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Writing for publication

Essentials 1 Check and follow the journal’s suggested format and length. Pay particular attention to the abstract, text and references. 2 Make sure that the objectives, methods, results and conclusions are logically consistent. 3 Be clear and concise. Introduction Sharing of research findings through publication is an important way of improving clinical practice. Publication may be by an original research manuscript, systematic or narrative review, brief…

Research methodology

Essentials 1. Research projects should be designed and undertaken in a structured, predetermined fashion. 2. During the study design phase, assistance from a statistician is highly recommended. 3. The study protocol should be written in advance of data collection and adhered to throughout the project. 4. Most research mistakes relate to inadequate sample size calculations and selection bias in subject recruitment. 5. Research ethics issues are…

Marine injury, envenomation and poisoning

Essentials 1 The majority of marine-related presentations can be effectively managed with attention to basic life support (BLS) and the provision of supportive therapy. This includes aggressive analgesia and meticulous wound management. 2 Pain associated with barbed fish stings can sometimes be attenuated by immersion of the effected limb in warm water (up to 45°C). 3 Tropical jellyfish envenoming may be life threatening and require early…

Spider bite

Essentials 1 Australasia has a number of venomous spiders, but the majority of bites cause only minor problems. 2 Redback spider (a widow spider) bite is the most common cause of medically significant human envenoming in Australia. It can cause severe and persistent pain and, less often, systemic effects, but it is not life-threatening. 3 Australia appears to have the highest rate of widow spider envenoming…

Exotic snakebite

Essentials 1 Exotic snakebite is a growing issue worldwide, especially with the growth in illegally held snakes. 2 Symptoms and signs may be different to those seen in Australian snakebites. 3 As many non-Australian snakes, especially the vipers, cause local tissue destruction and damage, pressure bandage immobilization is not recommended. 4 Expert advice is available and recommended in managing these cases and helping locate antivenom. 5…

Snakebite

Essentials 1 Australia has a number of medically important venomous snakes. All are elapids (front-fanged). New Zealand has no snakes of medical importance. 2 All patients giving a history of possible snakebite should be assessed and observed for at least 12 hours to rule out envenoming. 3 Most fatalities occur within hours of the bite from initial cardiac arrest and multiorgan failure. Delayed deaths are now…

Oral anticoagulants

Essentials 1 In overdose, any of the oral anticoagulants will elevate the international normalized ratio (INR), although not always in a direct dose-dependent manner. 2 Activated charcoal decreases the absorption following the ingestion of apixaban and is probably also effective following the ingestion of warfarin, dabigatran and rivaroxaban. 3 There are clear guidelines for the management of warfarin anticoagulation and these should continue to be followed.…

Opioids

Essentials 1 Opioid toxicity is characterized by respiratory depression, decreased level of consciousness and miosis. 2 The mainstay of treatment of opioid toxicity is naloxone and good supportive care. 3 Many opioid agents can have other toxic effects; for example, tramadol may cause seizures, methadone causes QT prolongation and dextropropoxyphene causes QRS widening. 4 Opioid exposure in children can result in significant morbidity and mortality. Introduction…

Chloroquine

Essentials 1 In overdose, chloroquine is a highly toxic drug with a high mortality rate. 2 Cardiac toxicity occurs early and may manifest before arrival at hospital. 3 Good supportive care and the use of adrenaline are the principles of management. 4 Expert advice on management from a toxicologist should be sought at an early stage. 5 All deliberate self-poisonings require hospital admission and cardiac monitoring…

Toxidromes

Essentials Anticholinergic (anti-muscarinic) toxic syndrome Anticholinergic toxic syndrome (ACTS) occurs as a result of the blockade of post-synaptic muscarinic receptors and/or a reduction or inhibition of cholinergic transmission at muscarinic receptor sites by drugs. Serotonin toxicity Clonus (spontaneous, inducible and ocular) can be diagnostic of serotonin toxicity (ST) once a serotonergic agent ingestion/toxicity has been identified. 1 The interaction of selective serotonin reuptake inhibitors (SSRIs) with…

Hymenoptera stings

Essentials 1 Hymenoptera strings are responsible for one or two deaths annually in Australia. 2 Hymenoptera venom is a common cause of allergy and anaphylaxis (∼3% of population). 3 Anaphylaxis is an absolute indication for venom immunotherapy. 4 Massive envenomation by bees and wasps can cause multi-organ involvement and death, although this is rare. 5 Mass envenomation does not appear to result from ant stings. Introduction…

Anticonvulsants

Essentials 1 Anticonvulsant overdose typically causes central nervous system effects, but other effects such as cardiotoxicity may be exhibited after the ingestion of certain agents. 2 Multiple doses of activated charcoal can reduce the duration of toxicity in carbamazepine and phenytoin toxicity. 3 Serum concentrations correlate with clinical toxicity in carbamazepine and phenytoin toxicity, guiding management in severe cases. 4 Depending on the agent, extracorporeal elimination…

Carbon monoxide

Essentials 1 Carbon monoxide is the commonest agent used in completed suicides by poisoning in Australia and the United Kingdom. 2 Carbon monoxide is produced by incomplete combustion and is found in car exhaust, faulty heaters, fires and in industrial settings. 3 Carbon monoxide poisoning may result in significant long-term neuropsychological sequelae. 4 Oxygen increases the elimination of carbon monoxide, and the extent of increase is…

Ethanol and other ‘toxic’ alcohols

Essentials 1 Ethanol is a major cause of morbidity, mortality and emergency department (ED) presentation in most Western societies. Presentations may result from acute intoxication, withdrawal or medical complications of chronic ethanol ingestion. 2 Ethanol causes central nervous system (CNS) depression that can be synergistic with other CNS depressants and can be life threatening without supportive care. 3 Ethanol withdrawal is commonly encountered in the ED…

Herbicides

Essentials 1 The mortality from acute paraquat poisoning is high owing to rapid multi-organ failure or delayed progressive pulmonary fibrosis. Ingestion of as little as one mouthful of 20% w/v solution is sufficient to cause death. No satisfactory treatment exists. 2 The toxic component of glyphosate-containing herbicides appears to be the surfactant co-formulant or its salt. The mechanism of toxicity is not confirmed, but severe poisoning…

Pesticides

Essentials 1 Acute pesticide poisoning is an important cause of morbidity and mortality worldwide, in particular in the Asia-Pacific region. 2 Existing systems for classifying the toxicity of pesticides are imperfect, whereby the toxicity of even ‘slightly hazardous’ pesticides is sometimes significant. Moderate-to-highly toxic pesticides may have a case-fatality rate of between 5% and 70% in patients with self-poisoning. 3 In addition to the pesticide constituent,…

Hydrofluoric acid

Essentials 1 Patients and medical staff are often unaware of the presence of hydrofluoric acid (HF) in household cleaning products. 2 Topical HF exposures may result in the gradual onset of severe local pain out of proportion to objective clinical signs. 3 Dermal exposures should be irrigated immediately and copiously. 4 Symptomatic dermal exposures should be treated with topical calcium. If pain persists, escalation to local…

Cyanide

Essentials 1 Cyanide is a metabolic poison associated with a high mortality. 2 Cyanide toxicity is characterized by rapid onset of central nervous, respiratory and cardiovascular effects and by metabolic acidosis. 3 Cyanide exposure correlates well with serum lactate levels. 4 Prompt resuscitative efforts with high-flow oxygen and administration of antidotes may be life saving; a number of alternative agents are available. 5 Cyanide poisoning from…

Drugs of abuse

Essentials 1 The diagnosis of intoxication with drugs of abuse is clinical. Good supportive care ensures optimal outcome in the majority of cases. 2 Predisposing factors for opioid-related deaths include co-ingestion of Central nervous system (CNS) depressant drugs, poor tolerance, high purity and reluctance to seek medical care. Naloxone is a useful adjunct in the management of airway and ventilation in opioid overdose. 3 Benzodiazepines are…

Iron

Essentials 1 Acute iron poisoning is a potentially life-threatening condition. 2 The risk of severe toxicity is determined by the dose of elemental iron ingested, not the weight of the iron salt. 3 Iron poisoning has both local (gastrointestinal) and systemic effects. 4 Early effective gastrointestinal decontamination with whole-bowel irrigation is important in the management of high-risk cases. 5 Chelation therapy with intravenous desferrioxamine is the…