Skull base osteomyelitis (SBO) is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week&#39;s history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on  the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT) scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

Mustafa Burak Sayhan

Cemil Kavalci

Ozgur Sog&#252;t

Eylem Sezenler

Skull Base Osteomyelitis in the Emergency Department: A Case Report

<i  >Objectives</i>. Incidental findings on computed tomography (CT) scans are common. We sought to examine rates of findings and disclosure among discharged patients who received a CT scan in the ED. 
<i  >Methods</i>. Retrospective chart review (Aug-Oct 2009) of 600 patients age 18 and older discharged home from an urban Level 1 trauma center.  CT reports were used to identify incidental findings and discharge paperwork was used to determine whether the patient was informed of these findings. 
<i  >Results</i>. There were 682 CT scans among 600 patients: 199 Abdomen &#x26; Pelvis, 405 Head, and 78 Thorax. A total of 348 incidental findings were documented in 228/682 (33.4&#x25;) of the scans, of which 34 (9.8&#x25;) were reported to patients in discharge paperwork.  Patients with 1 incidental finding were less likely to receive disclosure than patients with 2 or more (<svg style="vertical-align:-0.1575pt;width:50.349998px;" id="M1" height="9.7875004" version="1.1" viewBox="0 0 50.349998 9.7875004" width="50.349998"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,9.7875)">
		<g transform="translate(72,-64.17)">
			<text transform="matrix(1,0,0,-1,-71.95,64.37)">
				<tspan style="font-size: 11.21px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 11.21px; " x="9.7621679" y="0">=</tspan>
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				<tspan style="font-size: 11.21px; " x="28.961472" y="0">1</tspan>
				<tspan style="font-size: 11.21px; " x="34.565472" y="0">0</tspan>
			</text>

		</g>
	</g>
</svg>). Patients age &#x3c;60 were less likely to have incidental findings (<svg style="vertical-align:-0.27pt;width:50.349998px;" id="M2" height="9.9375" version="1.1" viewBox="0 0 50.349998 9.9375" width="50.349998"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
		<g transform="translate(72,-64.05)">
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				<tspan style="font-size: 11.21px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 11.21px; " x="9.7621679" y="0">&lt;</tspan>
				<tspan style="font-size: 11.21px; " x="20.555471" y="0">.</tspan>
				<tspan style="font-size: 11.21px; " x="23.357471" y="0">0</tspan>
				<tspan style="font-size: 11.21px; " x="28.961472" y="0">0</tspan>
				<tspan style="font-size: 11.21px; " x="34.565472" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>). There was no significant disclosure or incidental finding difference by gender. 
<i  >Conclusions</i>. While previous research suggests that CT incidental findings are often benign, reporting to patients is recommended but this is rarely happening. 


Ryan J. Thompson

Susan M. Wojcik

William D. Grant

Paul Y. Ko

Incidental Findings on CT Scans in the Emergency Department

Tsunami of 2004, caused by a 9.0 magnitude earthquake, is the most devastating tsunami in modern times, affecting 18 countries in Southeast Asia and Southern Africa, killing more than 250,000 people in a single day, and leaving more than 1.7 million homeless. However, less reported, albeit real, is its impact in the islands of the Indian Ocean more than 1,000 miles away from its epicenter. This is the first peer-reviewed paper on the 2004 tsunami events specifically in the eleven nations bordering the Indian Ocean, as they constitute a region at risk, due to the presence of  tectonic interactive plate, absence of a tsunami warning system in the Indian Ocean, and lack established communication network providing timely information to that region. Our paper has a dual objective: the first objective is to report the 2004 tsunami event in relation to the 11 nations bordering the Indian Ocean. The second one is to elaborate on lessons learned from it from national, regional, and international disaster management programs to prevent such devastating consequences of tsunami from occurring again in the future.

Georges Ramalanjaona

Impact of 2004 Tsunami in the Islands of Indian Ocean: Lessons Learned

We present two cases in which displaced proximal humeral fractures are accompanied by vascular injury. These Injuries are very rare but severe and the accompanying vascular impairment can have great clinical consequences. Therefore, we try to emphasize on the importance of thorough and accurate diagnostics, because it is obligatory for early diagnosis and improving the eventual outcome of these injuries. The specific order in treatment (internal fixation first or vascular repair first) depends on the severity of the accompanying vascular injury. The increasing use of endovascular procedures to treat vascular lesions is a very interesting development with several advantages, especially in elderly and multimorbid patients.

Martijn Hofman

Jochen Grommes

Gabriele A. Krombach 

Bernhard Schmidt-Rohlfing

Vascular Injury Accompanying Displaced Proximal Humeral Fractures: Two Cases and a Review of the Literature

<i>Introduction</i>. We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved. <i>Methods</i>. Descriptive exploratory study using semi-structured telephone interviews of doctors and nurses in Australian emergency departments (EDs), stratified to represent states and territories and rural or metropolitan location. Content analysis of responses developed themes and sub-themes. <i>Results</i>. Of 39 doctors and 32 nurses responding to email invitation, 20 doctors and 16 nurses were interviewed. Major themes were resources/environment, staff and patient issues. Clinicians noted lack of access in rural areas to psychiatric support services, especially alcohol and drug services, limited referral options, and a lack of knowledge, understanding and acceptance of mental health issues. The clinicians suggested resource, education and guideline improvements, wanting better access to mental health experts in rural areas, better support networks and visiting specialist coverage, and educational courses tailored to the needs of rural clinicians. <i>Conclusion</i>. Clinicians managing mental health patients in rural and remote Australian EDs lack resources, support services and referral capacity, and access to appropriate education and training. Improvements would better enable access to support and referral services, and educational opportunities.

G. A. Jelinek

T. J. Weiland

C. Mackinlay

N. Hill

M. F. Gerdtz

Perceived Differences in the Management of Mental Health Patients in Remote and Rural Australia and Strategies for Improvement: Findings from a National Qualitative Study of Emergency Clinicians


		
			<i>Aim</i>. To evaluate whether the introduction of a therapeutic hypothermia (TH) protocol consisting of cold saline infusion and surface cooling would be effective in targeting mild therapeutic hypothermia (32&#x2013;34<sup>&#x2218;</sup>C). Additionally, to evaluate if TH would improve survival after cardiac arrest. 
<i>Design</i>. Before-after design. 
<i>Setting</i>. General Intensive Care Unit (ICU) at an urban general hospital with 470 beds. 
<i>Patients and Methods</i>. Patients admitted in the ICU after cardiac arrest between 2004 and 2009 were included. Effectiveness of the TH protocol to achieve the targeted temperature was evaluated. Hospital mortality was compared before (October 2004&#x2013;March 2006) and after (April 2006&#x2013;September 2009) the protocol implementation. 
<i>Results</i>. Hundred and thirty patients were included, 75 patients were not submitted to TH (before TH group), and 55 were submitted to TH (TH group). There were no significant differences concerning baseline, ICU, and cardiac arrest characteristics between both groups. There was a significant reduction in hospital mortality from 61&#x25; (<svg style="vertical-align:-0.1575pt;width:38.474998px;" id="M1" height="9.8999996" version="1.1" viewBox="0 0 38.474998 9.8999996" width="38.474998" xmlns="http://www.w3.org/2000/svg">
				<g transform="matrix(1.25,0,0,-1.25,0,9.9)">
					<g transform="translate(72,-64.08)">
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							<tspan style="font-size: 11.21px; " x="19.468296" y="0">4</tspan>
							<tspan style="font-size: 11.21px; " x="25.072296" y="0">6</tspan>
						</text>
					</g>
				</g>
			</svg>) in the before TH group to 40&#x25; (<svg style="vertical-align:-0.09pt;width:38.474998px;" id="M2" height="9.7124996" version="1.1" viewBox="0 0 38.474998 9.7124996" width="38.474998" xmlns="http://www.w3.org/2000/svg">
				<g transform="matrix(1.25,0,0,-1.25,0,9.7125)">
					<g transform="translate(72,-64.23)">
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							<tspan style="font-size: 11.21px; " x="19.468296" y="0">2</tspan>
							<tspan style="font-size: 11.21px; " x="25.072296" y="0">2</tspan>
						</text>
					</g>
				</g>
			</svg>) in the TH group. 
<i>Conclusion</i>. Our protocol consisting of cold saline infusion and surface cooling might be effective in inducing and maintaining mild therapeutic hypothermia. TH achieved with this protocol was associated with a significant reduction in hospital mortality.

Cristina Granja

Pedro Ferreira

Orqu&#237;dea Ribeiro

Jo&#227;o Pina

Improved Survival with Therapeutic Hypothermia after Cardiac Arrest with Cold Saline and Surfacing Cooling: Keep It Simple

The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the &#8220;lap belt&#8221;. We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

Vincent O'Dowd

Christine Kiernan

Aoife Lowery

Waqar Khan

Kevin Barry

Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

Cardiopulmonary resuscitation (CPR) is an effective intervention for prehospital cardiac arrest. 
Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP). A bilingual facilitator conducted all the sessions. All discussions were taped, recorded, translated, and transcribed. Transcripts were analyzed by content analysis guided by the theory of diffusion. The majority of participants did not know of CPR and did not know where to get trained. Complexity of CPR procedure, advantages of calling 9-1-1, lack of confidence, and possible liability discourage LEP individuals to learn CPR. LEP individuals welcome simplified Hands-Only CPR and are willing to perform CPR with instruction from 9-1-1 operators. Expanding the current training to include Hands-Only CPR and dispatcher-assisted CPR may motivate Chinese LEP individuals to get trained for CPR.

Mei Po Yip

Brandon Ong

Shin Ping Tu

Devora Chavez

Brooke Ike

Ian Painter

Ida Lam

Steven M. Bradley

Gloria D. Coronado

Hendrika W. Meischke

Diffusion of Cardiopulmonary Resuscitation Training to Chinese Immigrants with Limited English Proficiency

About this journal

<p><em>Emergency Medicine International</em> publishes original research articles and&nbsp;review articles&nbsp;related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care and wound care</p>


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<p><em>Emergency Medicine International</em> maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.</p>


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Emergency Medicine International - Table of contents 2011

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Emergency Medicine International publishes original research articles and review articles related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care and wound care

Emergency Medicine International