in‐hospital mortality rate was 23% (29 deaths of 128). No clinically significant laryngeal injuries were reported. Unusual complications documented included hyperthermia, status epilepticus, carotid artery dissection, subarachnoid haemorrhage and pneumoperitoneum.Conclusions: Cervical spine injury, although uncommon, does occur in near hanging, and emergent airway management should take this into account. Laryngeal injury sufficiently severe to interfere with endotracheal intubation does not appear to occur. Cerebral oedema, aspiration pneumonia and acute respiratory distress syndrome are the commonest in‐hospital complications. Management of near hanging involves establishment of a safe airway, plus treatment of pulmonary and cerebral oedema along standard lines. In‐hospital mortality remains high.
Are too many head CT scans ordered in emergency departments?
Authors: Kelly Anne‐Maree , Kerr Debra 
Published: March 2003

Abstract Objectives: The aims of this study were to: (i) characterize ordering of head computed tomography scans from the emergency department; (ii) determine the proportion of scans that yield an abnormal result; (iii) correlate results with clinical syndromes and neurological findings; and (iv) identify areas where a change in ordering practice may be warranted. Method: Prospective case identification with detailed explicit review of clinical notes and radiological findings. Results: Two hundred and thirty‐six cases were analysed. The rate of head computed tomography scans was 2.3% of all emergency department attendances. Of the scans, 21.6% were abnormal with the most common abnormalities being haemorrhage or infarction. Indications that correlated highly with abnormal scans were altered mental state (43.7%), focal weakness (36.7%), mild head injury (21.2%) and confusion (18.5%). Headache, transient ischaemic attack and seizure had low correlations with abnormal scans. Conclusion: The results of this study suggest that the overall rate of head computed tomography scans ordered by the study emergency department was appropriate. It also supports the development of guidelines for the ordering of head computed tomography scans in patients with headache, seizure and transient ischaemic attack.
Australian and New Zealand 1997 thrombolysis audit
Authors: Mountain David , Jelinek George , O’Brien Debra , Ardagh Michael , Ieraci Sue , Lynch Dania , Jacobs Ian , Lopez Derrick 
Published: March 2003

Abstract Objectives: To describe patterns of revascularization techniques in acute myocardial infarction in Australasia, particularly time to thrombolysis, site of delivery, patient demographics, revascularization rates and outcomes. Methods: Seventy‐four Australasian emergency departments were surveyed. Data from 1997 were obtained on number of acute myocardial infarction patients, age, gender, time to revascularization, intracranial haemorrhage rate, mortality, location and rate of revascularization and angioplasty. Grouped data were analysed. Results: Thirty‐three hospitals responded (44.6%). Many others could not supply data. Of 2930 acute myocardial infarction patients, 29% received thrombolysis and 5% angioplasty. Tertiary hospitals thrombolysed more in coronary care units (24.2% versus 8.8%), while non‐tertiary hospitals used emergency departments more (16.2% versus 5.9%). Average emergency department door‐to‐needle time was 49.4 min (median 38.6) versus 63.9 min (median 66.8) in coronary care units. More patients had streptokinase than tissue‐type plasminogen activator. Inferior myocardial infarction accounted for 58% of cases. Primary angioplasty commenced on average 61.5 min (median 69.2) after arrival. Conclusions: Australasian revascularization procedure rates, times, mortality and intracranial haemorrhage rates are similar to internationally published values. Thrombolysis starts sooner if given in emergency departments. Hospitals thrombolysing patients in coronary care units should consider emergency department thrombolysis if median times are greater than 50 min.
QUEST: Questionnaire relating to patients’ Understanding and Expectations of their Symptoms and Treatment
Authors: Bartley Bruce , Cameron Peter 
Published: March 2003

Abstract Objectives: To survey patients’ perceptions of illness and their expectations of the emergency department visit in a major tertiary‐referral teaching hospital and to compare these responses with the doctors’ assessment in a major tertiary‐referral teaching hospital. Method: A two‐part survey was conducted. Patient questions focused on patient perception of illness severity, and expectation of process and outcome. Doctor questions focused on the severity of illness and the advice given. Results: Pre‐consultation: Of 141 patients, 94 (67%) were concerned that they were suffering from something serious or dangerous. Eighty‐three of 145 patients (57%) expected an explanation and/or reassurance. Eighty‐four of 145 patients (58%) expected investigation. Twenty‐seven of 135 patients (20%) expected admission to hospital. Post‐consultation: 119/126 patients (94%) who were given an explanation stated that they understood their illness. One hundred and thirteen of 122 patients (93%) felt reassured on departure. Conclusions: In this group of patients, fear of a dangerous or life‐threatening condition not borne out in the doctors’ assessment is common. Present clinical practice, including explanation and reassurance based on clinical and investigation findings, appears sufficient to meet patient expectations.
Chronic meningococcaemia
Authors: Teoh Ben , Williams Aled 
Published: March 2003

AbstractMeningococcal infection usually presents as a severe illness with septicaemia, cardiovascular collapse and a purpuric rash. Less commonly, it presents in a chronic form with an intermittent course over a number of weeks. Chronic meningococcaemia may mimic other conditions, such as viral illness or autoimmune disease. Early diagnosis of chronic meningococcaemia is essential because it may progress into the more familiar acute form. Emergency physicians need to be aware of the disease and its clinical features so that appropriate interventions can be made when a patient presents with a suggestive clinical picture. In this article, we present a case of chronic meningococcaemia that was seen three times in an emergency department before the correct diagnosis was made. We will also review the pathophysiology and the clinical features that may aid in the early diagnosis of this unusual condition.
Essential role of prehospital care in the optimal outcome from major trauma
Authors: Hodgetts Tim J , Smith Jason 
Published: March 2003

AbstractPrehospital care for major trauma victims is a balance of timely delivery to definitive care and appropriate intervention to maximize probability of survival. In the development of advanced, organized prehospital care systems, the evidence for the benefit of individual interventions has been limited and contradictory. Leading controversies reviewed are: the place of advanced life support, the role of doctors compared with paramedics, the optimal advanced airway adjunct, the role of intravenous fluids in serious injury, and the value of prehospital cardiopulmonary resuscitation following traumatic cardiac arrest. International differences in trauma epidemiology are discussed. The identification of prehospital care as the weak link within a trauma system is highlighted.
Establishing rudimentary health‐care facilities in East Timor
Authors: Galvin G Michael 
Published: March 2003

AbstractThe former Portuguese colony of East Timor was forcibly absorbed into the Republic of Indonesia in 1975. An armed East Timorese resistance movement maintained a fight for independence for the next quarter of a century. The Indonesian Government allowed a plebiscite of the population in August 1999, the result of which was strongly in favour of independence. Following the poll, there was an outbreak of extreme violence and the structure of the country was virtually destroyed. The Indonesian Government invited a multinational force to restore order. This report is of the medical work conducted while serving in a multifunction non‐government organization in East Timor in the post‐conflict environment. The work includes developing a tuberculosis clinic, conducting refugee medicine at the border crossing point and establishing a rudimentary health‐care system based on a primary‐care model. A background in emergency medicine is very useful in situations such as this, where improvisation becomes a core skill.
Suspected subarachnoid haemorrhage with a negative CT head scan: What next?
Authors: Foot Carole , Merfield Eve 
Published: March 2003

AbstractThe current recommended ‘next investigation’ for patients with a suspected subarachnoid haemorrhage and a negative non‐contrast computed tomography head scan, is a lumbar puncture. The cerebrospinal fluid obtained at lumbar puncture may be examined for the presence of blood and xanthochromia. Xanthochromia may be assessed by macroscopic examination or by spectrophotometry. Total red cell count and the three‐tube test have poor sensitivity and specificity as investigations for diagnosing subarachnoid haemorrhage. Macroscopic examination for xanthochromia is unreliable, with a risk of false‐negative results. Spectrophotometric examination for xanthochromia is associated with false positive results. The use of cerebrospinal fluid derivative spectroscopy and D‐Dimer testing using an enzyme‐linked immunosorbent assay need further evaluation. In the future, computed tomography angiography or magnetic resonance angiography may change current practice. Until then, all patients should be advised to have a lumbar puncture. A cerebrospinal fluid specimen obtained at least 8 h after the onset of headache and analysed for xanthochromia via spectrophotometry has the best chance of placing the patient in the lowest possible risk category. The emergency physician must be aware of the methods of cerebrospinal fluid analysis used locally.
Improving the quality of hospital‐generated police reports using a structured proforma
Authors: Parker Helen , Kelly Anne‐Maree , Wells David 
Published: March 2003

Abstract Objectives: This study compared the adequacy and utility of police statements prepared before and after the introduction of a structured proforma. Method: The study utilized two samples of 37 statements each, one before and one after the introduction of a structured proforma. Blinded, independent reviewers drawn from the ranks of police or coronial officers assessed the statements for the presence of key items and rated structure, language, adequacy and utility in centimetres on a visual analogue scale. Fisher’s exact test was used for comparison of proportions and the Mann–Whitney U‐test for comparison of visual analogue scale scores. Results: The overall rating of the adequacy of reports improved from a mean visual analogue scale score of 2.91 to 6.97 (P<0.001) with the structured proforma. Significant differences with the presence of opinions regarding causality and severity of injury were also demonstrated. Conclusion: A structured proforma to assist in the writing of police statements resulted in a higher proportion of key content items being included and significantly higher ratings of various aspects by end‐users. This approach could be generalized to other health‐care settings and situations where communication between health workers and investigating officers is needed.
Emergency department management of hip fractures: Development of an evidence‐based clinical guideline by literature review and consensus
Authors: Considine Julie , Hood Kerry 
Published: March 2003

AbstractThe Emergency Department at Dandenong Hospital has recently developed an evidence‐based clinical guideline for the emergency department management of hip fractures. This paper will comment on the role of clinical guidelines in the emergency department, discuss the process of the development of evidence‐based guidelines for the care of hip fractures and present the evidence found during the development process. Evidence‐based recommendations for practice are made regarding pulse oximetry and supplemental oxygen, preoperative use of skin traction, thromboembolism prophylaxis, pain management including the use of nerve blocks, pressure area care, the use of indwelling urinary catheters and time to surgical repair.
Identifying the core components of an anaesthesiology curriculum for emergency medicine trainees in Australasia
Authors: Amarasinghe Varna , Kelly Anne‐Maree , Rogers Ian , Jacobs Ian 
Published: March 2003

Abstract Objectives: To identify the components of anaesthesiology practice most important to emergency medicine practice with a view to informing discussion on a set of core objectives for an anaesthesiology attachment. Method: The study was a postal survey. Participants consisted of all trainees and Fellows in Victoria and New Zealand as at February 1997 (total 315). Data collected included demographics and training level/experience of respondent, rating of anaesthesiology skills important to the practice of emergency medicine, rating of the skills judged to be learned most usefully in an anaesthesiology rotation, desirability of a formal anaesthesiology attachment and its optimal length and timing. Descriptive analyses were undertaken. Results: The main aim of an anaesthesiology attachment should be the acquisition of airway skills. Fluid resuscitation and venous access techniques were considered secondary objectives. This is considered essential to emergency medicine training; the optimal attachment duration should be 6 months, occurring in the first 2 years of advanced training. Conclusion: An anaesthesiology rotation is an important component of emergency medicine training that should focus on the acquisition of airway skills. Consideration should be given to the development of a set of specific objectives to assist planning training programmes and monitoring progress.
NTS versus waiting time: An indicator without definition
Authors: Fatovich Daniel M , Jacobs Ian G 
Published: March 2003

AbstractObjective:The National Triage Scale versus waiting time is a key performance indicator for Australasian emergency departments. However, the point at which the clock starts to measure waiting time has not been defined. The aim of this study was to determine how this indicator is measured in Australia, as well as a number of other issues relating to the application of the National Triage Scale.Methods:A postal survey was sent to the directors of emergency medicine at 147 emergency departments in Australia.Results:There were 105 responses (71.4%). For measurement of the National Triage Scale versus waiting time indicator, 52 (49.5%) started the clock at the time of patient arrival, 33 (31.4%) at the start of triage, and 11 (10.5%) at the end of triage. Seventy‐four emergency departments (70.5%) change the National Triage Scale (NTS) after it has been assigned, and approximately half use set codes for given presentations. Only 28 (26.7%) automatically upgrade children one NTS category. The age definition of a child ranged from 3 years to 18 years.Conclusions:The measurement of this key performance indicator is not consistent across Australia. Therefore, caution is advised when comparing such data between departments. The Australasian College for Emergency Medicine should produce operational definitions relating to the use of the National Triage Scale in order to provide meaningful comparative data.
Disaster management in Australia: The national emergency management system
Authors: Abrahams Jonathan 
Published: March 2003

AbstractAustralia has a well‐established emergency management system to manage the threats to communities from natural and technological hazards. The key elements of the system are described with particular emphasis on the impact of disasters on Australia, fundamental concepts, and principles of planning. Emergency physicians have a key role in the development of emergency plans and in the overall health response to disasters. They can enhance their understanding of local, State and national arrangements by participating in exercises and appropriate disaster medicine and emergency management courses. See Commentary, page 143.
A global view of suicidal behaviour
Authors: Goldney Robert D 
Published: March 2003

AbstractSuicidal behaviour is a major public health problem. There is no one explanatory theory of suicidal behaviour, and various combinations of sociological and biological/medical interventions are required to reduce associated mortality and morbidity. The importance of primary prevention varies from community to community, and may have an impact at the population level. However, individual suicidal persons always require optimum assessment and management and that is usually provided by primary care and emergency physicians. This paper provides an overview of issues to be addressed in the assessment and management of suicidal patients. See Commentary, page 8.
Uvulitis and partial upper airway obstruction following cannabis inhalation
Authors: Boyce Stephen H , Quigley Michael A 
Published: March 2003

AbstractThe use of cannabis in our society is a common problem and the subject of much medical and political debate. We present a case in which a 17‐year‐old male regular cannabis user developed a large swollen uvula (uvulitis) and partial upper airway obstruction after smoking cannabis. Symptoms resolved with the administration of corticosteroids and antihistamines.
The appropriate use of references in a scientific research paper
Authors: Taylor David McD 
Published: March 2003

AbstractReferences have an important and varied role in any scientific paper. Unfortunately, many authors do not appreciate this importance and errors within reference lists are frequently encountered. Most reference errors involve spelling, numerical and punctuation mistakes, although the use of too many, too few or even inappropriate references is often seen. The consequences of reference errors include difficulty in reference retrieval, limitation for the reader to read more widely, failure to credit the cited authors, and inaccuracies in citation indexes. This paper discusses the value of accurate reference lists and provides guidelines for their preparation.
Long distance road transport of a patient with Wegener’s Granulomatosis and respiratory failure using extracorporeal membrane oxygenation
Authors: Rosengarten Andrew , Elmore Patricia , Epstein Joseph 
Published: March 2003

AbstractWegener’s Granulomatosis is a necrotizing vasculitis that in its most severe form can cause respiratory failure, renal failure and subglottic stenosis requiring surgical airway access. We describe the use of portable extracorporeal membrane oxygenation and the long distance road transport of a patient with Wegener’s Granulomatosis who developed respiratory failure that was refractory to conventional mechanical ventilation. We have demonstrated the effective use of portable extracorporeal membrane oxygenation for stabilization and safe acute interhospital transfer over a long distance by road ambulance to a tertiary centre for further management.
Drowning and near‐drowning
Authors: Moon Richard E , Long Robert J 
Published: March 2003

AbstractWater immersion is a frequent cause of accidental death and hospital admission. This article outlines the pathogenesis and principles of treatment. Drowning is defined as death by asphyxia due to submersion in a liquid medium. Near‐drowning is defined as immediate survival after asphyxia due to submersion.