Abstract:The association between air travel and pulmonary embolism (PE) is recognized, but the absolute risk has not been quanti ed. Due to its geographical isolation, more than 50% of international travelers arrive at Sydney airport after a ight of at least 9 hours. Patients who become acutely unwell upon disembarkation are taken to one of two hospitals. In this study we reviewed the presentations at these two hospitals. A retrospective analysis of all patients presenting to the emergency departments (ED) directly from Sydney International Airport with symptomatic PE over a three-year period was undertaken. Over 36 months, 17 patients were admitted from Sydney International Airport to the ED with acute PE. All patients had own for at least 9 hours. Seven patients had risk factors for thromboembolic disease. During the period of our review 6.58 million passengers arrived in Sydney on ights of at least 9 hours in duration, representing an incidence of 2.57 per million. In conclusion, the incidence of acutely symptomatic PE in association with long distance air travel is low and the majority of patients survive following hospital presentation.

A 44‐year‐old man suffered a life‐threatening anaphylactoid reaction to polyvalent snake antivenom, although he had been given the recommended pretreatment. Further research is needed to determine if pretreatment is necessary.

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Objectives: To present a case of ruptured ectopic pregnancy with hypotension, shock and a negative qualitative BhCG. To retrospectively review patients admitted to a Sydney teaching hospital with ruptured ectopic pregnancy over a two year period. Clinical features: A 30 year old woman presented to the emergency department with severe abdominal pain. On arrival she was shocked, with tachycardia and hypotension. Qualitative BhCG was negative. Laparotomy revealed 2.5L of blood in the peritoneal cavity and a bleeding mass in the right fallopian tube. Pathology reported trophoblastic tissue in the wall of the tube. Review of cases: Of 180 patients admitted to Royal Prince Alfred Hospital with ectopic pregnancy, 37 were found to have ruptured at operation. No cases of ruptured ectopic pregnancy with a negative BhCG were found. Conclusion: This case, though rare, illustrates the fact that a negative serum BhCG neither excludes the diagnosis of ectopic pregnancy nor the possibility of life‐threatening tubal destruction and haemorrhage.