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Medical Sciences	50%

Selected Abstracts

Emergency management of the morbidly obese

EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2004
Peter Grant
Abstract Objectives: To identify the difficulties encountered with the emergency management of morbidly obese patients and formulate recommendations to streamline care. Methods: An English language literature search was undertaken using Medline (1966,2003) with key words ,morbid obesity',anaesthesia',imaging',obesity',emergency',transportation',retrieval',critical illness' and ,monitoring'. Potential articles were selected for content applicable to emergency medicine based on title and abstract and reviewed in detail. Reference lists were manually searched for further relevant articles. In view of the very limited systematic study in this area, all information deemed by the authors' to be of assistance to the emergency physician was included regardless of evidence level. Additional information was sought from standard critical care textbooks and their bibliographies and through personal communication with local ambulance and retrieval services. The authors' unpublished personal experience in providing emergency care to the morbidly obese was included for aspects of management not documented in medical literature. Results: Obesity levels and associated health problems are rapidly rising in Australia. Few studies were identified dealing with critical illness in the morbidly obese and none specifically addressing ED management. Problems identified included size related logistical issues, and limitations of physical assessment, monitoring and routine investigations. Invasive procedures, intubation and ventilation can be particularly problematic, and modified techniques may be required. Limited data indicates a poorer outcome from critical illness most marked in the case of blunt traumatic injury. Conclusion: Very obese patients present a variety of logistical and medical challenges for EDs. A series of recommendations are made based on available data. Further studies in this area would be desirable to more specifically address ED issues. [source]

Gemcitabine-induced radiation recall in the treatment of pancreatic cancer

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 1 2009
Wan Mohd Nazri WAN ZAINON
Abstract Aim: To evaluate two cases of gemcitabine-induced radiation recall in patients who were treated for localized pancreatic cancer, and review the literature. Methods: The two cases of radiation recall (from a cohort of 80 patients treated for pancreatic carcinoma) were retrospectively identified using patient medical records. Prior publications were identified through an English language literature search of MEDLINE Ovid from January 1966 to October 2006, using the key words gemcitabine and radiation recall. Results: Both the radiation recall reactions were limited to the gastrointestinal system, localized to previous radiotherapy field. No pathology was identified on radiological investigation. The onset of the radiation recall phenomenon was 2 and 10 days, respectively, from the time gemcitabine was initiated. The treatment of radiation recall consisted of the cessation of gemcitabine, initiating steroid therapy and supportive therapy. Both of the patients' symptoms achieved complete resolution. A comprehensive review of the literature found 15 previous cases of radiation recall related to gemcitabine but one reported effect involving the gastrointestinal system. Previously reported sites of recall phenomena included the skin, muscles, brain stem and optic nerve. In the treatment of pancreatic carcinomas, there were only four reported cases, three involving the onset of myositis of abdominal muscle and one case of gastrointestinal bleeding. Conclusion: Radiation recall from gemcitabine chemotherapy is uncommon. It can potentially arise in any site that has been irradiated previously. The treating doctor needs to be aware of this phenomenon to be able to manage this condition appropriately. [source]

A systematic review of the features that indicate intentional scalds in children

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2009
Richard Reading
A systematic review of the features that indicate intentional scalds in children . MaguireS., MoynihanS., MannM., PotokarT. & KempA. M. ( 2008 ) Burns , 34 , 1072 , 1081 . DOI: 10.1016/j.burns.2008.02.011 . Background Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging. Aim To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds. Methods We performed an all language literature search of 12 databases 1950,2006. Studies were reviewed by two paediatric/burns specialists, using standardized methodology. Included: Primary studies of validated intentional or accidental scalds in children 0,18 years old and ranked by confirmation of intentional or unintentional origin. Excluded: Neglectful scalds; management or complications; studies of mixed burn type or mixed adult and child data. Results A total of 258 studies were reviewed, and 26 included. Five comparative studies ranked highly for confirmation of intentional/unintentional cause of injury. The distinguishing characteristics were defined based on best evidence. Intentional scalds were commonly immersion injuries, caused by hot tap water, affecting the extremities, buttocks or perineum or both. The scalds were symmetrical with clear upper margins, and associated with old fractures and unrelated injuries. Unintentional scalds were more commonly due to spill injuries of other hot liquids, affecting the upper body with irregular margins and depth. Conclusions We propose an evidence-based triage tool to aid in distinguishing intentional from unintentional scalds, requiring prospective validation. [source]

Drowning of babies in bath seats: do they provide false reassurance?

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2005
J. Sibert
Aims, To investigate the problem of children drowning in bath seats by examining case reports, by looking at the epidemiology of bath drowning in children under two years of age and by reviewing the literature. Methods, We describe two babies: one who drowned and one nearly drowned in the bath whilst in a bath seat. We examined the RoSPA/RLSS UK database of cases of children under two years drowning in the bath for the years 1989,2003. Cases are ascertained through a press cutting system. We conducted an all language literature search of original articles, references, textbooks and conference abstracts 1951 , October 2004 in 11 standard databases. Results, The two cases illustrate how parents can have a false sense of security with bath seats. We found six cases of babies under two years drowning in the UK associated with bath seats in the time period 1989,2003. They were all boys: five of the six were under one year of age. This compared with 47 children of similar age drowning in the bath not associated with a bath seat. The literature is sparse with only four papers since 1966. Discussion, A baby drowning after being placed in a bath seats is a rare but definite cause of death. Bath seats appear to give a false sense of security (even if not encouraged by the manufacturers). It is unclear whether putting a baby in a bath seat represents an increased risk of drowning compared with a baby without a seat. Without knowing the numbers of mothers that use bath seats it is difficult to come to firm conclusions on the risks to babies. New research is needed to clarify this issue. Whether in a seat or not it is clear that the main risk to babies in the bath is being left unsupervised. [source]