A Case Report on the Diagnosis of Acute Abdominal Aortic Occlusion Using Point-of-Care Ultrasound in the Emergency Department.

Point-of-care ultrasound (PoCUS) can be used to detect and evaluate for an aneurysm and/or a dissection of the abdominal aorta in suspected patients in the Emergency Department (ED). Despite the routine use of PoCUS for the assessment of the abdominal aorta in suspected aortic aneurysms and dissections, there is limited literature regarding its use in the diagnosis of acute abdominal aortic occlusions in the emergency setting. This is a case demonstrating the use of PoCUS in identifying an acute aortic occlusion in a 71-year-old female patient with known hypertension and diabetes mellitus. The patient presented with central abdominal pain and bilateral lower limb weakness to the ED. The patient had multiple differential diagnoses, including a possible acute aortic occlusion of the abdominal aorta. PoCUS of the aorta was utilized to diagnose an acute abdominal aortic occlusion in the ED. The rapid diagnosis expedited the referral to vascular surgeons for definitive management. Acute abdominal aortic occlusion is a time-sensitive and life-threatening emergency. PoCUS of the abdominal aorta to detect acute abdominal occlusions allows for a rapid diagnosis with the potential to improve outcomes. A protocol for detecting acute abdominal aortic occlusion should be included in the standard aorta PoCUS scan.

Massive purulent pericardial effusion with ultrasound features of tamponade secondary to non-typhoid Salmonella infection.

Purulent pericardial effusions are rare and represent the most severe form of bacterial pericarditis. The authors present a case of a male in his 40s with a massive purulent pericardial effusion due to non-typhoid Salmonella, who presented with ultrasound features of a cardiac tamponade. Invasive non-typhoid Salmonella cardiac infection is a rare but important consideration in immunocompromised individuals. This of particular concern in sub-Saharan Africa, where there is a high prevalence of HIV-infected individuals.

The reporting of adverse events in Johannesburg Academic Emergency Departments.

INTRODUCTION: Adverse events (AE) are a common occurrence in healthcare systems; however, the frequency of AEs occurring in South Africa and especially Emergency Departments (ED) is unknown. The aims of this study were to describe the frequency of AEs experienced by Healthcare providers (HCP) and the frequency of formal reporting thereafter over a 12-month period. METHODS: A cross sectional descriptive study was performed amongst HCPs at Helen Joseph Hospital and Chris Hani Baragwanath Academic Hospital EDs. The questionnaire incorporated ED relevant AEs using the South African National Procedural Manual for Patient Safety Incident Reporting and Learning. RESULTS: The questionnaires from 51 doctors and 49 nurses were analysed. All HCPs experienced >10 AEs over 1 year. Nurses were 21 times more likely than doctors to report >10 AEs (p < 0.001). Twenty four percent of AEs experienced were deemed to be minor, very minor or not adverse. CONCLUSION: There are low levels of formal AE reporting, especially amongst doctors, within Johannesburg Academic EM Departments despite large numbers of AEs experienced. There are multiple barriers, which influence these reporting practices. Improved reporting systems are needed to affect a change in the current environment.

Foreign Body Aspiration - A Potentially Life-Threatening Complication of Seizures.

In adults, foreign body aspiration is an uncommon clinical presentation. Aspiration can occur during a seizure and in the post-ictal period due to the loss of airway reflexes. Commonly aspirated contents include saliva, blood, or vomited gastric contents. Due to a common misconception that placing an object, such as a spoon, in a seizing person's mouth prevents tongue-biting, a variety of unusual items may also potentially be aspirated. With an unclear history, relatively small, radiolucent objects are often misdiagnosed or missed entirely. Chest pain or unexplained hemoptysis may be the only symptoms to suggest aspiration. In this report, the authors present a case of a patient with an unusual foreign body aspiration.

An Audit of Patients with Dog-bite Wounds Presenting to a Tertiary Level Hospital Emergency Department in South Africa.

Background Dog-bite wounds are a common emergency department (ED) presentation, accounting for approximately 5% of traumatic wounds in the US. However, only 20-50% of patients actually present to the ED for medical attention following a dog-bite wound. Methods This was a transverse, retrospective audit of medical records of patients that had presented to the Tembisa Provincial Academic Hospital ED with dog-bite wounds during the 2014 calendar year. Results Of the 269 patients that were included in the study, 148 (55%) were male. The median age of all study patients was 27 years (range: 3-77 years). Most patients presented between 18h00-24h00 (n = 111, 41.3%). Most wounds were sustained on the lower limbs (n = 80, 68.18%), followed by the upper limbs (n = 74, 28.03%). Patients who were ≤12 years of age had a higher prevalence of buttock/perineum (p = 0.0002) and head/face/neck (p = 0.009) wounds, whereas patients who were >12 years of age had a higher prevalence of lower limb wounds (p = 0.0006). Only 15 (5.6%) wounds were sutured, and antibiotics were prescribed to 120 (45.1%) patients. Tetanus toxoid vaccine (TTV) and the first dose of the rabies vaccine (RV) were administered to 152 (57.4%) and 240 (89.1%) patients, respectively. Conclusion Children are more likely to present with wounds to the head/face/neck or buttock/perineum regions, while adults are more likely to present with wounds to the lower limbs. Proper strategies should be implemented to ensure that clinicians adhere to the current antibiotics protocols as well as rabies and tetanus post-exposure prophylaxis (PEP)-prescribing guidelines.

Learning in the Digital Era - Awareness and Usage of Free Open Access Meducation among Emergency Department Doctors.

Introduction Information and communication technology has revolutionized the space of medical education by providing a multitude of up-to-date evidence-based data to healthcare practitioners. Despite the increasing popularity of FOAM - Free Open Access Meducation (Medical Education) globally - data relating to its awareness and usage in Africa is lacking. In this study, we explore the awareness and usage of FOAM among doctors working at select emergency departments in Johannesburg. Methods The study comprised a prospective, questionnaire based, cross-sectional survey of medical doctors working at five academically affiliated emergency departments in Johannesburg. Data was described and compared. Results One-hundred and four participants completed the survey. Most of the respondents were aged between 31 and 39 years (n = 40, 43.9%). There were no significant differences between the proportion of females and males that used FOAM (p = 0.56). Most participants (n = 91, 87.5%) were aware of FOAM, while 82 (78.8%) used FOAM, 13 (12.5%) were unsure if they used FOAM and nine (8.7%) did not use FOAM. Majority of those that used FOAM, only used it once a week (n = 47, 57.3%). Most participants spent between one and two hours per day on FOAM (n = 29, 35.4%). Smartphones were by far the most commonly used device to access FOAM (n = 91, 87.5%). Conclusion The level of awareness of FOAM is high and its usage is prevalent among emergency medicine healthcare professionals in Johannesburg. As technology becomes more prominent, institutions must aim to adapt to the digital era in their teaching methods.

The ultrasonographic determination of the position of the mental foramen and its relation to hard tissue landmarks.

OBJECTIVE: The goal of this ultrasound based cross-sectional study was to make use of ultrasound to determine the position of the mental foramen in relation to hard tissue landmarks. MATERIAL AND METHODS: One hundred Black and Caucasian subjects were included. An ultrasound transducer was used to locate the mental foramina. Distances to various landmarks were measured and compared. RESULTS: All mental foramina were visualised ultrasonographically. The mean distances to various landmarks from the mental foramen for the entire group on the right and left sides respectively were as follows: a) 22.8 mm (SD 2.04 mm) and 22.8 mm (SD 2.0 mm) to the cusp of the related tooth, b) 13.2 mm (SD 1.6 mm) and 13.2 mm (SD 1.6 mm) to the inferior border of the mandible. The mean position of the mental foramen was found to be 63.4% (SD 1.8%) of the distance from the cusp of the related tooth to the inferior border of the mandible on the right and 63.3% (SD 1.7%) on the left. There were statistically significant differences between race groups and genders, but not between age groups. CONCLUSION: These results suggest that ultrasound is a sensitive modality to locate the mental foramen. There are minor, statistically significant (but clinically insignificant) differences in the position of the mental foramen with regard to various hard tissue landmarks.

Finding the mental foramen.

The mental foramen and mental nerve are clinically important landmarks for clinicians across various disciplines including dentists, oral maxillofacial surgeons, emergency physicians and plastic and reconstructive surgeons. To minimize complications related to procedures in the vicinity of the mental foramen and nerve, knowledge of its anatomy and anatomical variations is cardinal to concerned clinicians. In this review, basic anatomy, procedural complications, hard and soft tissue relations, variations between population groups, asymmetry, accessory mental foramina and the use of various radiological modalities to determine the position of the mental foramen are reviewed to provide a more thorough understanding of this important landmark.

Humanitarian Medical Response to the Syrian Arab Republic (April 7, 2013 to April 23, 2013).

The Syrian Arab Republic is entrenched in a deadly civil war, plunging the country into a state of chaos. With 3.2 million refugees abroad, 7.6 million internally displaced persons, and more than 200,000 killed, humanitarian assistance and international intervention are in dire need. This report outlines the response to the Syrian humanitarian crisis by a South African-based nongovernmental organization (NGO). It describes the experiences of a health care worker, the patient profiles, and the lessons learned in a war zone. Responding to a nation in need is of paramount importance. In order to maximize the benefit conferred, the team should always attempt to implement measures that leave a lasting legacy.

A Somalia mission experience.

Reports about The Horn of Africa Famine Crisis in 2011 flooded our news bulletins and newspapers. Yet the nations of the world failed to respond and alleviate the unfolding disaster. In August 2011, the Gift of the Givers Foundation mobilised what was to become the largest humanitarian mission ever conducted by an African organisation. Almost a year later, the effort continues, changing the face of disaster medicine as we know it.