The emergency physician and patient confidentiality: A review

Confidentiality is a promise rooted in tradition, law andmedical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients.³⁴Although confidentiality is an important principle thatshould be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require, a breach of confidentiality. As Beauchamp and Childress noted, “the therapeutic role may sometimes have to yield to ones role as citizen and as protector of the interests of others”.¹⁹ In general, however, circumstances requiring a breach of confidentiality are rare.     

A patient with Werner's syndrome and osteosarcoma presenting as scleroderma.

Werner's syndrome (WS) is often mistaken for scleroderma. We describe a patient with WS who presented with an enlarging, painful mass of the right knee that proved to be a juxtaarticular osteosarcoma of the distal femur. Recognition of WS and prompt investigation of any painful, enlarging masses to exclude sarcomatous degeneration will benefit these patients.     

Seroprevalence and risk factors for hepatitis C virus antibody in pregnant women.

OBJECTIVE: To better understand hepatitis C viropathies and seroprevalence by performing an epidemiologic analysis of pregnant women seropositive for antibody against hepatitis C. METHODS: We studied 1013 consecutive obstetric patients at Parkland Memorial Hospital who gave informed consent for detailed interviews and serotesting. Sera were analyzed for antibody to the hepatitis C virus using both C100-3 and RIBA-4 assays. Neonatal assessment was carried out in the immediate postpartum period. RESULTS: Hepatitis C antibody was detected in 2.28% (N = 23) of the 1005 women in whom analysis was completed. Factors associated with seropositivity included intravenous (IV) drug use, sexually transmitted diseases, hepatitis B infection, maternal age greater than 22.5 years, increased parity (eg, greater than 2.1), history of transfusion, and three or more different lifetime sexual partners or a sexual partner who used IV drugs. Maternal and neonatal outcome was not different between hepatitis C antibody-positive and -negative groups. CONCLUSIONS: Epidemiologic data are consistent with sexual and parenteral modes of transmission. Women with hepatitis C antibody did not have excessive perinatal complications compared with antibody-negative women. A model protocol and cost analysis for screening pregnant women for hepatitis C infection are presented. However, routine screening for hepatitis C is not advocated.     

A high fidelity tissue-based cardiac surgical simulator.

OBJECTIVE: Issues concerning the training and certification of surgical specialists have taken on great significance in the last decade. A realistic computer-assisted, tissue-based simulator developed for use in the training of cardiac surgical residents in the conduct of a variety of cardiac surgical procedures in a low-volume cardiothoracic surgery unit of a typical developing country is described. The simulator can also be used to demonstrate the function of technology specific to cardiac surgical procedures in a way that previously has only been possible via the conduct of a procedure on a live animal or human being. METHODS: A porcine heart in a novel simulated operating theatre environment with real-time simulated haemodynamic monitoring and coronary blood flow, in arrested and beating-heart modes, is used as a training tool for surgical residents. RESULTS: Standard and beating-heart coronary arterial bypass, aortic valve replacement, aortic homograft replacement and pulmonary autograft procedures can be simulated with high degrees of realism and with the superimposition of adverse clinical scenarios requiring valid decision making and clinical judgments to be made by the trainees. CONCLUSIONS: The cardiac surgical simulation preparation described here would appear to be able to contribute positively to the training of residents in low-volume centres, as well as having the potential for application in other settings as a training tool or clinical skills assessment or accreditation device. Collaboration with larger centres is recommended in order to accurately assess the utility of this preparation as an adjunctive cardiothoracic surgical training aid.     

Thirty cases of Irukandji envenomation from far north Queensland

The Irukandji jelly fish (Carukia barnesi) is responsible for a significant number of envenomations in northern Australia during the summer. Emergency physicians in these coastal areas frequently manage patients who have been envenomed by this potentially serious marine creature. The jelly fish is small (its bell is up to 2.5cm across) but the tentacles may be up to half a metre in length. It is rarely seen before envenomating. The sting usually initially causes localised pain followed by systemic symptoms known as the ‘Irukandji syndrome’, which include potentially life threatening pulmonary oedema. This article discusses Irukandji envenomation and its treatment, and reviews our experience in treating 30 patients who presented to the Emergency Department of Cairns Base Hospital in December of 1996 having been stung by the Irukandji. Of these cases, 27 (90%) patients developed systemic symptoms (the Irukandji syndrome) and 19 (63%) required admission. Twelve (40%) patients required more than 100mg of titrated, intravenous pethidine to relieve the pain. There were no cases of pulmonary oedema. All patients were discharged home well within 24 hours.     

Augmentation by calcium channel antagonists of general anaesthetic potency in mice.

The effects of three kinds of calcium channel antagonists on the anaesthetic potencies of ethanol, pentobarbitone and argon were examined in mice. Ethanol and pentobarbitone anaesthetic potencies in mice were significantly increased by verapamil 10 mg kg-1, flunarizine 40 mg kg-1 and nitrendipine 100 mg kg-1. Argon anaesthetic potency was significantly increased by nitrendipine 50 mg kg-1 and 100 mg kg-1 in a dose-related fashion. Even at very high doses the calcium channel antagonists did not produce anaesthesia by themselves. At the doses used the calcium channel antagonists did not affect the blood concentrations of ethanol, 2 h, or pentobarbitone, 15 min, after anaesthetic administration.