Gyanendra Malla

Parenteral organophosphorus poisoning in a rural emergency department: a case report

BackgroundPoisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world.Case presentationHere we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result.ConclusionResource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure.

The Australasian Triage Scale applied in a tertiary care hospital in Nepal

Triage is an essential function in EDs, where many patients may present simultaneously. 1 The Australasian Triage Scale (ATS) was designed for use in hospitalbased emergency services in Australia and New Zealand, and has been extended to hospitals in Papua New Guinea and some south Pacific nations. 2 It has been shown that the triage code directly relates to a range of outcome measures such as the likelihood of admission, ED staffing and resource utilization, mortality and length of inpatient stay. 2

Jejunal perforation due to ingested buffalo bone mimicking acute appendicitis

BackgroundForeign body ingestion is seen quite frequently in clinical practice, intestinal perforation due to this is rare. The foreign body often mimics another cause of acute abdomen and requires an emergency surgical intervention. The majority of patients do not recall ingesting sharp foreign bodies.Case presentationWe report an interesting case of a fifty five year-old man who presented with pain in the right iliac fossa with localised tenderness which was clinically diagnosed as acute appendicitis. During the operation, the presence of purulent collection and the inflamed bowel with flakes raised suspicion of bowel perforation. The assessment of the proximal small bowel revealed two small perforations in the jejunum. A hard, bony and sharp object was extracted and the perforations were closed. Post-operative recovery was uneventful. Detailed food history was taken following the recovery of the patient from surgery. It revealed the history ingestion of home prepared buffalo meat. The extracted object was identified as ‘buffalo bone’ by the patient and the care taker of the patient. The jejunum was perforated by the ingested buffalo bone causing local peritonitis in right iliac fossa.ConclusionIntestinal perforation by ingested foreign bodies should be suspected in acute abdomen. It requires a high degree of suspicion and awareness on the part of the clinician.

Penetrating orbit injury: challenge to emergency medicine

BackgroundPenetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. The setting and causes of eye injury are diverse, but previous studies have demonstrated that the risk and type of injury is often correlated with age, gender, and race. Pediatric ocular injury is often accidental and may be preventable. A focused history and prompt ocular examination are essential to immediate management.Case presentationThis article describes a case of protruding foreign body-related penetrating orbit injury with a retained foreign body in a 4-year-old male from a town in the eastern part of Nepal. The child presented to the emergency with foreign body in situ without receiving any pre emergency care without any medical attendance. The patient was managed with non-operative removal of foreign body in the emergency. The case discussion will review the initial presentation, examination, resultant management decisions, and final outcome.ConclusionForeign body presentations may be diverse and non-operative management may be considered in selected cases. Resource availability and conditions at presentations may also influence the management decisions. This case presentation has described such a scenario in developing country like Nepal and is expected to be interest across various medical specialties.

Time to analgesia in an emergency department in Eastern Nepal

Nepal is a least developed country, with limited healthcare resources. An 18 month Fellowship in Emergency Medicine has contributed some improvements to care. This study assessed time to first analgesia in higher and lower acuity patients.