Ketamine as a rescue treatment for severe acute behavioural disturbance: A prospective prehospital study.

Objective: Rapidly and safely managing severe acute behavioural disturbance (ABD) in the prehospital setting is important for the welfare of both patient and prehospital clinician alike. We investigated the safety and effectiveness of ketamine as rescue sedation in patients with severe ABD.

Methods: This prospective observational study investigated ketamine use by a state ambulance service as rescue sedation for patients with severe ABD who remained agitated following droperidol administration.

Prospective study of the safety and effectiveness of droperidol in elderly patients for pre-hospital acute behavioural disturbance.

Objective: Acute behavioural disturbance in the elderly (≥65 years) is a significant issue for emergency medical services with increasing prevalence of dementia and aging populations. We investigated the pre-hospital safety and effectiveness of droperidol in the elderly with acute behavioural disturbance.

Methods: This was a pre-hospital prospective observational 1-year study of elderly patients with acute behavioural disturbance.

Use of a tablet-based application for clinical handover and data collection.

Inpatient toxicology services undertake remote as well as inpatient management of poisoned patients. The aim of this study is to describe the introduction of a tablet-based electronic data collection tool allowing data to be captured on inpatient and remote consultations. Retrospective review of all cases entered in the database from 1 March 2014 to 28 February 2016.

One single large intramuscular dose of naloxone is effective and safe in suspected heroin poisoning.

Objective: Naloxone is an established antidote for the treatment of heroin poisoning; however, dosing regimens vary widely, with a current trend towards small titrated intravenous dosing. This study aims to characterise naloxone use in the treatment of patients presenting with suspected heroin poisoning.

Methods: This was a retrospective review of poisoned patients presenting to a clinical toxicology unit in Brisbane from January 2015 to December 2017.

Neurotoxicity in chronic lithium poisoning.

Background: Lithium-induced neurotoxicity typically occurs with chronic accumulation rather than following acute overdose. There is little emphasis in the literature on the protracted nature of lithium neurotoxicity long after the lithium concentration returns to the therapeutic range.

Aims: To characterise lithium neurotoxicity, with a view of increasing awareness of this important phenomenon.

Methamphetamine presentations to an emergency department: Management and complications.

Objective: There is little recent published data characterising methamphetamine intoxication. The present study aims to describe the clinical effects, management, complications and disposition of patients with methamphetamine exposure.

Methods: This is a retrospective review of patients presenting with methamphetamine intoxication to an ED in 2016.

Clinical outcomes from early use of digoxin-specific antibodies versus observation in chronic digoxin poisoning (ATOM-4).

In our previous study on chronic digoxin poisoning, there was a minor improvement after treatment with digoxinspecific antibody (digoxin-Fab). We hypothesised patients with elevated digoxin concentrations may derive little benefit from digoxin-Fab because their presenting complaint was more closely related to their multiple co-morbidities. We aimed to compare the outcome of patients who were initially treated with digoxin-Fab with those that received supportive care.

A Prospective Study of the Safety and Effectiveness of Droperidol in Children for Prehospital Acute Behavioral Disturbance.

Although uncommon, children (<16 years) with acute behavioral disturbance are a significant issue for emergency medical service providers. In this study, we aimed to investigate the safety and effectiveness of droperidol in children with prehospital acute behavioral disturbance. This was a prospective observational study over 1 year investigating the use of droperidol (0.

Acute bone marrow suppression and gastrointestinal toxicity following acute oral methotrexate overdose.

Objective: Acute methotrexate overdose rarely causes systemic toxicity due to saturable absorption and rapid renal elimination. We present a case of methotrexate toxicity following acute overdose.

Case Report: A 56-year-old female presented soon after an overdose of 1250 mg of methotrexate, zopiclone and tramadol.

A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance.

Study Objective: Acute behavioral disturbance is a common problem for emergency medical services. We aimed to investigate the safety and effectiveness of droperidol compared to midazolam in the prehospital setting.

Methods: This was a prospective before and after study comparing droperidol to midazolam for prehospital acute behavioral disturbance, when the state ambulance service changed medications.

Modified release paracetamol overdose: a prospective observational study (ATOM-3).

Background: Modified-release (MR) paracetamol is available in many countries as 665 mg tablets of which 69% is MR and 31% is immediate release. There are concerns that MR paracetamol overdose has higher rates of liver injury despite standard treatment algorithms. The objective of this study was to describe the clinical characteristics and outcomes of acute MR paracetamol overdose.

The safety of high-dose insulin euglycaemia therapy in toxin-induced cardiac toxicity.

Context: High-dose insulin euglycaemia (HIE) is recommended in the management of toxin-induced cardiac toxicity, with increasing insulin doses now being used. We aimed to investigate the safety of HIE in toxin-induced cardiac toxicity.

Methods: This was a retrospective review of cases from two clinical toxicology units.

2-Methyl-4-chlorophenoxyacetic acid (MCPA) and bromoxynil herbicide ingestion.

Context: Ingestion of bromoxynil and 2-methyl-4-chlorophenoxyacetic acid (MCPA) in combination is associated with high mortality. Toxicity is characterised by hyperthermia and metabolic acidosis. Dialysis is a proposed treatment, but little data exist regarding its effectiveness.

The Australian Snakebite Project, 2005-2015 (ASP-20).

Objective: To describe the epidemiology, treatment and adverse events after snakebite in Australia.

Design: Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation.

Massive paracetamol overdose: an observational study of the effect of activated charcoal and increased acetylcysteine dose (ATOM-2).

Context: Paracetamol is commonly taken in overdose, with increasing concerns that those taking "massive" overdoses have higher rates of hepatotoxicity and may require higher doses of acetylcysteine. The objective was to describe the clinical characteristics and outcomes of "massive" (≥ 40 g) paracetamol overdoses.

Methods: Patients were identified through the Australian Paracetamol Project, a prospective observational study through Poisons Information Centres in NSW and Queensland, over 3 and 1.

Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days.

Objective: This study evaluates the effect on the average length of stay (LOS), relative stay index (RSI), bed days and costs saved following the establishment of a dedicated clinical toxicology unit in an Australian tertiary referral hospital.

Methods: This retrospective descriptive study uses Health Roundtable and other state and federal data to compare the average LOS, RSI, estimated bed days and costs saved by patients admitted with a diagnosis-related group (DRG) of X62 (Poisoning/Toxic Effects of Drugs and Other Substances), over the 4 year period 2012-2015. This period corresponds to before and after the introduction of the clinical toxicology unit in February 2014 at the Princess Alexandra Hospital, a tertiary referral teaching hospital in Brisbane, Queensland, Australia.

Self-poisoning by older Australians: a cohort study.

Objective: To examine the epidemiology and severity of self-poisoning by older people in Australia; to compare these data with those for overdoses in younger adults.

Design, Setting, Participants: A cohort study of people presenting to a tertiary toxicology centre after self-poisoning over 26 years (1987-2012).

Main Outcome Measures: Hospital length of stay (LOS); types of drug ingested; intensive care unit (ICU) admissions; in-hospital deaths.

Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity.

Context: There are limited reports of adult clonidine overdose. We aimed to describe the clinical effects and treatment of clonidine overdose in adults.

Methods: This was a retrospective review of a prospective cohort of poisoned patients who took clonidine overdoses (>200 μg).

Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department.

Study Objective: We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation.

Methods: This was a prospective study of patients given ketamine for sedation who had failed previous sedation attempts. Patients with severe acute behavioral disturbance requiring parenteral sedation were treated with a standardized sedation protocol including droperidol.

Cardiovascular toxicity with levetiracetam overdose.

Objective: To describe the cardiovascular toxicity and pharmacokinetics of levetiracetam in overdose.

Case Report: A 43-year-old female presented 8 h post ingestion of 60-80 g of levetiracetam with mild central nervous system depression, bradycardia, hypotension and oliguria. Her cardiovascular toxicity transiently responded to atropine and intravenous fluids.

A prospective observational study of a novel 2-phase infusion protocol for the administration of acetylcysteine in paracetamol poisoning.

Context: The current 3-phase acetylcysteine infusion for paracetamol poisoning delivers half the dose over 15-60 min and frequently results in adverse reactions.

Objective: We aimed to determine adverse reaction frequency with a modified 2-phase infusion protocol with a longer initial infusion.

Materials And Methods: A prospective observational study of a modified 2-phase acetylcysteine protocol was undertaken at two hospitals.