The Medical journal of Australia
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The limiting of the reporting of maternal deaths to those that are included in the criteria of the World Health Organization excludes deaths which yield useful information for further improvements in clinical performance. In this series of 22 maternal deaths, six deaths would have been excluded from reporting: one "direct" obstetric death of pre-eclampsia; one "indirect" death as a result of renal and cardiac failure; two deaths as a result of postnatal depression which led to suicide three and four months postpartum, respectively; and two deaths of cancers, where diagnostic delay may have been a result of the coexistent pregnancy. The importance of primary pulmonary hypertension, cardiomyopathy and psychiatric illness is emphasized. We endorse the recent recommendation of the International Federation of Gynaecology and Obstetrics (FIGO) that all maternal deaths that occur more than 42 days after the end of a pregnancy should be assessed for possible relationships with childbirth, and suggest that a time limit of one year would include all deaths that are worthy of scrutiny.
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A case of the delayed diagnosis of envenomation by the redback spider (Latrodectus mactans hasselti) is reported. The common and more unusual presentations then are discussed, together with treatment guide-lines, and comparison is made with the management of latrodectism in the United States as a result of envenomation by the black-widow spider.
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A study has shown that, when applied to Physalia ("bluebottle") jellyfish stings, cold packs are effective as topical analgesia in the relief of mild-to-moderate skin pain. The application of ice also has been shown to be effective for topical analgesia in a number of other jellyfish stings, including by Cyanea ("hair jellyfish"), Tamoya sp. ("Moreton Bay stinger" or "fire jelly") and Carybdea rastoni ("jimble") as well as by Physalia. In the current state of knowledge, cold packs or ice are recommended as the first-aid treatment for jellyfish stings with local skin pain.
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Case Reports
Successful use of Chironex antivenom by members of the Queensland Ambulance Transport Brigade.
We report the first administration in Australia by ambulance officers of the Commonwealth Serum Laboratories' Chironex fleckeri antivenom, in two separate, major, potentially life-threatening Chironex envenomations. In both cases, the antivenom was effective in helping to relieve signs and symptoms (including pain). This antivenom still is the most specific part of the treatment of a major Chironex fleckeri sting after stabilization of the airway, breathing and circulation. The additional use of verapamil may contribute to the prevention of some of the cardiac complications that result from the direct effects of the Chironex venom.