Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2012
Case ReportsCase of scrub typhus complicated by severe disseminated intravascular coagulation and death.
Scrub typhus is an infectious disease that is caused by Orientia tsutsugamushi. The authors describe an autopsied case of scrub typhus complicated with severe disseminated intravascular coagulation (DIC). An 82-year-old man complained of fever 4 days after climbing a mountain. ⋯ The endothelial tissue of the white pulp of the spleen was markedly infiltrated by plasma cells. The authors speculated that a severe immune reaction against O. tsutsugamushi enhanced an inflammatory response, leading to DIC. This case is a warning to doctors who are not familiar with scrub typhus.
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Emerg Med Australas · Oct 2012
Capacity building in emergency care: An example from Madang, Papua New Guinea.
Divine Word University (DWU) is an emerging national university of Papua New Guinea (PNG) based in the provincial capital of Madang, providing training for Health Extension Officers (HEOs). HEOs form the backbone of healthcare delivery in PNG as clinicians, public health officers and health centre managers. Both campus-based and clinical teaching at the nearby Modilon Hospital is limited because of significant resource constraints. ⋯ This programme provides positive models of both emergency care capacity building in a resource-constrained setting and training in international EM for Australasian clinicians.
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Emerg Med Australas · Oct 2012
Case ReportsInterstitial ectopic pregnancy presenting after failed termination of pregnancy.
Pregnant women frequently present to the ED for complaints related to the first trimester of pregnancy. The emergency physician must confirm the presence of an intrauterine pregnancy for many such complaints. ⋯ The ED physician identified an inappropriately thin endomyometrial mantle raising suspicion for the diagnosis of an interstitial pregnancy. The case illustrates the importance of this uterine wall measurement given the otherwise normal appearance of a pregnancy within the uterus.
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Emerg Med Australas · Oct 2012
Prevalence of suicidality in asymptomatic adolescents in the paediatric emergency department and utility of a screening tool.
Many authorities recommend screening adolescents for risk of suicide. The ED is a potential setting for such screening. The aim of this study is to explore the use of the Risk of Suicide Questionnaire (RSQ) as a screening tool for suicidality in patients who come to the ED without mental health concerns and without recent mental health history. The Suicide Ideation Questionnaire (SIQ) was the comparison standard. ⋯ The prevalence of suicidal ideation in asymptomatic patients presenting to this paediatric ED is very low. Using this selection method, the RSQ could not be validated, but would be unlikely to be suitable for screening this low-risk population with a high false positive rate.
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Emerg Med Australas · Oct 2012
Unravelling relationships: Hospital occupancy levels, discharge timing and emergency department access block.
To investigate the effect of hospital occupancy levels on inpatient and ED patient flow parameters, and to simulate the impact of shifting discharge timing on occupancy levels. ⋯ Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system.