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Darwin, Australia

Zardawi I.M.,Royal Darwin Hospital
Journal of Forensic and Legal Medicine

Objectives: To determine the precise nature of the non-homicide coronial autopsy. Design and setting Retrospective analysis of coronial autopsies between 2005 and 2011 in a rural setting on the Mid North Coast of New South Wales. Results: A total of 1446 autopsies were performed during the 7 year study period. There were 1428 (98.75%) coronial and 18 (1.25%) hospital autopsies. Death in the coronial cases was attributed to natural causes in 829 (58%) of the cases, accidental causes in 321 (22.5%) of the cases, suicide in 244 (17%) of the cases and no apparent cause (indeterminate) in 34 (2.5%) of the cases. Acute myocardial ischaemia constituted 66.7% of the natural causes. Road traffic and other motorised vehicle-related accidents were responsible for 60.7% of deaths in the accidental group. The 2 main types of death in the suicide group were hanging (36.5%) and drug overdose (31.5%). In 34 deaths, the cause remained unclear, however, because of lack of suspicious circumstances and negative histology and toxicology, they were presumed to be due to natural causes. Conclusions: The hospital autopsy has almost completely disappeared. On the other hand, coronial autopsies are on the rise. General Practitioners appear reluctant to issue death certificates in certain situations where there are no suspicious circumstances and the Coroners feel obliged to ask for autopsies. Currently, there is a severe shortage of pathologist and the additional coronial works adds to the burden on those pathologists who engage in such work. The coronial system needs to think about the role of the autopsy in these circumstances. Furthermore, additional resources from the various stakeholders are required for the increasing educational role of the coronial autopsy in undergraduate and postgraduate teaching. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Source

Brearley M.B.,National Critical Care and Trauma Response Center | Heaney M.F.,Royal Darwin Hospital | Norton I.N.,National Critical Care and Trauma Response Center
Prehospital and Disaster Medicine

Introduction Responses to physical activity while wearing personal protective equipment in hot laboratory conditions are well documented. However less is known of medical professionals responding to an emergency in hot field conditions in standard attire. Therefore, the purpose of this study was to assess the physiological responses of medical responders to a simulated field emergency in tropical conditions. Methods Ten subjects, all of whom were chronically heat-acclimatized health care workers, volunteered to participate in this investigation. Participants were the medical response team of a simulated field emergency conducted at the Northern Territory Emergency Services training grounds, Yarrawonga, NT, Australia. The exercise consisted of setting up a field hospital, transporting patients by stretcher to the hospital, triaging and treating the patients while dressed in standard medical response uniforms in field conditions (mean ambient temperature of 29.3°C and relative humidity of 50.3%, apparent temperature of 27.9°C) for a duration of 150 minutes. Gastrointestinal temperature was transmitted from an ingestible sensor and used as the index of core temperature. An integrated physiological monitoring device worn by each participant measured and logged heart rate, chest temperature and gastrointestinal temperature throughout the exercise. Hydration status was assessed by monitoring the change between pre- and post-exercise body mass and urine specific gravity (USG). Results Mean core body temperature rose from 37.5°C at the commencement of the exercise to peak at 37.8°C after 75 minutes. The individual peak core body temperature was 38.5°C, with three subjects exceeding 38.0°C. Subjects sweated 0.54 L per hour and consumed 0.36 L of fluid per hour, resulting in overall dehydration of 0.7% of body mass at the cessation of exercise. Physiological strain index was indicative of little to low strain. Conclusions The combination of the unseasonably mild environmental conditions and moderate work rates resulted in minimal heat storage during the simulated exercise. As a result, low sweat rates manifested in minimal dehydration. When provided with access to fluids in mild environmental conditions, chronically heat-acclimatized medical responders can meet their hydration requirements through ad libitum fluid consumption. Whether such an observation is replicated under a harsher thermal load remains to be investigated. Copyright © World Association for Disaster and Emergency Medicine 2013 2013 World Association for Disaster and Emergency Medicine. Source

Zardawi I.M.,Royal Darwin Hospital
American Journal of Case Reports

Objective: Unusual clinical course, Mistake in diagnosis Background: Pheochromocytoma is a rare catecholamine-producing neuroendocrine tumour with protean clinical manifestations, which can mimic a variety of conditions, often resulting in erroneous and delayed diagnosis. Case Report: A case of undiagnosed pheochromocytoma in a 36 year old female with a 15 year history of anxiety and depression is described. The patient collapsed while on the phone to the next of kin and stopped breathing. She was initially revived but suffered a cardiac arrest and died. At autopsy an undiagnosed adrenal pheochromocytoma was found. Conclusions: When considering a diagnosis of anxiety and depression, medical causes of the symptoms must be excluded. Common conditions, such as thyroid disorders, stimulant abuse, asthma, cardiac arrhythmias, alcohol withdrawal and rarely pheochromocytoma, causing a similar spectrum of symptoms should be excluded by history and clinical examination. © Am J Case Rep, 2013. Source

Sistenich V.,Royal Darwin Hospital
EMA - Emergency Medicine Australasia

This article provides background information about the emerging field of international emergency medicine (IEM) and how emergency physicians in Australasia can participate in its practice and development. It reviews the seven key areas of knowledge and skills involved in the practice of IEM as put forward by US fellowship programmes: (i) Emergency Medicine Systems Development; (ii) Humanitarian Relief; (iii) Disaster Management; (iv) Public Health; (v) Travel and Field Medicine; (vi) Programme Administration; and (vii) Academic Skills. Current obstacles to the development of similar programmes in Australasia are explored and identified as primarily financial. Means by which individuals can fund and engage in IEM activities are proposed. This article provides a reference of domestic and international IEM training resources that can be obtained by Australasian emergency physicians and trainees today. © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. Source

Rahimi K.,University of Oxford | Majoni W.,Royal Darwin Hospital | Merhi A.,University of Oxford | Emberson J.,University of Oxford
European Heart Journal

Aims The effect of statin treatment on ventricular arrhythmic complications is uncertain. We sought to test whether statins reduce the risk of ventricular tachyarrhythmia, cardiac arrest, and sudden cardiac death.Methods and resultsWe searched MEDLINE, EMBASE, and CENTRAL up to October 2010. Randomized controlled trials comparing statin with no statin or comparing intensive vs. standard dose statin, with more than 100 participants and at least 6-month follow-up were considered for inclusion and relevant unpublished data obtained from the investigators. Twenty-nine trials of statin vs. control (113 568 participants) were included in the main analyses. In these trials, statin therapy did not significantly reduce the risk of ventricular tachyarrhythmia [212 vs. 209; odds ratio (OR) 1.02, 95 confidence interval (CI) 0.841.25, P = 0.87] or of cardiac arrest (82 vs. 78; OR 1.05, 95 CI 0.761.45, P = 0.84), but was associated with a significant 10 reduction in sudden cardiac death (1131 vs. 1252; OR 0.90; 95 CI 0.820.97, P = 0.01). This compared with a 22 reduction in the risk of other 'non-sudden' (mostly atherosclerotic) cardiac deaths (1235 vs. 1553; OR 0.78, 95 CI 0.710.87, P < 0.001). Results were not materially altered by inclusion of eight trials (involving 41 452 participants) of intensive vs. standard dose statin regimens.ConclusionStatins have a modest beneficial effect on sudden cardiac death. However, previous suggestions of a substantial protective effect on ventricular arrhythmic events could not be supported. © 2012 The Author. Source

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