ED staff are able to perform resuscitation procedures in PPE without adverse physiological effects or impact on performance. Subjective concerns regarding task performance were not reflected in objective measurements. This might indicate that appropriate training and feedback could reduce the negative impression associated with activities undertaken while wearing PPE.

Background Metoclopramide is a commonly used drug in the emergency department for managing nausea, vomiting and migraines. There are currently no reported studies of the rates of metoclopramide‐induced akathisia in the emergency department. Aim To determine the risk and severity of metoclopramide‐induced akathisia. Method This was an observational study of emergency department patients who were administered metoclopramide parenterally and matched controls who were administered parenteral medications not known to cause akathisia (e.g. normal saline or antibiotics). Akathisia was assessed by a blinded interviewer at least one hour after drug administration, using a modified version of the Prince Henry Hospital Akathisia Rating Scale. Results 232 patients were enrolled, 26 were excluded due to missing data or protocol violations. 99 were in the control group and 107 in the metoclopramide group. The mean age was 45.4 ± 19.4 years and 109/206 (53%) were male. 18 patients (16.6%, 95%CI 10.5–25.6) who received metoclopramide developed akathisia compared to 9 patients (9.1%, 95%CI 4.5–17.0) who received a control drug; the risk ratio was 1.85 (95%CI 0.87–3.92, p = 0.10). Conclusion This study showed a trend towards an increased incidence of akathisia following metoclopramide administration in the emergency department. As this is a commonly administered drug in emergency departments, staff should be aware of the potential for akathisia to develop and should consider monitoring patients for this adverse effect.

BackgroundMost bile duct injuries are not recognized at the time of initial surgery. Optimal treatment requires early recognition. CT IVC has become increasingly important in identifying bile leaks and their source after cholecystectomy. Our study aims to report the outcomes of using CT IVC post operatively and how accurately it can detect or localise bile leaks.MethodsFrom 2000 - 2009, twenty patients were managed for suspected bile leak post cholecystectomy within the Alfred Hospital. The study included a retrospective evaluation of the initial procedure, presenting symptoms, site of ductal injury, diagnostic procedures and therapeutic interventions. Results were analysed to determine success of the imaging procedure, and to correlate imaging diagnosis with results both diagnostically and clinically.ResultsTwenty patients had a suspected bile leak, of which 3 were detected at the time of surgery. Seven patients had a CTIVC as their primary investigation. It identified bile leak in 6 and the anatomical site in 5. One had a leak excluded and was managed conservatively.ConclusionsCT Cholangiography is a feasible and low-risk tool for imaging of the biliary tract in suspected bile leaks post cholecystectomy. It is a valuable non-invasive investigation that may help avoid endoscopic retrograde Cholangiography or surgery.

Gastrointestinal tract (GIT) symptoms are increasingly reported as the presenting symptoms of coronavirus disease 2019 . These symptoms vary from diarrhea to severe colitis or bleeding. This paper reports a rare case of pancolitis as a consequence of GIT involvement secondary to active COVID-19 in a previously healthy 52-year-old lady. The diagnosis was confirmed by a CT scan of the abdomen and the patient was hospitalized and treated conservatively and discharged home after three days of hospital admission. She was followed up in the outpatient surgical clinic in two weeks with no more gastrointestinal symptoms and a normal physical examination. Careful consideration of gastrointestinal symptoms in the context of COVID-19 and a prompt diagnosis will facilitate early recognition and management and avoid any sinister complications.

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