Emergency medicine

In reply: We thank Mountain for his comments. As he points out, it is only possible to infer cause and effect from observational data. The fact that referrals for D-dimer levels and computed tomography pulmonary angiography increased during the same period does not prove that one “drove” the other, although we believe this is a reasonable inference. Importantly, D-dimer testing was introduced as a “rule-out” ...

William B G Macdonald · Tatiana Segard

Outlier patients may be at risk if their therapeutic and monitoring needs are only met on their home ward

John D Santamaria MD BS, FRACP, FCICM · Antony E Tobin MB BS, FRACP, FCICM · Matthew H Anstey MB BS, FCICM, FACEM · Roger J Smith BN, MPH · David A Reid

New recommendations will hopefully help standardise care of people bitten by snakes in Australia

Mark Little FACEM, MPH

Half of asylum seekers needed ED care in 2011, suggesting primary health care in closed detention is lacking

Adrienne K Deans MB BS, FRACGP, FACEM · Clare J Boerma MB BS · James Fordyce MB BS, MPH, FACEM · Mark De Souza MB BS, FACEM · Didier J Palmer FRCP, FRCS, FACEM · Joshua S Davis MB BS, FRACP, PhD

We report the first and only known case of envenoming by the Lake Cronin snake (Paroplocephalus atriceps), which is closely related to Hoplocephalus spp. A 24-year-old man was bitten while photographing the holotype of the species. He developed venom-induced consumption coagulopathy but no neurotoxicity or myotoxicity, similar to the clinical features of Hoplocephalus envenoming. He was treated with polyvalent antivenom and made a full recovery.Clinical ...

George E Allen BSc, MB BS · Steve K Wilson · Geoffrey K Isbister BSc, FACEM, MD

Objectives: To determine the incidence of patients presenting to a major metropolitan hospital after experiencing syncope at church, and to compare their outcomes with those of patients experiencing syncope at other locations.Design, setting and participants: A retrospective matched cohort study in which patients presenting with church syncope between July 2009 and June 2013 were compared with controls (patients presenting after syncope experienced elsewhere) matched by ...

Biswadev Mitra MB BS, PhD, FACEM · Andrew J Tagg BSc, MB BS, MRCS · Elyse Fyfe · Gerard M O’Reilly MB BS, FACEM, ASTAT

Clinicians should sometimes just say no to the “just in case” peripheral intravenous catheter to reduce harm caused.

Claire Dendle · Rhonda L Stuart · Diana Egerton-Warburton

Is it jumping the gun to include tranexamic acid in trauma protocols? A forthcoming Australian trial aims to fill some of the evidence gaps.

on behalf of the PATCH-Trauma study investigators*

A case of prolonged exposure to mercury vapour highlights the immediate and delayed effects of such poisoning on multiple organs. Prompt and sometimes prolonged treatment may prevent long-term damage.

Mohamed Saleem MB BS, FRCPA · Sam Alfred MB BS, DipTox, FACEM · Rebecca A Bahnisch BSc · Penelope Coates MB BS, FRACP, FRCPA · Daniel J Kearney MB BS, FRCPA

Part 2 of the MJA’s Cardiology series focuses on assessing patients with possible cardiac chest pain, including risk stratification, cardiac biomarkers and the role of non-invasive testing for myocardial ischaemia and coronary artery disease.

William A Parsonage DM, MRCP, FRACP · Louise Cullen MB BS, FACEM · John F Younger MB ChB, MRCP, FRACP

Contrary to common rhetoric, general practice-type patients do not significantly contribute to ED congestion or burden. And it is usually more appropriate for patients to seek immediate care in the ED rather than visit a general practitioner.

Gerard J FitzGerald MD, FACEM, FRACMA · Ghasem Toloo BA, MA, PhD

Punishing on-call and after-hours arrangements are threatening Australia’s rural medical workforce.

Chee S Koh

Three of the four methods used to calculate general practice-type patient attendances at EDs estimate that these patients account for 10%–12% of attendances and less than 5% of the total length of stay in the EDs of Perth’s major hospitals. The fourth method, used by the Australian Institute of Health and Welfare, estimates these attendances at about 25%, raising the question of whether it is an overestimate.

Yusuf Nagree MB BS, FACEM, MBA(E) · Vanessa J Camarda · Daniel M Fatovich MB BS, FACEM, PhD · Peter A Cameron MB BS, MD, FACEM · Ian Dey MB BS, FACEM · Andrew D Gosbell PhD · Sally M McCarthy MB BS, FACEM, MBA · David Mountain MB BS, FACEM

To the Editor: We congratulate Nowak on her discussion surrounding communication in the emergency department (ED).1 This is certainly an issue that has an impact on both patient safety and satisfaction, and is an area in which all medical personnel can improve. The challenges in ED are manifold, and time-based targets tend to militate against effective communication.2 A strategy that we have employed in our ...

Alan E O’Connor · William G Lukin · Victoria A Brazil