Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2011
ReviewIntravenous lipid emulsion as antidote: a summary of published human experience.
Intravenous lipid emulsion (ILE) has been demonstrated to be effective in amelioration of cardiovascular and central nervous system sequelae of local-anaesthetic and non-local-anaesthetic drug toxicity in animal models. Sequestration of lipophilic toxins to an expanded plasma lipid phase is credited as the predominant beneficial mechanism of action of ILE. Systematic review of published human experience is however lacking. ⋯ Forty-two cases of ILE use (19 local-anaesthetic, 23 non-local-anaesthetic) were identified, with anecdotal reports of successful resuscitation from cardiovascular collapse and central nervous system depression associated with ILE administration in lipophilic toxin overdose. Although significant heterogeneity was observed in both agents of intoxication, and reported outcomes; case report data suggest a possible benefit of ILE in potentially life-threatening cardio-toxicity from bupivacaine, mepivacaine, ropivacaine, haloperidol, tricyclic antidepressants, lipophilic beta blockers and calcium channel blockers. Further controlled study and systematic evaluation of human cases is required to define the clinical role of ILE in acute poisonings.
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We present the cases of two infants with complications following accidental button battery ingestion with delayed presentations to medical care. Both cases had button batteries recognized as oesophageal foreign bodies and removed appropriately but the time delay resulted in significant morbidity as they developed spinal erosion and tracheo-oesophageal fistula, respectively. Close follow up is required of all children with delayed removal of button batteries as the injury initiated by the battery can lead to a chronic inflammation with significant injury to the surrounding structures.
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Emerg Med Australas · Apr 2011
Treatment and assessment of emergency department nausea and vomiting in Australasia: a survey of anti-emetic management.
To describe the treatment and assessment of emergency department nausea and vomiting (EDNV) in Australasia by Fellows of the Australasian College for Emergency Medicine (FACEM). To determine the influence of various factors on FACEM anti-emetic choice. To compare the influence of drug effectiveness, side effects, cost and pharmacy directives on adult EDNV anti-emetic choice between FACEM choosing the two most common first-line agents. ⋯ Fellows of the Australasian College for Emergency Medicine anti-emetic choice in Australasian ED has been described. The main influences on anti-emetic choice were patient age, perceived drug efficacy and drug side-effect profiles.