The Poisoned Patient
- : Melbourne VIC 3000
How is it that such an accessible medicine - paracetamol - can be so harmful? Maybe you’ve witnessed the fatal damage that opioids are causing? Substances that we as nurses administer or are routinely exposed to, can be powerful sources of harm. Many substances have the potential to intentionally or accidentally enter the body and become poisons. Attend this conference to find out more. Topics include:
- Modern toxicology update for nurses
- What you need to know about the low therapeutic index - common medicines that cause harm
- Opioids, paracetamol and the rising number of fatal overdoses
- Assessing a poisoned patient in emergency situations
- Communication following a deliberate self-poisoning
- Household and environmental poisons - the facts
- Synthetic cannabinoids - emerging toxins of concern
- Paediatric case studies and much, much more…
8:30AM REGISTRATION FOR DAY ONE
9:00Welcome and Introduction
Jeff RobinsonA Day in the Life of a Poisons Information Centre
Australians have been fortunate enough to have established Poisons Information Centres for over 50 years. Four centres operate across different states and provide a 24/7 telephone emergency advisory service to members of the public and health professionals including nurses. This session sets the scene for the conference and provides an overview of these services and includes:
- How the Australian Poisons Information system works
- An introduction to the most common poisons and toxins in Australia
- Types of incidents - accidental/unintentional vs intentional
- Causes of incidents including therapeutic errors, occupational exposures, deliberate self-poisoning, envenomations and toxic hazard situations
- Current trends in poisoning in Australia
- A few examples…
Jeff RobinsonToxicology Overview - Update for Nurses
This session will provide an overview of some of the most important aspects of the assessment and management of poisoned patients. It will cover key principles such as:
- Dose is important!
- Risk assessment
- Toxicokinetics - what happens to a drug once it is in the body?
- Decontamination - ways to remove poisons
- Enhanced elimination techniques
- Toxidromes and antidotes
- High-dose insulin euglycaemia therapy (HIET)
10:45 MORNING TEA
Dr Jenny GowanMedicines as Toxins? - Shining a Light on Low Therapeutic Indices
Have you ever considered that a medicine may be a toxin? There are a range of medicines that have have a potential for causing harm and are commonly involved in therapeutic errors. Poor pharmaco-vigilance, by a nurse or a person who has been prescribed a medicine may lead to inappropriate medicine use and the potential for significant harm. As well, there are certain medicines with low therapeutic indices which we should identify as ‘red flag’ medicines. This session reviews the following
- Are medicines considered toxins?
- What is meant by a low therapeutic index?
- Why are special populations such as older people or children more at risk for harm caused by medicines?
- What are commonly administered medicines with a low therapeutic index and why can these cause harm?
- What is a cholinergic burden and why is this important when we are considering certain medicines’ potential for harm?
Jeff RobinsonPaints, Pesticides and Petrol - Workplace Toxicology
Forget “toxic bosses” or "backstabbing colleagues", there are a wide variety of workplace products that may unintentionally or accidentally cause harm. Have you ever thought what toxins people may be exposed to in the workplace? An update on how different forms of toxins such as liquids, fumes, gases and dust may harm a person and the immediate actions that improve patient outcomes. This session will assist nurses to confidently manage such presentations. Topics include:
- Workplace exposure overview
- Some specific workplace tox risks
- First Aid responses in the immediate period and clinical management of more serious events
- Useful resources to minimise the risk of exposure
- A few examples…
1:00PM LUNCH BREAK
Associate Professor Louis RollerParacetamol Overdose and Toxicity
Paracetamol remains one of the most common agents used in overdose. It’s ease of access, yet potential for significant harm, in the setting of abuse or unintentional overdose demands that all nurses must be familiar with the following:
- What constitutes a toxic dose of paracetamol in adults and children?
- Stages of paracetamol intoxication including respective symptoms and associated severity
- Current Guidelines for treatment including the use of n-acetylcysteine and concurrent investigations
- Prognostic factors - what are risk factors for toxicity that affect health outcomes?
- Novel therapies that may facilitate liver detoxification e.g albumin dialysis
- When may liver transplant be considered?
3:00 AFTERNOON TEA
Jeff RobinsonAround the Traps - Household Agents and Toxicity
Household products represent a huge potential for accidental poisoning. Many medicines, disc/button batteries, some cleaning products and some other common household agents can be significant risks to children. While preventative measures such as supervision and safe storage can prevent mishaps, accidents do occur and can be severe, even life-threatening. This informative session will bring you up-to-date with household poisoning risks:
- Epidemiology of paediatric poisoning
- Common low-risk paediatric exposures
- High-risk paediatric exposures
- Home first aid
- Preventing poisoning in the home
4:30 CLOSE OF DAY ONE OF PROGRAM
9:00AM COMMENCEMENT OF DAY TWO
Ross DonaldsonThe Poisoned Patient in ED - Nursing Management
Self-poisoning from the deliberate use drugs of abuse may result in clinical toxicity and be a cause of presentation to an Emergency Department. This session will provide an overview of the standard nursing principles of assessment and management following a deliberate self-poisoning attempt. Includes:
- Guidelines for initial assessment and management
- Back to Basics - ABCCD
- Important questions to ask that illicit the most clinically relevant information
- What to document and how
- Other considerations e.g ECG, weight and risk of self-harm
Craig MaloneyWhen the Toxin Has Gone - Alcohol Withdrawal
Alcohol is one of the most difficult toxins to withdraw from and is associated with common chronic dependence and relapse. Management of withdrawal requires a collaborative and careful approach. This sessions follows on from the previous session by looking at the following:
- What is the difference between alcohol abuse and alcohol dependence?
- Potential complications of chronic alcohol use
- Screening tools to assess extent of problem and readiness to change behaviour
- What is alcohol withdrawal and how can it vary from mild symptoms to a severe syndrome?
- Management of concurrent withdrawal from alcohol and other substances e.g. benzodiazepines
- Assessment and management of post-withdrawal depression, relapse and other psychological symptoms
10:30 MORNING TEA
Craig MaloneyDeliberate Self-Poisoning - Postvention - Where to Next?
Self-poisoning from the deliberate abuse of toxins such as medicines, alcohol or other poisonous substances is likely to warrant careful psychological consideration as well as clinical management following an untoward event. If management occurs in a critical care environment such as an Emergency Department or Intensive Care Unit, many nurses may not feel confident that they have the psychotherapeutic skills to work with these patients. As such, this session will provide an very practical overview of some of the ways in which you can navigate this situation following a deliberate self-poisoning attempt. Includes:
- First things first - what do you say? Or do you just listen?
- Is it important to understand someone’s motivation for self-poisoning?
- Tips for remaining non-judgemental
- How to engage with someone post attempted overdose
- When may referral for psychiatric treatment be necessary?
Beck GardnerPaediatric Poisonings - Case Studies and Scenarios
Paediatric poisonings are mostly accidental but do still remain a frequent cause of admissions to Emergency Departments. Advances in clinical practice plus a range of safety improvements have led to decreased fatalities, however, adult toxicology principles cannot be specifically translated to children. As such, this session looks at the paediatric population in more detail and includes:
- What are the leading causes of paediatric poisonings?
- How does the management of children differ to adults?
- Case studies to demonstrate how developmental and physical considerations are applied to paediatric populations
12:30PM LUNCH BREAK
Dr Shaun GreeneOpioid Overdose - Clinical Assessment and Management
Opioids are widely prescribed, frequently administered by nurses and commonly used in the community. These medicines and drugs such as Morphine, Heroin, and Oxycodone have huge potential to cause significant harm. Because of the action of these substances and capacity for respiratory depression, opioids are being implicated in a large and increasingly rising number of fatal overdoses. The prevalence of this demands that nurses are well informed about the following:
- Why are opioids causing such high numbers of overdose deaths?
- Signs and symptoms of opioid overdose
- Assessment and recognition of opioid overdose
- How opioid overdose is managed
- Guidelines for the administration of naloxone
- Preventing opioid overdose - safe practises and a look at harm minimisation
Dr Shaun GreenePink Blood? - Carbon Monoxide Poisoning - A Silent Killer
Carbon monoxide is an odourless, tasteless and colourless gas that means it can be inhaled without people realising. This invisible substance is linked to preventable mortalities relating to the use of gas appliances which may be a significant source of carbon monoxide. This session considers:
- Prevention first - importance of awareness and safety
- Who may be particularly susceptible to carbon monoxide poisoning?
- Common causes of accidental and non-accidental exposure
- What are the clinical features of mild, acute and chronic carbon monoxide poisoning?
- Immediate first-aid required and overview of management principles including resuscitation
2:45 AFTERNOON TEA
Dr Shaun GreeneBut Wait … There’s More! Emerging Substances of Concern
Many new psychoactive substances (NPS) or synthetic drugs are being rapidly produced and readily available on the internet. These new drugs are developed and designed to imitate the effects of drugs that are illegal (such as cannabinoids and some stimulants). Even minor changes to the chemical structure of a drug can produce a new drug that is not yet illegal. These drugs have variable potency; are unregulated; and may place users at significant risk. This final session discusses the growth in the use of these drugs in the community and ways in which we can reduce the harm related to them. Includes:
- What are some of these emerging substances?
- What are the issues we need to be aware of in relationship to their use?
- How can we recognise if a person has been using one or more of these drugs?
- What are some of the risks involved?
- What nurses and other frontline professionals need to know about these drugs and their impact in order to deliver appropriate care?
3:45Final Questions and Discussion
4:30 CLOSE OF DAY TWO OF PROGRAMThe Goal Need for Program
Many substances exist that may be potential sources of serious harm. Common medicines such as paracetamol, opioids and medicines with low therapeutic indices are commonly implicated in serious accidental toxic events and self-poisonings. Environmental exposure to toxins may also pose a serious risk to a person's health. Nurses working in a wide variety of settings will benefit their patients if they are equipped with the most up-to-date knowledge on which substances pose the greatest risk and why. Confidence relating to appropriate nursing management skills and knowledge of how to rapidly act will improve overall outcomes for the poisoned patient.Purpose of Program
To improve patient outcomes by providing nurses with evidenced education about the management of poisoned patients.Your learning outcomes:
Use basic toxicology principles to improve your clinical assessment of a poisoned patient
Apply best-available evidence to the nursing management and care of a poisoned patient
Identify high risk medicines involved in deliberate and accidental poisonings and use this knowledge to prevent errors
Confidently use basic psychotherapy principles to communicate with a person after a deliberate self-poisoning actionPresenters
Jeff Robinson is the Manager of the Victorian Poisons Information Centre (VPIC), which is located in the Emergency Department of ... Read More
Jenny, a practicing pharmacist, is a Teaching Associate at Monash University, Melbourne. She is a member of the PSA Branch ... Read More
Associate Professor Louis Roller, PhC, BPharm, BSc, MSc, PhD, DipEd, FPS, FACPP has been an academic at the Faculty of ... Read More
Dr Shaun Greene is a clinical toxicologist and emergency medicine physician who works at Austin Health in Melbourne. He is ... Read More
Craig Maloney has an impressive background which includes a Master of Mental Health Nursing and graduate qualifications in Child Adolescent ... Read More
Ross Donaldson has been working in an inner city Emergency Department for 14 years. He is always attempting to broaden ... Read More
Geoffrey Ahern is a Senior Mental Health Clinician from Melbourne, who works with Victorian Police on a specialised mental health ... Read More
Beck Gardner is an emergency nurse practitioner who works at both Austin and Alfred Health. She started her nurse ... Read More