Perforation of Meckel's diverticulum with a foreign body mimicking acute appendicitis: A rare complication.

Meckel's diverticulum mimicking acute appendicitis is a very rare condition encountered in practice. MD is asymptomatic in most of cases and only about 4 to16% of cases develop complications. Perforation of MD by a foreign body is even rarer being only reported in few cases in the literature. The surgical management might be wedge resection or segmental resection and primary anastomoses depending on the intra operative findings. We report a case with foreign body impaction in MD with perforation mimicking acute appendicitis.

Self-reported preparedness of New Zealand acute care providers to mass emergencies before the Canterbury Earthquakes: a national survey.

INTRODUCTION: Disasters occur more frequently. Acute care providers are the first to respond to mass emergencies from the healthcare sector. The preparedness of acute care providers in New Zealand to respond to mass emergencies has not been previously studied. OBJECTIVE: To assess the self-reported training and experience of New Zealand acute care providers to respond to mass emergencies and the factors associated with strong preparedness. METHODS: A cross-sectional national survey of 1500 acute care providers in New Zealand carried out between 2009 and 2010. The survey assessed experience, training and self-reported preparedness. It also determined the factors associated with strong perceived preparedness. RESULTS: The response rate to this survey was 60.7%. Nurses had a higher response rate than doctors or paramedics. Only 29.2% of acute care providers reported responding to a previous mass emergency event. There were 53.5% of acute care providers who reported having formal training in how to deal with mass emergencies, whereas 58.1% of participants reported that they were aware of their role during a healthcare mass emergency response. The factors associated with self-reported strong preparedness to deal with mass emergencies included: being a paramedic, previous training, participation in a drill, willingness to report to work during an infection or man-made emergency, ability to triage and general awareness of the role during a mass emergency. CONCLUSION: Almost half of New Zealand acute healthcare providers have no training in dealing with mass emergency events. Training and general awareness of the role during a mass emergency response were the main factors associated with strong self-reported preparedness of acute care providers. The apparent efficacy of training allied to lack of availability means that it should be a national priority.

Emergency medical services versus private transport of trauma patients in the Sultanate of Oman: a retrospective audit at the Sultan Qaboos University Hospital.

AIMS: This study aims to assess the differences in the outcome of road traffic trauma patients between those transported by emergency medical services (EMS) and those privately transported to the Sultan Qaboos University Hospital in the Sultanate of Oman in 2011. METHODS: This is a retrospective study of road traffic trauma patients admitted to the Sultan Qaboos University Hospital between January to December 2011. Data for all cases were retrieved from the emergency department database. The general linear multivariate regression analysis model was performed to test the differences in outcome. The analysis controlled for age, gender, ethnicity, weekend injury, time of injury, triage status, Injury Severity Score, existence of head injury, need for intensive care unit admission and need for surgical management. RESULTS: There were 821 trauma cases in 2011. 66.7% were transported by EMS. Male patients represented 65.7% of the cases. There was no significant difference in the characteristics of EMS and non-EMS trauma patients. In terms of inhospital mortality, the relative ratio of inhospital mortality between EMS and non-EMS groups was 0.64 (0.36-1.13), and p value 0.13. There is no significant difference in all other secondary outcomes tested. CONCLUSIONS: EMS transported trauma patients had a statistically non-significant 36% reduction in mortality compared with privately transported patients admitted to the Sultan Qaboos University Hospital in 2011. Further, research that incorporates prehospital factors such as crash to arrival of EMS services and transport time to definitive healthcare facility should be conducted to evaluate the effectiveness of such a system in trauma care. Since non-EMS transport is likely to continue, public first aid training is critical to reduce mortality and morbidity of road traffic trauma in Oman.

Challenges of the New Zealand healthcare disaster preparedness prior to the Canterbury earthquakes: a qualitative analysis.

BACKGROUND: Disasters are a growing global phenomenon. New Zealand has suffered several major disasters in recent times. The state of healthcare disaster preparedness in New Zealand prior to the Canterbury earthquakes is not well documented. OBJECTIVE: To investigate the challenges of the New Zealand healthcare disaster preparedness prior to the Canterbury earthquakes. METHOD: Semi-structured interviews with emergency planners in all the District Health Boards (DHBs) in New Zealand in the period between January and March 2010. The interview protocol revolved around the domains of emergency planning adopted by the World Health Organization. RESULTS: Seventeen interviews were conducted. The main themes included disinterest of clinical personnel in emergency planning, the need for communication backup, the integration of private services in disaster preparedness, the value of volunteers, the requirement for regular disaster training, and the need to enhance surge capability of the New Zealand healthcare system to respond to disasters. CONCLUSION: Prior to the Canterbury earthquakes, healthcare disaster preparedness faced multiple challenges. Despite these challenges, New Zealand's healthcare response was adequate. Future preparedness has to consider the lessons learnt from the 2011 earthquakes to improve healthcare disaster planning in New Zealand.

Are we ready? Preparedness of acute care providers for the Rugby World Cup 2011 in New Zealand.

UNLABELLED: New Zealand is hosting the Rugby World Cup (RWC) 2011. It is the largest sporting event in New Zealand's history, with around 70,000 fans estimated to visit the country from September to October 2011. This influx of tourists will have an impact on its already stretched healthcare services. The preparedness of New Zealand's healthcare system to handle this mass event is unclear. OBJECTIVES: The two main objectives of this study were (1) to determine the perceived preparedness of acute care providers in New Zealand to respond to the healthcare demands of RWC 2011; and (2) to determine the factors associated with perceived strong preparedness among acute care providers in New Zealand. METHOD: A cross-sectional survey of 1500 doctors, nurses and ambulance officers working in acute care services in New Zealand was conducted between June 2010 and March 2011. RESULTS: 911 surveys were completed (response rate 60.7%). Only 12.7% of acute care providers felt they were prepared to deal with possible health issues arising from RWC 2011. Perceived preparedness was highest among ambulance officers and lowest among providers in intensive care units (16.3% vs 4.1%, p<0.01). Acute care providers who were aware of their role in a mass emergency were more likely to report preparedness with a prevalence OR of 3.5 and a 95% CI of 2.1 to 5.7. CONCLUSION: Only 12.7% of acute care providers in New Zealand perceived preparedness for RWC 2011. Perceived preparedness followed a stepwise decline from prehospital services, emergency department, to surgery and then finally to intensive care services. This indicates that current preparedness activities are focusing on prehospital emergency services and neglecting surgical and intensive care services. Awareness about the role of acute care providers during emergencies, training and previous experience were associated with perceived strong preparedness for RWC 2011.

Ovarian Hernia: A rarity.

Ovarian hernias are extremely rare. The prevalence of ovaries and fallopian tubes in operable inguinal hernias is only about 2.9%. We report here an unusual case of an ovary in a hernia sac in an adult female. She presented with symptoms and signs of an incarcerated left inguinal hernia. The left ovary contained a haemorrhagic cyst and, along with the left fallopian tube and broad ligament, these were found in the sac. She underwent a left ovarian cystectomy and the inguinal hernia was repaired with mesh.

Blunt Cerebrovascular Injuries: A review of the literature.

Blunt cerebrovascular injuries (BCVI) have been a topic of interest to many researchers worldwide as evidenced by the vast amount of available literature. The interest in these rare injuries is probably due to the significant possibility of mortality and morbidity amongst patients who sustain them, when the employment of radiological screening methods could prevent such an outcome. Recognition of these injuries is the most important step towards prevention of adverse outcomes. We present a comprehensive review of the literature regarding the mechanism of injury, imaging, management, and complications of BCVI. Articles were identified through a search of MEDLINE and the Cochrane Central Register of Controlled Trials using the keywords Blunt; Vascular; Carotid; Vertebral; Trauma; Stroke; Management, and Endovascular. The search was limited to humans and articles in English.

Atypical case of acute Fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) is a life threatening obstetric emergency. The most common presentation is malaise, nausea, vomiting and epigastric pain followed by jaundice. Due to high maternal and perinatal mortality, early diagnosis, prompt delivery and supportive care are required. We report an atypical case of AFLP and discuss the management and complications of this rare obstetric disorder.

Laparoscopic repair of traumatic intraperitoneal bladder rupture.

Intraperitoneal rupture of the bladder is an uncommon condition that is usually caused by pelvic fractures. This is a true surgical emergency managed conventionally by open laparotomy with single or double layer repair. We present a case of successful laparoscopic repair of an intraperitoneal bladder rupture secondary to blunt abdominal trauma and pelvic fracture in a 37 year-old man. The repair was done using single layer repair, with successful results.