The profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department, South Africa.

BACKGROUND: With 23.5 suicide-related deaths per 100 000 population, South Africa (SA) has the eighth-highest age-standardised suicide rate in the world. Intentional self-poisoning is associated with significant morbidity, mortality and cost. In SA, self-poisoning is the leading method of suicide in females and the second leading method in males. OBJECTIVES: To determine the profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department. METHODS: The study was a cross-sectional, retrospective audit of the medical records of patients who presented over a 12-month period with intentional self-poisoning. RESULTS: Of the 288 patients included, 62.8% were female, 62.1% were aged 18 - 30 years, 22.2% were foreign nationals, 88.9% were single, 62.8% were unemployed, 82.3% reported that the episode was precipitated by an acute stressful event, 5.6% required intensive care unit (ICU) admission, and 4.5% died prior to hospital discharge. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning (25.3%) and was responsible for the majority of ICU admissions (81.3%), cases requiring hospitalisation for >6 days (56.5%) and deaths (69.2%). CONCLUSION: A large proportion of patients were female, 18 - 30 years of age, single, unemployed, and reported an acute stressful event as a precipitant. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning and accounted for the majority of deaths and ICU admissions. Nationwide efforts should be aimed at enhancing awareness and implementing strategies to identify those at increased risk of suicidal behaviour.

Stimulant use among prehospital emergency care personnel in Gauteng Province, South Africa.

BACKGROUND: Emergency medical service (EMS) personnel are exposed to high levels of psychological, physical and emotional stressors. There has been an increase in stimulant use among healthcare professionals worldwide. There is a paucity of data pertaining to the use of stimulant products among EMS personnel in South Africa (SA). OBJECTIVES: To determine the prevalence of and other aspects pertaining to use of stimulant products among EMS personnel in Gauteng Province, SA. METHODS: A prospective cross-sectional study using a questionnaire-based model was used to survey EMS personnel in Gauteng. RESULTS: Of the 315 respondents who completed the questionnaire, 310 (98.4%) reported use of stimulant products, 295 (93.7%) consumed tea/coffee, 187 (59.4%) consumed commercial energy drinks, 60 (19.0%) used caffeinated energy-enhancing tablets, 14 (4.4%) used non-caffeinated prescription stimulant medications, 50 (15.9%) used illicit drugs, 134 (42.5%) exceeded the recommended daily allowance (RDA) of caffeine, 201 (63.8%) exceeded the RDA of sugar, 231 (73.3%) experienced difficulty remaining awake during a shift, 148 (47.8%) used stimulants off shift, and 71 (22.5%) experienced insomnia. Common reasons for use of stimulants were enjoyment (n=218; 69.2%), to stay awake (n=125; 39.7%) and improvement of physical and mental performance (n=94; 29.8%). CONCLUSIONS: The high prevalence of stimulant use among respondents is a cause for concern. Strategies to address it should be aimed at promoting awareness and education, improving working conditions, enhancing support structures, and regulating the stimulant content of commercial products.

Peri-mortem laparotomy in a patient with a ruptured intra-abdominal pregnancy

Introduction :Intra-abdominal pregnancies can present at an advanced stage of pregnancy and can have the potential for life-threatening rupture and haemorrhage. The purpose of this case report was to discuss the early recognition and prompt management options of a patient with a life threatening ruptured intra-abdominal pregnancy.Case report:We report what we believe to be the first case of a patient who presented with an intra-abdominal pregnancy who underwent a peri-mortem laparotomy in the Emergency Centre following a cardiac arrest; and who exhibited a return to spontaneous circulation (ROSC).Conclusion: Peri-mortem laparotomy/thoracotomy coupled with high quality CPR and resuscitation may be lifesaving in a patient with a life threatening ruptured intra-abdominal pregnancy