ORCID Profile
0000-0001-8911-0078
Current Organisations
Nepean Blue Mountains Local Health District
,
Western Sydney Local Health District
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Publisher: Springer Science and Business Media LLC
Date: 06-08-2018
DOI: 10.1007/S12012-018-9476-9
Abstract: Monoamine oxidase inhibitors (MAOIs) are known to cause hypertensive crisis when combined with intake of tyramine, classically found in cheese. We present a case of MAOI-induced hypertensive crisis leading to significant troponin release after soft cheese intake. A 51-year-old lady presented with left-sided chest pain, palpitations and headache in the context of significant hypertension after eating soft cheese. She had a similar episode 2 month prior to this presentation, which resulted in a diagnosis of non-ST elevation myocardial infarction after a troponin of 2768 ng/L (Ref < 17 ng/L) with normal cardiac investigations and CT pulmonary angiogram. She was known to be on tranylcypromine for bipolar depression. Subsequent cardiac investigations were normal, as were those for phaeochromocytoma and Conn's disease. Tranylcypromine is a non-selective irreversible MAOI used in refractory depression and bipolar disorder. MAOIs are known to cause hypertensive crisis when combined with soft cheese due to unopposed release of catecholamines from reduced tyramine metabolisation, leading to injury and possible myonecrosis. Three previous case reports have demonstrated either creatinine kinase or troponin rise with myocardial infarction due to this hypertensive crisis and our case is the fourth with significant hypertension and cardiac biomarker rise related to MAOI, specifically tranylcypromine.
Retrospective Study Of The Management Of Suspected Febrile Neutropenia In A Single-Centre Metropolitan Western Sydney Hospital
Publisher: Informa UK Limited
Date: 11-2019
DOI: 10.2147/CA.S218391
Publisher: Wiley
Date: 13-03-2021
Abstract: To investigate the utility of non‐contrast head computed tomography (CT) in poisoned patients. A retrospective cohort study of patients referred to a toxicology unit between August 2010 and December 2017. Our database yielded patients who underwent head CT at presentation to the ED. Pre‐specified information was compiled from the medical records. There were 6261 presentations of which 1142 underwent head CT (17%). Median age was 41 years, and 437 (38%) were female. There were 492 (43%) recreational ingestions and 466 (41%) deliberate self‐poisonings. The commonest agents were sedatives 376 (33%) and opioids 282 (24%) 334 (29%) cases were intubated. Signs of head injury were found in 153 cases (13%) and focal neurological signs in 68 (6%). No acute pathology was reported in 884 head CTs (77%), chronic changes in 193 (17%) and incidental findings in 26 (2%). Acute pathology was found in 39 (4%) patients: 15 with hypoxic‐ischaemic injury, three infarctions, nine with intra‐cranial haemorrhage, 11 facial bone fractures and one retro‐bulbar haematoma. No patient required an immediate surgical intervention, and only one patient had a change to clinical treatment. Acute head CT pathology was associated with at least one of the following clinical features: need for intubation, signs of head injury, seizure, headache, and unexpected neurological signs. Non‐contrast head CT is a low‐yield investigation in patients presenting with poisoning. Consideration should be given as to whether the clinical presentation is consistent with the expected toxidrome and whether the patient would benefit from head CT.
Publisher: Wiley
Date: 16-08-2019
Publisher: Wiley
Date: 27-03-2023
Abstract: To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub‐analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non‐OM groups were analysed. The study recruited 342 patients who presented mostly with finger or hand‐related conditions (82%, n = 279) and managed by an ENP with less than 10 years of experience (65%, n = 224). Disposition decisions by ENP compared to PST were the same in 80% ( n = 274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66–0.78). For the OM and non‐OM groups, disposition decisions were the same in 94% ( n = 320), with a Cohen's kappa 0.85 (95% confidence interval 0.79–0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/875857
Abstract: We highlight a case of distal renal tubular acidosis secondary to ibuprofen and codeine use. Of particular interest in this case are the patient’s perception of over-the-counter (OTC) medication use, her own OTC use prior to admission, and her knowledge of adverse reactions or side effects of these medications prior to taking them.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/CC6880
Publisher: SAGE Publications
Date: 10-2014
DOI: 10.1177/175114371401500417
Abstract: Limbic encephalitis is a rare auto-immune condition that usually presents subacutely with vague symptoms such as headache, confusion and memory loss. 1 If not diagnosed early the sequelae can be severe, including refractory status epilepticus. The majority of cases are associated with underlying neoplasia. We present a case of voltage-gated potassium channel limbic encephalitis and its subsequent management during a long ICU admission. We discuss the classification, diagnosis and treatment of limbic encephalitis, review the use of sodium thiopental to achieve burst suppression in refractory status epilepticus, and the use of continuous EEG monitoring in the ICU.
Publisher: Wiley
Date: 07-03-2023
Abstract: To characterise paediatric poisoning presentations to EDs and determine if the advent of the COVID‐19 pandemic was associated with increased intentional paediatric poisoning presentations. We performed a retrospective analysis of paediatric poisoning presentations to three EDs (two regional and one metropolitan). Simple and multiple logistic regression analysis were performed to determine the association between COVID‐19 and intentional poisoning events. In addition, we calculated the frequency with which patients reported various psychosocial risk factors as being an implicating factor in engaging in an intentional poisoning event. A total of 860 poisoning events met inclusion criteria during the study period (January 2018–October 2021), with 501 being intentional, and 359 unintentional. There was an increased proportion of intentional poisoning presentations during the COVID‐19 pandemic (261 intentional and 218 unintentional in the pre‐COVID‐19 period vs 241 intentional and 140 unintentional during the COVID‐19 period). In addition, we found a statistically significant association between intentional poisoning presentations and an initial COVID‐19 lockdown (adjusted odds ratio 26.32, P 0.05). ‘The COVID‐19 lockdown’ or ‘COVID‐19’ was reported to be implicating factor for psychological stress in patients who presented with intentional poisonings during the COVID‐19 pandemic. Intentional paediatric poisoning presentations increased during the COVID‐19 pandemic in our study population. These results may support an emerging body of evidence that the psychological strain of COVID‐19 disproportionately impacts adolescent females.
No related grants have been discovered for Mark Salter.