- CIAP Newsletters
June 2016 Issue 6
Focus on... Poisons and Toxicology
The NSW Poisons Information Centre describes poison as: ‘Chemicals,
medicines, animals and plants (that) can be dangerous, even in small quantities, if you are exposed to enough of them’. Toxicology is
the science and study of poisons and their harmful effects. The term ‘toxin’ generally refers to a poisonous substance produced
within living cells or organisms, though most people commonly use the terms ‘toxin’ and ‘poison’ synonymously. Venoms
are toxins that are injected by a bite or sting.
Any product or substance can be harmful if it is used in the wrong way, by the wrong person, or in the wrong amount, and poisonings can
occur at any age. Routes of poisoning include swallowing, inhalation, injection or absorption. Some poisons are particularly dangerous if they
come into contact with eyes or skin, while others may be toxic if absorbed as a result of a bite or sting from an animal, or contact with a
plant or its sap.
Common poisonings are those from household items such as cleaning, laundry or cosmetic products; chemicals at work or in the environment
such as solvents, acids and pesticides; drugs including prescription, over-the-counter, herbal, or illicit drugs; and inhalation from smoke
and gases such as carbon monoxide. Of course, in Australia, we have some of the world’s most venomous snakes and spiders and though poisonings
from these sources are less frequent, they are potentially life-threatening.
The effects of poisoning cover a wide range of symptoms and outcomes, from minor irritation to death. Some poisons may lead to subtle changes
in health that may not even be noticed for years. Diagnosis, management, monitoring and treatment of poisonings remain important across NSW Health,
as poisonings may present at any time and in any setting.
CIAP provides a range of evidence-based clinical decision support resources for NSW Health staff in the management of poisonings.
The Therapeutic Guidelines (eTG) provides
comprehensive information related to poisonings in the Australian context, including guidelines and management strategies, in its Toxicology and
Wilderness section. Highly authoritative and evidence-based, the eTG Toxicology and Wilderness information includes risk assessment, first aid,
hospital management, investigations, details of individual medications poisonings, other chemical poisonings, snake and spider bite management,
marine envenomation, resuscitation guidelines, paediatric poisonings, and much more. eTG is easily searchable by browsing the index of the Toxicology
and Wilderness section, or by entering a symptom, condition or drug into the keyword search box. One of the features of eTG is its use of tables,
boxes and figures to provide summarised information. In Toxicology and Wilderness, the tables cover a diverse range of topics. A small sample of
- Drugs highly associated with QRS widening and sodium channel blockade
- Features to assist in the diagnosis of serotonin toxicity
- Major clinical toxicity of sedating antihistamines
- Risk of severity of warfarin overdose classified according to INR
- Clinical effects of envenoming by Australian snakes
Poisons information centres in Australia are staffed by specialist pharmacists at all times, with access to clinical toxicologists for medical
advice as required. Contact details and a link to the NSW Poisons Information Centre may be found through ‘Emergency Care’ in CIAP’s left menu,
and contact details are also provided in eTG.
UpToDate contains many topics on Toxicology, such as medications poisonings and overdose, inhalation poisonings, intoxication of agents (such as
opioids), contact and absorption agents, and more. Fully referenced information about pathophysiology, presentation, diagnosis, management, treatment,
poison elimination and other features is available, along with tables and graphs where relevant. Summary overviews, as well as clinical topics that
are searchable by specific poison or agent provide comprehensive toxicology information.
UpToDate will be available via CIAP from July 2016. For more information see CIAP Update.
For staff working in Emergency settings, links to several key resources are provided though ‘Emergency Care’ in CIAP’s left menu.
Browse or search CIAP’s collection of Journals and Books for further useful resources. eBooks of particular interest may be:
The Bioterrorism Sourcebook, which examines infectious agents, biotoxins, chemical weapons and nuclear and radiation syndromes;
while another is Current Diagnosis and Treatment: Occupational & Environmental Medicine 5e, which includes a comprehensive section on
occupational and environmental exposures.
To learn more about using CIAP’s resources visit the Learning
Centre where you can find User Guides,
Video Tutorials and other learning options to support your
use of CIAP resources including educational events.
We are excited to announce that UpToDate will be included in the CIAP collection from July 2016, following the successful
procurement of a statewide licence for NSW.
UpToDate is a highly authoritative, evidence-based and peer reviewed decision support resource, which contains in-depth clinical content
and analysis across a range of specialties, delivered in easy to search and easy-to-read formats.
Updates to the CIAP Collection
After extensive collaboration with clinician working groups, specialty experts, and established CIAP networks/committees, a full
review of the current CIAP collection has now been completed. This process identified duplications, gaps and redundancies, resulting
in a streamlined and optimised collection of resources for NSW Health staff.
The CIAP review encompassed the identification of highly regarded titles that would provide value to the current collection.
Following consultation with clinicians in specialty areas, the following titles will be available from July 2016:
- Archives of Physical Medicine and Rehabilitation
- Journal of Voice
- Manual Therapy
- International Journal of Stroke
- Australian Social Work
Updates and new additions, along with the inclusion of UpToDate, will provide the best possible collection of evidence-based decision
support resources for NSW Health staff via CIAP.
For a full list of discontinued resources with alternate recommendations, download the CIAP Collection Changes document.
You will see some changes to the CIAP website and the CIAP collection over coming months. The CIAP team will work to support CIAP
users in this period of transition by providing information via the CIAP website, newsletters, and CIAP Clinical Partners, as well
as by providing user guides and other training opportunities.
Article in Focus
Asia Pacific Allergy 5(1) 3–16: Published January 2016
Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat
allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring
worldwide where ticks are endemic. Sensitisation to galactose-α-1, 3-galactose (α-Gal) has been shown to be the mechanism
of allergic reaction in mammalian meat allergy following tick bite. Tick anaphylaxis is rare in countries other than Australia.
Tick anaphylaxis is secondarily preventable by prevention and appropriate management of tick bites. Analysis of tick removal
techniques in tick anaphylaxis sufferers offers insights into primary prevention of both tick and mammalian meat anaphylaxis.
Gems on CIAP
Poisoning & Drug Overdose
Section 2 of Poisoning &
Drug Overdose in AccessMedicine contains a comprehensive list of over 150 different specific poisons and drugs with a diagnosis
and treatment for each. You can also note that the other three sections of the book may also be useful as they contain information
regarding Comprehensive Evaluation and Treatment; Therapeutic Drugs and Antidotes; and Environmental and Occupational Toxicology.
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