https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:14461 Wed 11 Apr 2018 16:21:58 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:14505 Wed 11 Apr 2018 15:19:38 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:14507 1.5) in Russell’s viper envenoming, the specificity of negative WBCT20 in non-envenomed patients and directly compared paired WBCT20 and INR. Results: Admission WBCT20 was done in 140 Russell’s viper bites with coagulopathy and was positive in 56/140 [sensitivity 40% (95% confidence interval (CI): 32–49%)]. A negative WBCT20 led to delayed antivenom administration [WBCT20−ve tests: median delay, 1.78 h (interquartile range (IQR): 0.83–3.7 h) vs. WBCT20 + ve tests: median delay, 0.82 h (IQR: 0.58–1.48 h); P = 0.0007]. Delays to antivenom were largely a consequence of further WBCT20 being performed and more common if the first test was negative (41/84 vs. 12/56). Initial WBCT20 was negative in 9 non-envenomed patients and 48 non-venomous snakebites [specificity: 100% (95% CI: 94–100%)]. In 221 paired tests with INR > 1.5, the WBCT20 was positive in 91(41%). The proportion of positive WBCT20 only increased slightly with higher INR. Conclusions: In clinical practice, the WBCT20 has low sensitivity for detecting coagulopathy in snake envenoming and should not over-ride clinical assessment-based decisions about antivenom administration. There is an urgent need to develop a simple bedside test for coagulopathy in snake envenoming.]]> Wed 11 Apr 2018 11:31:16 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:4914 20% was only 10%. In 55 patients with systemic effects, these improved in 58% after IV antivenom vs. 65% after IM antivenom (-8%; 95% CrI: -32% to +17%). Twenty-four hours after antivenom pain had improved in 84% in the IV group vs. 71% in the IM group (+13%; 95% CrI: -2% to +27%). A meta-analysis including data from a previous trial found no difference in the primary outcome between IV and IM administration. Discussion: The difference between IV and IM routes of administration of widow spider antivenom is, at best, small and does not justify routinely choosing one route over the other. Furthermore, antivenom may provide no benefit over placebo.]]> Sat 24 Mar 2018 10:14:08 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7749 Sat 24 Mar 2018 08:41:50 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7361 100) occurred on 44 occasions (56%) and hypotension only twice. There were no seizures, dysrhythmias or deaths. Multivariate analysis of 215 presentations (in 181 patients) where dose of promethazine ingested was known demonstrated that dose, administration of charcoal within 2 h and co-ingestants predicted whether patients developed delirium. No relationship was shown for sex and age. A plot of probability that a patient will develop delirium vs. dose was constructed which showed the probability of delirium for 250 mg was 31%, 500 mg was 42% and for 1 g was 55% for promethazine alone overdoses. Conclusion: The main feature of promethazine toxicity is delirium, the probability of which can be predicted from the dose ingested. The administration of charcoal and the presence of co-ingestants appears to reduce the probability of delirium in a predictable manner.]]> Sat 24 Mar 2018 08:40:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7112 Sat 24 Mar 2018 08:34:11 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:1442 24 h. Of these, only 6 (11%) received antivenom. One severe neurotoxic envenoming by an Australian funnelweb spider required antivenom. No definite spider bites resulted in necrotic ulcers (0%, 99%CI 0–0.7%). There were no early allergic reactions and secondary infection occurred in seven cases (0.9%, 95%CI 0.4–1.9%). Circumstances and early clinical effects were strongly associated with taxonomic spider identification, with positive predictive values >0.95 for common groups of spiders. Conclusions: Australian spider bite caused minor effects in most cases and is unlikely to cause necrotic ulcers, allergic reactions or infection. Redback spider bite (widow spider) caused prolonged pain, and antivenom could have been used more frequently. The circumstances and early clinical features of spider bites may allow early appropriate advice and treatment of spider bite without taxonomic identification.]]> Sat 24 Mar 2018 08:28:07 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:2481 38°C were universal in such patients; these features were therefore added. Using these seven clinical features, decision rules (the Hunter Serotonin Toxicity Criteria) were developed. These new criteria were simpler, more sensitive (84% vs. 75%) and more specific (97% vs. 96%) than Sternbach’s criteria. DISCUSSION: These redefined criteria for serotonin toxicity should be more sensitive to serotonin toxicity and less likely to yield false positives.]]> Sat 24 Mar 2018 08:27:43 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:5476 Sat 24 Mar 2018 07:47:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:25285 Sat 24 Mar 2018 07:38:12 AEDT ]]>