There is an improvement in ECG interpretation accuracy with advancing years of emergency medicine training in Victoria. There exists, however, a low level of accuracy for some critical ECG diagnoses. There is a call by trainees for more formalized and regular ECG education to begin earlier in their training.

ObjectiveTo determine the factors considered most important by emergency physicians when deciding to institute or withhold resuscitation in a hypothetical patient with a lifethreatening illness. MethodA self-administered questionnaire containing a clinical scenario was posted to all Victorian emergency physicians in April 1997. Respondents were asked to decide between intubation and no active treatment, to rate the importance of various factors in making this decision and to rate the likelihood of altering the decision given hypothetical changes in the scenario. ResultsThe response rate was 67% (46/69). Of those choosing intubation (89%), most would have changed the decision if the patient had dementia, was permanently bed-bound or was totally dependent for activities of daily living. Decisions were most influenced by reversibility of the illness, the patient's functional state and the perceived quality of life. ConclusionEmergency physicians consider many factors when deciding whether or not to actively resuscitate patients. Further study of the decision making process is recommended.

Clearance of technetium-99m-labelled diethylenetriaminepenta-acetic acid was used to measure total and individual kidney glomerular filtration rates in 48 girls with covert bacteriuria. The mean (±SD) of the total rates of 18 girls with scarred kidneys (99±24 ml/min/1-73 m2) was significantly (0 005 >p >0-002) lower than that in 30 girls with unscarred kidneys (119± 18 ml/min/1-73 m2). This reduction in glomerular filtration was related to the loss of kidney substance associated with scarring rather than to vesicoureteric reflux. The glomerular filtration rate was unrelated to the duration of bacteriuria.These findings suggest that in girls aged 4 and over neither vesicoureteric reflux nor covert bacteriuria contributes to the progression of kidney damage.

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