The Utility of POCUS by Novice Clinicians in Diagnosing Heart Failure Project

Acutely decompensated heart failure is a significant cause of morbidity and mortality worldwide. In 2020-21, it is estimated that around 34,400 presentations to the emergency department were due to heart failure. One of the most common ways in which patients present to the Emergency Department with this end diagnosis is with acute dyspnoea secondary to acute pulmonary oedema. Traditionally, acute pulmonary oedema is detected using a combination of history, physical examination findings and Chest XR (CXR). The recent widespread availability and use of point of care ultrasound (POCUS) has drastically changed the way patients are assessed in the emergency setting. Delays in completing X-rays and awaiting formal laboratory results (such as BNP) can result in delays in the diagnosis and management of patients in acutely decompensated heart failure. POCUS offers a bedside alternative that may be able to fast track a patient’s assessment in the emergency department. This study aims to determine the utility of POCUS by novice ultrasound users, to assist in detecting acute pulmonary oedema and to assist with diagnosing acutely decompensated heart failure in the emergency department. The outcome of this study may support the widespread training of medical officers working in emergency departments in the use of POCUS for detecting acute pulmonary oedema. If proven to be non-inferior to CXR and BNP, POCUS LUS will have a significant impact on the way patients with acutely decompensated heart failure are assessed.

Research Capacity Building Grant – The Prince Charles Hospital

The proposed Research Capacity Building grant aims to increase participation in research, strengthen the research culture and ensure that research becomes core business within The Prince Charles Hospital Emergency Department (TPCH-ED). The strategic vision includes strengthening of systems and structures that enable researchers, both novice and experienced, across all disciplines to participate in high-leverage, practice-changing research activities, with a view to embedding a research culture into day-to-day practice. A core element is the strengthening of collaborations between departments, across disciplines and with other health facilities. The proposed strategy is the training of a group of research nurses to equip them with the foundation skills, knowledge, and preliminary experience to actively promote and support research in the department. The model is one of appointment of experienced clinical nurses, new to research roles, in part-time sequential appointments. Recruitment from existing ED workforce would be ideal, allowing retention of a substantive position which the researcher would return to after the research immersion. This would assist in embedding a research culture amongst clinical nurses and provide opportunity for continuation of research engagement on return to clinical duties. The expected benefit of this approach is that there will be a highly visible research focus within the ED, with multiple opportunities for engagement, underpinned by the premise that depth and breadth in a research group, rather than reliance on a few key individuals, is paramount. This proposal would ensure that research enthusiasm and knowledge is shared across a multidisciplinary group of dedicated individuals and retained within the organization.

Pharmacological Emergency management of Agitation in Children and Young People – randomised controlled trials of Oral and intraMuscular medication: PEAChY-O and PEAChY-M

Acute severe behavioural disturbance (ASBD) is an emergency situation where a patient experiences severe agitation or aggression. These individuals commonly present to the emergency department (ED) for treatment. Medications are often provided to assist the person to feel calmer. In most instances, oral medications are used. When the patient is extremely agitated, an intramuscular (IM) injection will be given.

In individuals less than 18 years, there is minimal available evidence to guide doctors about which medications work best. It is also not known how well these medications are tolerated by these young people. Therefore, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network is running two trials across a number of Australian EDs to create evidence to be used to guide the treatment for these young people.

The first study (PEAChY-O) compares two oral medications - olanzapine and diazepam - to determine which medication works better. The second study (PEAChY-M) compares two IM medications – olanzapine and droperidol. These medications were chosen because they are used as standard of care in Australian EDs and are recommended on current Clinical Practice Guidelines (CPGs). These are important studies because they will be the first trials to compare any medications head-to-head in a randomised trial across either the oral or IM routes.
Once the results are available, they will be used to guide future clinical practice including influencing the recommendations made in Australian guidelines, ensuring that these young people receive evidence-based treatments.

Capacity Building Grant – third year: The Prince Charles Hospital

This grant provides a 'third-year' extension of funding as part of a 2011 EMF Capacity Building grant awarded to The Prince Charles Hospital Emergency Department. With the Capacity Building grant, the Department has engaged in more than 20 research projects. The majority involve significant input from the Hospital's emergency clinicians, who are working in collaboration with other Queensland and interstate emergency department and/or academic institutions such as CSIRO.

STOPAsthmaQLD

Grass pollen is the major outdoor allergen globally and grass pollen exposure has an important measurable and manageable impact on the medical burden of asthma. We propose investigating the role of allergy status on triggers for asthma in patients visiting hospital emergency departments in two regions of south east Queensland over a two year period, coinciding with NHMRC and ARC funded environmental health research led by collaborator CI Davies.

Data on weather and pollen exposure will be integrated with direct assessment of specific IgE profiles and respiratory viral triggers of asthma. Patients, including children over 12 years, presenting with primary diagnosis of asthma to a major urban hospital in a subtropical region and rural hospitals in the temperate regions of the Darling Downs will be recruited with informed consent.

Outcomes of this study are expected to inform need for utilising local current pollen exposure information to manage emergency department demand surges and underpin better management of pollen allergies outside of hospital by allergy physician and general practice.

Adrenaline Delivery through Ventilation of Aerosolised Nanoparticles in Cardiac arrEst (ADVANCE Study)

Every second counts when a patient’s heart stops and critical to this is restarting the heart and maximising blood flow to the brain. Without adequate blood flow to the brain, eventual survivors can be left with a devastating brain injury and be forced to live for their remaining years with severely reduced quality of life. The rapid delivery of adrenaline to restore cardiac function and deliver blood to the brain is critical to improving survival. Current techniques for delivering adrenaline focus on cannulating a vein. This can take many of those crucial seconds and more frequently several minutes, as the collapsed veins post cardiac arrest are extremely difficult to find and access. If the cannula is successfully inserted, the lack of blood flow within them prevents rapid delivery of adrenaline back to the heart.

This research team is developing a device with the potential for safe, rapid adrenaline delivery directly to the lungs with each breath without the need for venous cannulation. This rapid delivery of adrenaline to the lungs, and subsequent absorption to the blood and then the heart, may change the outcome from a brain injury rendering a previously fit person unable to walk, to 100% recovery.

A randomised controlled trial of interventional versus conservative treatment of primary spontaneous pneumothorax

Primary spontaneous pneumothorax (PSP) is defined as a collapsed lung with air in the pleural cavity that occurs in the absence of clinically apparent underlying lung disease. PSP is a significant global health problem affecting adolescents and young adults. Throughout the 20th century the treatment of PSP was predominantly bed rest, with invasive treatment reserved for severely symptomatic episodes. A study in 1966 suggested that managing large and small PSP in the community was safe. Despite this, rates of intervention have steadily increased over the decades. The reasons for this are unclear and this approach has recently been questioned in the scientific literature. Preliminary data suggests that a conservative approach to management may allow faster healing and reduce the risk of recurrence from around 25 per cent to 5 per cent in the first year. Conservative management is also likely to reduce the risks of prolonged admission due to persistent leak from approximately 30 per cent to less than 10 per cent and of other complications related to interventional management. Clinicians are, however, unlikely to change a practice entrenched for decades and re-enforced by current international guidelines without robust evidence.

This study will significantly increase our understanding of Primary spontaneous pneumothorax and its optimal management. If allowing the lung to remain collapsed initially results in improved healing of the pleural defect and lower recurrence rates then this study will contribute to improve outcomes and a reduction in the morbidity associated with current treatment.