SVT with ST-T Changes: is there cause for concern?

Supraventricular tachycardia [SVT] is a common arrhythmia presenting to the Emergency Department and acute care clinics. Paroxysmal SVT can occur in patients of all age groups, and may occur in the presence, or absence, of heart disease, including coronary artery disease. During episodes of SVT, it is not uncommon to see ST segment and T wave changes. This may persist transiently in the post conversion period. How significant are these changes? The 4 cases illustrated here, together with the discussion that follows hopes to address some of the questions front line clinicians have in the management of these patients

Riding motorcycles: is it a lower limb hazard?

<p><b>UNLABELLED</b>The morbidity and mortality among motorcyclists involved in road traffic accidents (RTA) in Singapore is high. Due to their relatively small size, they represent a vulnerable group of road-users. Many reports from studies performed overseas have shown that both lower limb and head injuries appear to be common among motorcyclists.</p><p><b>OBJECTIVES</b>To study the characteristics of lower limb injuries among motorcyclists involved in RTA, who present to the Department of Emergency Medicine of an urban, tertiary, teaching hospital for treatment.</p><p><b>METHODS</b>The study was conducted prospectively from 1 July 2000 to 30 June 2001. Demographic data was collected together with details of the type of injuries, mechanism involved, management and disposition. SPSS (Chicago, Inc.) was utilised for data management and statistical analysis.</p><p><b>RESULTS</b>Of the 1,809 motorcyclists studied, 1,056 (58.3%) sustained lower limb injuries, 328 (18.1%) had head injuries and 256 (14.2%), sustained facial injuries. The mean age was 26.4 +/- 7.2 years and males made up the majority of the patients (1,733, 95.8%). Helmet usage was 100%. The commonest type of lower limb injury was fractures (531, 50.3%). The most common type of fracture was that of the shaft of the tibia and fibula (231, 43.5%), followed by fractures around the ankle (186, 35.0%). For those with more than one body region injured, head injury was noted to be not commonly associated with lower limb injuries. The commonest mechanism of injury was collision with another vehicle, while approaching a turn (769, 42.5%). There were 96 motorcyclists (5.3%) who had clinical evidence of alcohol consumption on their breath at presentation. There were 533 (29.5%) patients who were admitted for in-patient management and the mean duration of stay was 4.8 +/- 4.5 days. Amongst those with lower limb injuries, the admission rate was 30.5% (322 of 1,056) and the mean duration of hospitalisation was 5.3 +/- 3.9 days.</p><p><b>CONCLUSION</b>Lower limb injuries represent the commonest form of injury among motorcyclists involved in RTA. Improved training via motorcycle rider education, better design of future motorcycles and protective footwear may help to reduce this problem.</p>