Metal fume fever is a relatively uncommon presentation to the emergency department. Resulting from inhalation of metal oxides, it presents as an acute, self‐limiting, flu‐like symptom complex often misdiagnosed as a viral illness. We report a case of a 26‐year‐old male presenting with metal fume fever 4 h after oxycutting galvanized steel. The literature is reviewed with respect to pathogenesis, the common presenting symptom complex, investigations and current accepted management of metal fume fever.

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Intrathecal baclofen administered by bolus or continuous infusion has been shown to be of benefit in the treatment of spinal spasticity.Reporting of complications has been limited, particularly in the emergency medicine literature. Reports have been primarily associated with clinical trials.We report a case of intrathecal baclofen overdose in a patient presenting to the emergency department with an altered level of consciousness and cardiorespiratory depression, who required mechanical ventilation, fluid resuscitation and intensive care admission.The literature is reviewed with respect to the action and effectiveness of intrathecal baclofen, use of the relevant implantable devices, suggested methods of management in overdose and the other reported complications from this treatment modality. Case reportA 46 year old male presented to the emergency department by ambulance with a decreased level of consciousness (Glascow Coma Score [GCS] of eight), one hour after injection of baclofen into an intrathecal pump.He was a T9 paraplegic following a knife injury five years previously. An intrathecal baclofen pump (Infusaid®, Medical Specialties Ltd) had been inserted three years earlier to help control se\'ere leg pain from muscle spasm.A swelling had been noted over the pump site 24 hours pre\'iously and had been < U

ObjectiveTo describe the clinical interventions undertaken by retrieval physicians during interhospital transfer between different hospital types and discuss the implications for staff training. MethodCase sheets from all interhospital transfers undertaken by the Sydney Aeromedical Retrieval Service for the 1995 calendar year were analysed retrospectively. Clinical interventions were categorised into airway management, invasive procedures, fluid resuscitation and drug therapy. Each category was then reviewed according to the functional level of the referring hospital. ResultsA total of 577 interhospital transfers occurred during this period. Two hundred and fifty eight (44.7%) patients transported required at least one clinical intervention. A total of 421 interventions were made. Of the 421 interventions performed 43% were classified as drug therapy, 34.4% as invasive procedures, 13.3% as fluid resuscitation and 9.3% as airway management. The overall intervention rate for those patients transported from tertiary hospitals was 0.31, for other metropolitan hospitals 0.78, for rural base hospitals 0.70 and for other rural hospitals 1.06. ConclusionThose physicians with advanced training in critical care medicine are most suited to the requirements of retrieval medicine. Patients from smaller hospitals have a greater likelihood of requiring intervention by the retrieval physician.