Decompression sickness (DCS), commonly called the bends, involves formation of gas bubbles in the body following scuba diving. These bubbles can cause a variety of problems, ranging from minor aches and pain, to severe stroke-like symptoms.
Providing pre-hospital oxygen therapy at the highest concentration possible provides needed oxygen to body tissues, reduces bubbles and can often relieve symptoms. Oxygen has been shown to reduce the number of hyperbaric treatments a diver with DCS will require so improving pre-hospital oxygen delivery will lead to decreased hospital costs. However, the ideal oxygen delivery system has not been determined.
Using new techniques and equipment, this research will identify the optimal device for delivering oxygen to divers with DCS leading to recommendations which will improve the health outcomes of injured divers. We will measure how effectively varied breathing devices deliver oxygen to the body tissues and remove bubbles from the diver’s blood while assessing innovative equipment. This study will assess a new commercially available oral mask to improve oxygen delivery with a demand system. A medical oxygen re-breather, which like an anaesthetic machine absorbs carbon dioxide and adds small amounts of oxygen to the breathing circuit, will be also assessed.
Assessing the use of these devices will not only determine their efficacy to deliver oxygen to injured divers but also provide guidance on appropriate systems to use for dive operators with limited medical oxygen. Assessing the change in bubble grade with oxygen delivery will add evidence for its use.
This research will provide information that can guide pre-hospital and emergency clinicians when choosing the type of oxygen delivery devices used for injured divers improving patient outcomes and decreasing costs.READ MORE
The aeromedical retrieval of acute psychiatric patients is a challenging scenario for the most experienced clinician. This is due to the potential for unpredictable behaviour among these patients, coupled with the inherent dangers of the aviation environment.
Chemical restraint is one of the accepted strategies in this environment to ensure patient and crew safety and to minimise patient distress. Benzodiazepines and antipsychotics have been the most commonly employed drugs for chemical restraint, although they are sometimes limited by adverse reactions and inadequate sedation endangering the safety of patient and health care providers. Consequently, there has been increasing interest in drugs like ketamine and propofol in patients where benzodiazepines and antipsychotics have been inadequate or unsafe. However, their adoption into routine clinical practice has been limited by a lack of good quality data about their safety and effectiveness.
In this study, we will compare the safety and effectiveness of ketamine and propofol in sedating acute psychiatric patients needing aeromedical retrieval. We believe that this is the first trial of its kind which will elucidate the complications, the safety profile and effectiveness of the two drugs in sedating acute psychiatric patients.
The study will be a prospective, open-labelled, randomised controlled trial. Patients will be drawn the Northern Territory and Queensland.
Through this study, we will better inform clinicians in their choice of a suitable sedation agent and potential provide an additional sedation choice in aeromedical and other critical care environments. Furthermore, this research has the potential to establish sedation guidelines in the aeromedical retrieval of acute psychiatric patients for Australia and internationally.READ MORE
Status epilepticus (SE) occurs when seizures do not stop spontaneously and can result in long-term disabilities and occasionally death. There is a paucity of high quality evidence on SE, particularly in children and causes and outcomes are different from adults. This programme of research on SE uses mixed methods to address this gap in knowledge. The research includes establishing a national registry of status epilepticus in children, identifying consensus research priorities amongst experts, and a qualitative evaluation of alternatives to informed consent (which is a potential barrier to prospective emergency research).READ MORE
The importance of good quality clinical trials in health care is being increasingly recognized worldwide. The London School of Hygiene & Tropical Medicine (LSHTM) is the leading postgraduate medical institution in Europe in the subjects of public health and tropical medicine.
The Master of Science in Clinical Trials, conducted online, aims to provide those with some experience in the area of clinical trials to broaden their role in design, management, analysis and reporting of clinical trials.
The first year of the course covers the core topics of; fundamentals of clinical trials, basic statistics for clinical trials, clinical trials in practice and reporting and reviewing clinical trials. Techniques, and methods learnt from the course will directly benefit the Emergency Department at Townsville and with emergency medicine research activities at the hospital and within the region.READ MORE
Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of bubbles and make symptoms worse before divers can access treatment. This study will determine if this is true – will bubbles actually be increased by the vibration associated with helicopter flight? If vibration does increase bubble formation, then in the future alternative strategies for transporting DCI patients can be implemented to reduce the risk to these patients. To ensure safety the vibration record of helicopter flight will be recorded and reproduced using a vibrating basket model. Healthy volunteers accompanying divers in the recompression chamber will be assessed with a special ultrasound to detect bubbles following the ‘dive’ and then placed in the vibrating basket. The number of bubbles present after this will be measured again. This study will help ensure safe transport of injured divers not just in Queensland but internationally. This global importance is represented in the research team, which includes members from both Canada and other Australian states, which are collaborating in a Queensland based study.READ MORE
Disasters have caused the loss of more than 12 million lives and affected more than 50 million people in the past 50 years alone. Disasters involve not just more patients, but a different type of patient in a system under extreme stress. Emergency Departments (ED), as the ‘front door’ to the health system are a key part of the disaster response and a well prepared ED is essential to save lives. Being prepared involves education and training however disaster health education is not well developed in Australia. The research program aim is the development of a disaster education framework for the health workforce in Australia. This framework will incorporate learning needs and identify strategies to meet them in a manner which is both cost and outcome effective. A key outcome will be development and evaluation of a post graduate qualification in disaster health consistent with this framework. The current state of education in disaster health in Australia will be reviewed including a comparison of strategies used, relative effectiveness and barriers to success. Common problems will be identified from literature and Australian experience to help target educational priorities. This will include ED and Australian teams deployed overseas, many of whom were ED staff. A secondary aim is development of a network to strengthen both emergency medicine response to disasters and disaster health research.READ MORE
Nausea and vomiting is a common and distressing presenting complaint in emergency departments. Nausea describes the unpleasant sensation of the imminent need to vomit, whereas vomiting refers to the forceful oral expulsion of gastric contents associated with contraction of the abdominal and chest wall musculature. The complications from nausea and vomiting can range from trivial to serious, such as dehydration and oesophageal rupture.
High level evidence supports the use of antiemetics in the management of nausea and vomiting in many settings and populations, however there is little guidance or consensus in recommendations for the management of nausea and vomiting in the adult emergency department setting. Recommendations are inconsistent and rarely evidence based. It is not possible to extrapolate this evidence from other treatment settings to the emergency department population because of differences in aetiologies, patient populations and other factors.
Using the strict methodology outlined by the Cochrane collaboration, we will conduct a systematic review of randomized controlled trials (RCTs) of antiemetic agents in the management of nausea and vomiting in the emergency department setting.READ MORE
Sick and injured children in the Emergency Department (ED) often require procedures which can cause severe pain (like fracture reduction, stitching wounds, abscess drainage) or otherwise require the child to be still and cooperative (CT scans, lumbar punctures, removal of foreign bodies). Sedative drugs are given to these patients both to relieve pain/distress and to keep them still for the procedure.
ED sedation of children now has a well established body of evidence. Most of the literature relates to when the drug is given intravenously or intramuscularly. Drug delivery by these routes leads to reliable effects as the drug bypasses the liver without being broken down before it reaches the brain. However, both these routes require a needle which requires staff to hold down a young child against their will, frequently causing great distress along with the pain of the needle. Great efforts have gone into making EDs "Ouchless" where unnecessary pain for children is reduced or eliminated. Sedation is itself part of this effort. The intranasal route (injecting the medicine up the nose with a plastic syringe) could represent a needle-free alternative.
Ketamine is the most common drug used for paediatric sedation in Australian EDs and can be given intranasally. No studies have examined its use for ED sedation but many studies support its use in anaesthetics and dental clinics where it has been shown to be safe and effective.READ MORE
Convulsive status epilepticus (CSE) occurs when seizures do not stop spontaneously. It is the most severe form of epilepsy, and can result in long-term disabilities and rarely death. It can affect both adults and children, although the causes and outcomes are different in these groups of patients. Treatments of patients with CSE are largely based on expert opinion rather than strong evidence, due to the difficult nature of conducting quality trials in patients with this relatively infrequent condition in the emergency setting. We will determine the incidence and causes of CSE in children in Australia and New Zealand and collect information on the type of seizure, duration, treatment and outcome to determine ways to improve the management of children with CSE.READ MORE
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