Toxicological seizures: characteristics, outcomes and recurrence.

Introduction: Seizures are a marker of severe toxicity following overdose. Research characterising toxicological seizures is limited. We aim to study toxicological seizures, causative agents, and recurrence.

Life-threatening anaphylaxis following antivenom administration in two patients with horse dander allergy.

Introduction: Antivenom is used to treat systemic envenomation and is immunoglobulin G raised from animals, mainly horses, inoculated by venom.

Methods: We report two cases of life-threatening anaphylaxis following the administration of antivenom in patients with known horse dander allergy.

Results: A 14-year-old boy presented with redback spider envenomation.

Application-Based Education for Corneal Foreign Body Removal in an Emergency Medicine Residency.

Study Objective: To assess whether Emergency Procedures App (EPApp) use among emergency physicians improves knowledge and skill in performing corneal foreign body removal compared with usual practice.

Methods: This single-blinded, multicenter, randomized trial involved emergency physicians assessing their knowledge and performance in corneal foreign body removal. Participants were randomized into 2 groups (crossover and EPApp) and completed written and procedural assessments.

Loperamide-induced severe cardiotoxicity: a toxicokinetic and toxicodynamic analysis derived from a case series and the published literature.

Introduction: Chronic loperamide overdose is associated with cardiotoxicity. We describe the toxicokinetics of loperamide and N-desmethyl loperamide, and their concentration-response relationship on cardiotoxicity in newly described and published cases.

Materials And Methods: We obtained serial loperamide and N-desmethyl loperamide concentrations, and corresponding electrocardiographic intervals in three episodes (two patients) of loperamide-related cardiotoxicity.

Paracetamol (acetaminophen) poisoning; consensus definitions of poisoning types and outcomes to be used in the clinical toxicology recommendations collaborative systematic review.

Introduction: Paracetamol (acetaminophen) poisoning is common, and many publications describe various outcomes and treatments. As internationally agreed definitions are non-existent to describe patterns of paracetamol overdose (acute, repeated supratherapeutic, chronic, or staggered), it is difficult to analyze outcomes between studies. The Clinical Toxicology Recommendations Collaborative was tasked to provide guidance on the management of paracetamol poisoning and formed the Paracetamol Workgroup.

High dose insulin is an inodilator, not an antidote in the poisoned patient!

High dose insulin therapy has become an increasingly popular treatment for poisonings over the last two decades. It is often mistakenly considered an antidote for poisonings of multiple drug classes, including beta-blocker and calcium channel blocker overdose. This misconception has encouraged overzealous and, at times, inappropriate use, particularly in patients who have vasoplegic shock following poisonings from drugs such as dihydropyridine calcium channel blockers.

Clinical effects of acute lamotrigine overdose (ATOM-10).

Introduction: Lamotrigine overdose is not typically associated with severe toxicity. However, both severe toxicity and serotonin toxicity is occasionally reported following large ingestions. We aimed to investigate the clinical effects of lamotrigine overdose.

Early cardiovascular collapse after envenoming by snakes in Australia, 2005-2020: an observational study (ASP-31).

Objectives: To investigate the frequency, timing, and characteristics of cardiovascular collapse after snakebite in Australia, and the complications of collapse following envenoming.

Study Design: Observational study; analysis of prospectively collected demographic and clinical data.

Setting, Participants: People with confirmed snake envenoming recruited to the Australian Snakebite Project at one of 200 participating Australian hospitals, 1 July 2005 - 30 June 2020.

A prospective study of acute propranolol overdose defining dose thresholds of severe toxicity (ATOM - 9).

Introduction: Propranolol is a beta-adrenoceptor blocking drug with sodium channel-blocking properties that can cause life-threatening toxicity in overdose. Limited research defines dose thresholds of toxicity. We aimed to investigate propranolol overdose and dose thresholds for severe toxicity.

Real world delays in antivenom administration: patient, snake or hospital factors (ASP-33).

Objective: Early antivenom administration is essential for effective treatment. We investigated the delays in antivenom administration.

Methods: We reviewed snakebites from the Australian Snakebite Project (2006-2021) given antivenom, presenting to hospital within 12 h.

Experience, knowledge, practices and attitudes of emergency department medical staff regarding teledermatology.

Objectives: The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology.

Methods: Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia).

Results: Seventy-nine staff completed the questionnaire.

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Serotonin syndrome (toxicity), resulting from an excessive accumulation of serotonin in the central nervous system, it can occur due to various factors such as the initiation of medication, overdose or drug interactions. Diagnosing serotonin toxicity presents challenges as there are no definitive criteria. This review delves into the pathophysiology, incidence, clinical assessment and management of serotonin toxicity, stressing the significance of promptly recognizing and managing severe cases.

Cognitive impairment following sedative overdose.

Introduction: Patients with sedative overdose may have residual cognitive impairment at the time they are deemed medically cleared for discharge. Impairment could affect the performance of high-risk activities, including driving. The Trail Making Test is an alpha-numeric assessment that can be performed at the bedside to assess cognitive function.

Rivastigmine for the management of anticholinergic delirium.

Introduction: Anticholinergic agents are commonly taken in overdose, often causing delirium. The spectrum of anticholinergic delirium ranges from mild agitation to severe behavioural disturbance. Physostigmine is an effective treatment for anticholinergic delirium, but its availability is limited.

Evaluating Clinical Prediction Rules for Bacteremia Detection in the Emergency Department: A Retrospective Review.

Background: Bacteremia is a major cause of morbidity. Blood cultures are the gold standard for diagnosing bacteremia.

Objective: To compare previously published clinical decision rules for predicting a true positive blood culture (bacteremia) in the emergency department.

Intestinal injury in paracetamol overdose (ATOM-8).

Background And Aim: Paracetamol, a widely used medication, is known for its delayed hepatotoxicity in cases of overdose. However, the potential for intestinal toxicity resulting from very high paracetamol concentrations during absorption is not well explored. This study aims to investigate the presence of intestinal toxicity and its correlation with observations in early and late paracetamol toxicity.

Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model.

Study Objective: Button battery ingestion can cause alkaline esophageal injury. There is interest in first-aid household products to neutralize the injury. The objective was to investigate which household products are effective at reducing button battery injury.