Emergency Medicine and Clinical Toxicology

Southern Health and Monash University Emergency Medicine and Clinical Toxicology Research Group Projects for B Med Sci and Honours Students

Background

The Southern Health Emergency Medicine Research Group is coordinated by Professor Andis Graudins and comprise of medical, nursing and allied health researchers affiliated with the Southern Clinical School of Monash University and the three hospital campuses of the Southern Health Emergency Medicine Program (Monash Medical Centre, Dandenong Hospital and Casey Hospital). Research interests of the group are wide-ranging both in the areas of clinical research in emergency medicine, and toxicology as well as applied basic-science research in various aspects of clinical toxicology.
Specific projects for 2012 Academic year are based at a number of sites. Clinical projects are offered at all of the Southern Health Emergency Departments. Laboratory research is also possible in toxicology research in a dedicated laboratory in the Department of Pharmacology at Monash University, Clayton campus.

Toxicology Projects

1. Development of an animal model of oral drug toxicity to assess the effectiveness of intravenous lipid emulsion (ILE) therapy in the reversal of cardiovascular toxicity of lipophilic drugs implicated in severe human poisoning.
   
   ILE therapy has been touted as a novel antidote in severe CVS toxicity resulting from lipophilic drug poisoning. Several animal studies have suggested a positive effect when toxins are administered intravenously. Human case report data is not as compelling in the degree of effectiveness of this therapy. Using an established animal model, this project aims to investigate whether the effectiveness of ILE is less significant in a controlled environment of oral poisoning than that seen with intravenous toxin administration utilising a range of drugs implicated in human poisoning.
   
   

   Site:	Toxicology Laboratory in Department of Phamacology, Monash Clayton Campus
   Supervisor:	Professor Andis Graudins

   
   
2. A retrospective review of digoxin poisoning and Digoxin Fab antibody use at Southern Health hospitals
   
   Supratherapeutic digoxin concentrations are not an uncommon finding in elderly patients presenting to the ED with a multitude of medical problems. Many patients exhibit signs of digoxin toxicity. This chart review aims to correlate the incidence of symptomatic patients with elevated digoxin concentrations and define the appropriateness of use of digoxin specific Fab antibodies in patients with increased serum digoxin concentrations and suspected digoxin toxicity.
   
   

   Site:	Emergency Department, Monash Medicial Centre, Clayton, ED
   Supervisor:	Professor Andis Graudins

Emergency Medicine Projects

1. Qualitative study on what factors influence patients' decisions to present to the Emergency Department (ED) with Stroke.
   
   The treatment time to maximize survival or morbidity from acute stroke is known as the door to thrombolysis time, which measures the time it takes for the occluded artery to be opened up by the administration of tissue plasminogen activator, a thrombolytic agent. This time frame is less than 4.5 hours. From previous research it has been shown that only a small proportion of patients present to the ED within this time frame. In this study we will interview people when they arrive in the Emergency Department and determine what key decisions the patient and/or their family made prior to arrival and what influenced the decisions they made. This data will support a wider range of research we are undertaking with the National Foundation to evaluate and inform behavior of patients having a stroke.
   
   

   Contact:	Professor Andis Graudins
   Supervisors:	Professor George Braitberg and Associate Professor Ian Mosely
   Site:	Emergency Department, Monash Medicial Centre, Clayton, ED

   
   
2. The development and implementation of a ‘real time' adverse event monitoring system in the emergency department.
   
   The Emergency Department, with its large undifferentiated patient load, high staff numbers with varying levels of experience, long hours and frequent interruptions is likely to have the highest rate of adverse events within a hospital. Despite this concern, research in ED adverse events is lacking, which means that evidence based planning of corrective interventions is almost impossible. The development of an adverse event monitoring system will be followed by appropriate data analysis and preparation of a report which
   will explore the nature of some possible interventions to reduce identified types of adverse events.
   
   

   Contact:	Professor Andis Graudins
   Supervisor:	Dr Robert Meek/Professor Andis Graudins
   Site:	Dandenong Hospital ED

   
   
3. Evidence-based analgesia in the emergency department:
   
   
   1. An assessment of intranasal ketamine as primary analgesia for adults with moderate to severe pain in the ED - a prospective observational study
      
      Ketamine is a potential alternative analgesic agent to opioids in moderate to severe pain. To date, there is little controlled evidence assessing the efficacy of ketamine in emergency department acute pain scenarios. This project utilises sub-anaesthetic doses of intranasal ketamine in an assessment of reduction of pain scores and patient satisfaction in adult patients with moderate to severe pain.
      
      

      Contact:	Professor Andis Graudins
      Supervisors:	Professor Andis Graudins Dr Diana Egerton-Warburton Associate Professor Ed Oakley
      Site:	Adult Emergency Department MMC, Clayton

   2. Intranasal ketamine in paediatric musculoskeletal injury pain - dose-finding study
      
      Ketamine is a potential alternative analgesic agent to opioids in moderate to severe pain. To date, there is little controlled evidence assessing the efficacy of ketamine in emergency department acute pain scenarios. In paediatric patients, the optimal dose of intranasal ketamine resulting in analgesia without marked sedation is not well characterised. This study utilises an observational sequential dose-finding methodology in assessing the most effective dose of IN ketamine not resulting in sedation in moderate to severe musculoskeletal pain in the ED.
      
      

      Contact:	Professor Andis Graudins
      Supervisors:	Professor Andis Graudins Associate Professor Ed Oakley Dr Diana Egerton-Warburton
      Site:	Paediatric Emergency Department MMC, Clayton

   3. An assessment of three oral analgesic regimens in the treatment of moderate pain from musculoskeletal injuries in adult patients in the emergency department
      
      Current analgesic guidelines suggest that patients with moderate pain should have an opioid analgesic included in their medication regimen. Oxycodone is suggested over codeine given that it does not need to be metabolised to gain analgesic effectiveness and also because a significant proportion of patients given codeine are poor metabolisers of this drug. However, some studies suggest that many patients respond well to simple analgesia with paracetamol and ibuprofen alone. This study examines the effectiveness of three drug regimens in the treatment of moderate pain in a double-blind randomised controlled fashion.
      
      

      Contact:	Professor Andis Graudins
      Supervisors:	Dr Alastair Meyer Professor Andis Graudins
      Sites:	This is a cross campus study at all three Southern Health emergency departments. Study is based at MMC, Clayton and Casey Hospitals