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Australasian College for Emergency Medicine

Media release (all except for the 14.40 presentation are embargoed until 12.01 am Sunday)
The Christchurch earthquakes, cardiac arrest following drug poisoning, superwarfarin poisoning, Monday morning fever, party drugs, and more. These issues will be discussed at the Winter Symposium of the Australasian College for Emergency Medicine being held in Queenstown, New Zealand, July 10-12.

Highlights for Sunday July 10
9.00 Dr John Fountain, medical toxicologist at the New Zealand National Poisons Centre
TOXINZ is an internet-accessible clinical poisons information database developed at the University of Otago, and widely used in New Zealand hospitals.
It provides rapid access to critical poisons information for doctors and other healthcare providers, containing up-to-date management information relating to almost 200,000 chemicals, chemical products, pharmaceuticals, plants, and hazardous creatures.
Following several user surveys, the website interface has been recently redesigned and will be demonstrated and released during the conference.
The new website is expected to improve doctor's access to poisons information in an emergency, thereby benefitting patients.

09.15 Professor Andis Graudins, Professor of Emergency Medicine and Clinical Toxicology Research at Monash University
Although cardiac arrest following drug poisoning is uncommon, it presents particular difficulties.
Poisoned patients are often younger, have healthier heart muscle, and fewer pre-existing health problems than those presenting in shock or cardiac arrest from other causes.
Patients may benefit from resuscitative measures that are over and above those recommended in standard resuscitation guidelines, including the use of toxin-specific antidotes, prolonged CPR, and/or other measures to bypass the poisoned heart muscle.
Expertise in toxicology will assist in decisions on when to withdraw active treatment in cardiac arrest or shock from known or suspected poisoning and ensure that all potential treatment options have been considered.

09.30 Dr Naren Gunja, clinical toxicologist at Westmead and Blacktown Hospitals in Sydney and Acting Medical Director of the NSW Poisons Centre in Sydney
Warfarin, an anticoagulant, is generally described as a “blood thinner”, although it does not affect the thickness or viscosity of blood. Instead, it acts on the liver to decrease the quantity of substances in the blood which allow it to clot.
It has been found effective in preventing blood clots in many disorders, including after heart attacks.
It was marketed initially as a pesticide against rats and mice and is still popular for this purpose although in a more potent form dubbed “superwarfarin”
Brodifacoum is a common superwarfarin ingredient in commercial rodenticides.
Toxicity from long-acting anticoagulant rodenticides is primarily from uncontrolled bleeding if left untreated.
There is very little published information on brodifacoum poisoning in humans, and management of such patients is contentious because of uncertainty over the dose, frequency, and duration of antidote treatment with vitamin K.
Dr Gunja will discuss the difficulties of treating superwarfarin poisoning.

9.45 Dr Paul Gee, emergency physician at Christchurch Hospital.
Party drugs are fast becoming a big part of youth culture not only in New Zealand but also in most Western countries.
They are not scheduled so are therefore legal by default.
They are sold in many retail outlets and over the internet often without any restriction.
Dr Gee will discuss the history of one of these – BZP – in New Zealand, and the range of currently available unscheduled party drugs.

11.15 Dr Grant Cave, emergency physician and intensivist at Hutt Hospital in Wellington.
For 10 years, Dr Cave has been researching the use of intravenous lipid emulsions as an antidote to drug poisoning.
His research collaborative has over 20 publications in this area, including in the Annals of Emergency Medicine and editorials in Critical Care Medicine and Anesthesiology.
The researchers have also contributed to a guideline for the Anaesthesia Association of Great Britain and Ireland.
His conference address, titled “Chewing the fat”, will provide a history of this treatment and focus on possible new directions for this area.
At 3 pm, the conference will conduct a debate on intralipid treatment.

11.30 Associate Professor David Reith, clinical pharmacologist and toxicologist and also paediatrician at the Dunedin School of Medicine
Should children with suspected poisoning be treated as little adults? Associate Professor Reith will argue that this question should be answered by yes and no.
The approach to children with suspected poisoning differs from that for adults because of different reasons for the poisons exposure, the unreliability of the history of exposure, differences in normal physiological values, and differences in the rate of elimination of toxins.
However, the mechanisms of toxicity are similar, and some of the treatments can be adjusted on the basis of size.

14.40 Dr Anselm Wong, Emergency Department, Austin Hospital, Melbourne
Monday morning fever” – metal fume fever – is a persisting problem, despite changes in modern-day work practices. And in the home or students doing metal work are at great risk.
First described in 1822, it is a disease which may have been forgotten by GPs and ED doctors but is well known to toxicologists.
Dr Anselm Wong and colleagues from the Emergency Department at Melbourne’s Austin Hospital and Victorian Poisons Information Centre analysed all metal fume fever-related calls to the Victorian Poisons Information Centre between June 2005 and December 2010.
They found 85 reported exposures, mostly in males (82 – 96% of cases).
Almost all (84 – 99%) of these calls were about adults.
Most (81 – 95%) of the callers reported symptoms occurring within 24 hours, and 53% of the exposures occurred in the workplace.
The most frequent days of exposure with symptoms were Monday (20 – 24%) and Tuesday (18 – 21%).
The most common symptoms were fever, headache, and chills.
All of the calls were people involved in welding metal, zinc being the most common (38%).
The researchers concluded that metal fume fever may still be a public health issue and potentially an indicator of poor work place practices.
Chronic respiratory disease is the fourth leading cause of death of Australasians and this study is an indicator that further efforts are required to ensure safe workplace practice and minimise potentially harmful exposures.
“In the workplace, prevention is the key to this disease – such as avoidance of direct contact with toxic metal fumes, improved engineering controls including exhaust ventilation systems, personal protective equipment such as respirators, and education of workers on the features of the disease.
“However, people in the workshop at home or students doing metal work may not have access to all of these.”

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