In this pilot study, scribe usage was feasible, and overall improvements in consultations per hour were seen. Overall income improved by AUD104.86 (95% CI AUD38.52, AUD171.21) per scribed hour. Further study is recommended to determine if results are sustained or improved over a longer period.

Clinical records Patient 1A 39-year-old woman presented to a rural hospital 2 hours after ingesting 24 g of amisulpride (therapeutic dose, 50-1200 mg/day), and unknown quantities of nitrazepam and diazepam. On examination, she was drowsy with a Glasgow Coma Score (GCS) of 14, heart rate of 100 beats per min (bpm), and systolic blood pressure of 70 mmHg. Activated charcoal (50 g) and intravenous normal saline (2 L) were administered, and the hypotension resolved. She was transferred to a tertiary emergency department.On arrival, 7 h after the overdose, her condition remained unchanged. An electrocardiogram (ECG) showed sinus rhythm, heart rate of 67 bpm, QRS interval of 128 ms, prolonged QT interval of 560 ms and bifid T waves (Box 1). Twelve hours after ingestion, her level of consciousness decreased (GCS, 4), and broad complex tachycardia was observed on the electrocardiography monitor and subsequent ECG. No hypotension was recorded. She was intubated, hyperventilated, given NaHCO 3 , magnesium and calcium gluconate, and transferred to the intensive care unit. The QRS interval narrowed to 112 ms within 4 h, but the QT interval remained prolonged for another 12 h. Patient 2A 40-year-old man presented to a hospital emergency department after ingesting amisulpride (32 g), mirtazapine (300 mg), valproate (7 g), amitriptyline (1.25 g) and omeprazole (unknown quantity). On arrival, he had a GCS of 14, heart rate of 90 bpm, and blood pressure of 120/70 mmHg. An ECG at presentation showed sinus rhythm with a heart rate of 90 bpm, QT interval of 460 ms and bifid T waves. He was admitted to the intensive care unit. About 12.5 h after ingestion, he developed a broad complex tachycardia with rate 120 bpm (left bundle branch pattern), but remained haemodynamically stable. The QRS complex did not significantly narrow when the patient was treated with a bolus of NaHCO 3 . An NaHCO 3 infusion was started, and he was intubated and ventilated. Eighteen hours after ingestion, the QT interval was 560 ms, with heart rate of 79 bpm and a normal QRS interval (Box 2A).About 29 h after ingestion, the patient developed pulseless torsades de pointes, but sinus rhythm with a QT interval of 560 ms was restored after a single direct current cardioversion shock (Box 2B). He had a second episode of torsades de pointes 32.5 h after ingestion, and an episode of ventricular tachycardia 34 h after ingestion. By 5 days after the overdose, the QT interval had shortened to 360 ms (Box 2C).Serum amisulpride level was measured by high performance liquid chromatography using a modified method of Bohbot et al, 1 and was 23.2 mg/L at 12.5 h after ingestion. Patient 3A 39-year-old woman presented to hospital about 12 hours after ingesting amisulpride (16-24 g). At presentation, she was drowsy, with a heart rate of 59 bpm and blood pressure of 81/44 mmHg. She was given 1 L of intravenous fluid. An ECG demonstrated sinus rhythm with heart rate of 62 bpm, and QT interval of 600 ms. Two hours after presentation, her condition deteriorated rapidly, with a GCS o...

Objective: To describe the incidence and outcomes of assault resulting in serious injury in Victoria. Design and setting: Analysis of population‐based data from the Victorian State Trauma Registry for assaults between 1 July 2001 and 30 June 2007. Main outcome measures: Overall trends in the rate of assault‐related major trauma, inhospital mortality, and functional outcomes 6 months after injury as measured by the Extended Glasgow Outcome Scale. Results: The rate of assault‐related major trauma rose significantly over the 6‐year study period (incidence rate ratio [IRR], 1.21 [95% CI, 1.16–1.26]), particularly for blunt assault (IRR, 1.33 [95% CI, 1.26–1.41]). There were 803 admissions for major trauma related to assault: 484 (60%) were for blunt trauma and 319 (40%) for penetrating trauma. Most patients were young men. Compared with penetrating trauma, blunt trauma was associated with more severe injury; 396 patients (82%) with blunt trauma had serious head injuries, and 102 (24%) of these required inpatient rehabilitation. A higher percentage of patients with penetrating trauma died in hospital compared with those with blunt trauma (35 [11%] v 23 [5%]; P = 0.001). Follow‐up at 6 months showed that only 19% of respondents (42 patients) had made a complete recovery; outcomes at 6 months were worse for patients with blunt trauma than for those with penetrating trauma. Conclusions: The incidence of assault resulting in severe trauma rose significantly between 2001–02 and 2006–07, mostly due to a rise in assault resulting in blunt trauma. The increase in incidence, the young age of the victims, and the potential for high burden of injury and poor outcome, combined with the preventable nature of assault, highlight the importance of developing effective assault‐prevention strategies.

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