Pacing Over the Guidewire in Cardiac Structural Intervention: A Practical Guide.

Left ventricular access for aortic valve intervention provides the opportunity to deliver rapid pacing over the guidewire for device positioning and deployment. Temporary pacing delivered via the left ventricle can obviate the need for venous access and has been shown to be a safe alternative to temporary right ventricular pacing. The technique requires some basic knowledge and experience in temporary cardiac pacing. We outline safe practical steps and common pitfalls in using this technique.

Contemporary Management of Coronary Artery Perforation.

While coronary artery perforation remains an uncommon complication of percutaneous coronary intervention, appropriate recognition, early stabilisation and definitive treatment are essential. The immediate goals are to prevent progressive haemodynamic deterioration complicating cardiac tamponade, avoid the need for surgical intervention and limit accompanying mortality. Understanding the role and utility of newer devices that may influence procedural planning and improve procedural results when these complications occur is essential to minimise morbidity and mortality.

Yersinia intussusception: case report and review.

Intussusception is a recognised paediatric presentation in emergency department and primary care settings. The aetiology of intussusception is multifactorial and largely unknown but includes infection in some cases. Yersinia has been the most frequently cited bacterial association in children. Identifying Yersinia affects the role and choice of antibiotics in a child's treatment regimen. This article reports on Australia's first proven case of Yersinia enterocolitica intussusception, and reviews the clinical epidemiology of all known reported cases world-wide.

External injury documentation in major trauma victims is inadequate: grounds for routine photography in the emergency department?

OBJECTIVE: There is no widely accepted measure of clinical documentation quality in the ED. The present study creates a measure for comparing the quality of clinical documentation of external injuries with autopsy reports. This is used to discuss the advantages and disadvantages of introducing routine photography to improve clinical documentation of injuries. METHODS: This retrospective case series addressed all non-surviving major trauma patients (Injury Severity Score > or =15) presenting to St. Vincent's Hospital ED, Sydney, within the 5 year period from 1 July 2002 to 30 June 2007. Comparison between clinical and autopsy documentation of external injuries was completed for each major trauma patient. RESULTS: Of the 48 major trauma patients, there were an average of 11.6 injuries missed in documentation per patient (P < 0.001, 95% CI 8.6-14.6). ED documentation recorded on average 29% (95% CI 26%-32%) of the external injuries that appeared in the autopsy report. We call this percentage the external injury documentation rate. The external injury documentation rate was influenced by injury count and body region, but was not influenced by age, sex, severity (using the Abbreviated Injury Scale and Injury Severity Score), or whether the clinician used a trauma survey or standard progress notes or not, and there was no visible trend over time. CONCLUSION: Clinical documentation of external injuries in major trauma is poor. This is presumably because of many factors, including time pressures and high-stress environments. A possible strategy to improve this documentation is routine photography, which should offer both clinical and legal benefits.