Garry J Wilkes - Academia.edu (original) (raw)

Papers by Garry J Wilkes

British Journal of Surgery, Aug 1, 1993

The management of 405 patients presenting with head injury to an accident and emergency departmen... more The management of 405 patients presenting with head injury to an accident and emergency department was assessed. Sixty-nine patients were admitted, although this number should have been 127 according to current guidelines on the management of head injury. Only three attenders were admitted inappropriately according to these guidelines. An accident and emergency observation ward was open on weekdays only; at weekends, patients with head injury were admitted to a general surgical ward. When the observation ward was open, 51 of the 76 patients (67 per cent) presenting with admission criteria were admitted. When closed, only 15 of the 51 patients (29 per cent) with these criteria were admitted. Guidelines were applied effectively to reduce the number of unnecessary admissions, but there was a significant number of patients with minor head injury who were discharged inappropriately. This number was much reduced when an observation ward was available.

Emergency medicine, Aug 26, 2009

... A diagnosis of hydrofluoric acid burns was suspected on the basis of the typical presentation... more ... A diagnosis of hydrofluoric acid burns was suspected on the basis of the typical presentation. ... Case 2. A 39 year old woman used 10% hydrofluoric acid on a sponge to clean rusty metal for 45 minutes without wearing gloves. ...

QJM: An International Journal of Medicine, Mar 4, 2008

Background: Widow spider-bite causes latrodectism and is associated with significant morbidity wo... more Background: Widow spider-bite causes latrodectism and is associated with significant morbidity worldwide. Antivenom is given by both the intravenous (IV) and intramuscular (IM) routes and it is unclear which is more effective. Aim: To compare the effectiveness of IV vs. IM redback spider antivenom. Design: Randomized controlled trial. Methods: Patients with latrodectism were given either IV or IM antivenom according to a randomized double-dummy, double-blind protocol. The first antivenom treatment was followed by another identical treatment after two hours if required. The primary outcome was a clinically significant reduction in pain two hours after the last treatment. A fully Bayesian analysis was used to estimate the probability of the desired treatment effect, predetermined as an absolute difference of 20%. Results: We randomly allocated 126 patients to receive antivenom IV (64) and IM (62).

Emergency Medicine Australasia, Jun 1, 2001

To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressan... more To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressant toxicity. Medline search from 1966 to October 2000 (articles in all languages were included) and examination of bibliographies. Published papers including animal studies, in vitro studies, human case reports, case series and retrospective studies were reviewed. Our search identified 115 publications, all of which were retrieved. Human studies included eight case reports, four case series, one controlled study and two retrospective chart reviews. No randomized controlled human trials were found. Twelve animal studies were identified that investigated pH manipulation or saline load and their effects on physiological parameters in tricyclic antidepressant toxicity. The practice of alkalinization for tricyclic antidepressant toxicity is based on animal studies, case reports and opinion. The mechanism of action appears to be multifaceted and may vary between different tricyclic antidepressants. Significant interspecies variation makes extrapolation from animal studies to humans difficult. Alkalinization therapy appears reasonable in patients with compromising dysrhythmias and shock when supportive interventions have been ineffective; however, the available evidence does not support prophylactic alkalinization in the absence of life-threatening cardiovascular toxicity.

Journal of Quality in Clinical Practice, Sep 1, 1999

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner ... more In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a reopened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

Http Www Libreriasaulamedica Com, 2009

Tienda online donde Comprar Examination Emergency Medicine A Guide to the ACEM Fellowship Examina... more Tienda online donde Comprar Examination Emergency Medicine A Guide to the ACEM Fellowship Examination al precio 77,69 € de Joseph Ting | Carole Foot | Bronwyn Peirce | Garry Wilkes, tienda de Libros de Medicina, Libros de Urgencias y Emergencias - Medicina de urgencias y emergencias

Emergency Medicine, Dec 1, 1996

Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocard... more Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio-ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30-50%. Kussmaul's sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient. Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarction is increased by right ventricular infarction, but may be lessened by thrombolytic therapy in eligible patients.

Journal of Quality in Clinical Practice, 1999

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner ... more In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a reopened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

Emergency Medicine Australasia, 2009

Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocard... more Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio-ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30–50%. Kussmaul‘s sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient. Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarchon is increased by righ...

BACKGROUND: Many patients presenting to the emer-gency department (ED) for assessment of possible... more BACKGROUND: Many patients presenting to the emer-gency department (ED) for assessment of possible acute coronary syndrome (ACS) have low cardiac troponin concentrations that change very little on repeat blood draw. It is unclear if a lack of change in cardiac troponin concentration can be used to identify acutely presenting patients at low risk of ACS. METHODS: We used the hs-cTnI assay from Abbott Di-agnostics, which can detect cTnI in the blood of nearly all people. We identified a population of ED patients being assessed for ACS with repeat cTnI measurement who ultimately were proven to have no acute cardiac disease at the time of presentation. We used data from the repeat sampling to calculate

Research in veterinary science, Jan 20, 2018

The aim of this study was to compare sedation of sheep with acepromazine and buprenorphine or mor... more The aim of this study was to compare sedation of sheep with acepromazine and buprenorphine or morphine. Twenty merino sheep received acepromazine (0.03mg/kg) with buprenorphine (0.02mg/kg, AB, n=10) or morphine (0.3mg/kg, AM, n=10) by intramuscular injection. Sedation was scored (SS) on a scale from 0 (no sedation) to 10 (heavy sedation). Response to restraint was scored (RS) on a scale from 0 (agitated) to 4 (relaxed). Three independent blinded observers and a single blinded observer determined the SS and RS, respectively. The SSs were summed (maximum 30). Data were compared using a t-test. Data is mean±SD (95% confidence interval). Each group comprised 2 wethers and 8 ewes. There was no difference between the AB and AM groups: weight 44±3.1kg and 44.7±3kg (p=0.58); SS 4.6±3.2 (2.4-6.9) and 6.6±3.5 (4.1-9.1) (p=0.21); and RS 1.6±1.3 (0.5-2.7) and 2±1.5 (0.7-3.3) (p=0.6). No adverse effects of the drugs were observed. Sedation with AB or AM at these doses is similar in sheep without...

The Medical journal of Australia, Jan 2, 1997

We administered a record eight ampoules of antivenom over one week to a 55-year-old woman with a ... more We administered a record eight ampoules of antivenom over one week to a 55-year-old woman with a red-back spider bite on her chronically lymphoedematous right arm. She had severe local signs of envenomation but relatively little systemic effect. The final antivenom dose, injected subcutaneously at the bite site, had a good effect.

Emergency Medicine Australasia, 2005

To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Re... more To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Red-back spider (RBS) envenoming. Randomized, double-dummy, double-blind, multicentre trial of patients with red-back spider envenoming requiring AV treatment recruited from five hospital EDs in Western Australia. Thirty-five patients were recruited; two were excluded; 33 were available for initial analysis, but two who were unblinded after one ampoule of trial AV and given i.v. AV had limited data; 31 remained in the study and had more complete data. After AV, pain scores for both i.m. and i.v. groups improved rapidly. At 24 h, the i.v. group was better with a 55% absolute difference (76% vs. 21%; 95% CI 25-85% difference) in the proportion pain-free. There were no safety issues. Red-back spider antivenom was initially effective by both i.m. and i.v. routes. The study generates the hypothesis that at 24 h, significantly more patients are pain-free with i.v. administration. Definitive recommendations on the optimal route of administration of RBS AV await the results of further studies.

Emergency Medicine Journal, 2011

Journal of Quality in Clinical Practice, 1999

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner ... more In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

ABSTRACT The pain and disability associated with musculoskeletal conditions represent a significa... more ABSTRACT The pain and disability associated with musculoskeletal conditions represent a significant and increasing health burden worldwide. Musculoskeletal conditions of acute onset and short duration occur commonly, affect all age groups, and are usually idiopathic. Successful management of acute pain is paramount if chronic pain conditions are to be avoided.This article focuses on interventions for five areas of acute musculoskeletal pain (acute low back pain, acute thoracic spinal pain, acute neck pain, acute shoulder pain and anterior knee pain). It summarizes the results of a multidisciplinary evidence review recently conducted by the Australian Acute Musculoskeletal Pain Guidelines Group.

British Journal of Surgery, Aug 1, 1993

The management of 405 patients presenting with head injury to an accident and emergency departmen... more The management of 405 patients presenting with head injury to an accident and emergency department was assessed. Sixty-nine patients were admitted, although this number should have been 127 according to current guidelines on the management of head injury. Only three attenders were admitted inappropriately according to these guidelines. An accident and emergency observation ward was open on weekdays only; at weekends, patients with head injury were admitted to a general surgical ward. When the observation ward was open, 51 of the 76 patients (67 per cent) presenting with admission criteria were admitted. When closed, only 15 of the 51 patients (29 per cent) with these criteria were admitted. Guidelines were applied effectively to reduce the number of unnecessary admissions, but there was a significant number of patients with minor head injury who were discharged inappropriately. This number was much reduced when an observation ward was available.

Emergency medicine, Aug 26, 2009

... A diagnosis of hydrofluoric acid burns was suspected on the basis of the typical presentation... more ... A diagnosis of hydrofluoric acid burns was suspected on the basis of the typical presentation. ... Case 2. A 39 year old woman used 10% hydrofluoric acid on a sponge to clean rusty metal for 45 minutes without wearing gloves. ...

QJM: An International Journal of Medicine, Mar 4, 2008

Background: Widow spider-bite causes latrodectism and is associated with significant morbidity wo... more Background: Widow spider-bite causes latrodectism and is associated with significant morbidity worldwide. Antivenom is given by both the intravenous (IV) and intramuscular (IM) routes and it is unclear which is more effective. Aim: To compare the effectiveness of IV vs. IM redback spider antivenom. Design: Randomized controlled trial. Methods: Patients with latrodectism were given either IV or IM antivenom according to a randomized double-dummy, double-blind protocol. The first antivenom treatment was followed by another identical treatment after two hours if required. The primary outcome was a clinically significant reduction in pain two hours after the last treatment. A fully Bayesian analysis was used to estimate the probability of the desired treatment effect, predetermined as an absolute difference of 20%. Results: We randomly allocated 126 patients to receive antivenom IV (64) and IM (62).

Emergency Medicine Australasia, Jun 1, 2001

To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressan... more To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressant toxicity. Medline search from 1966 to October 2000 (articles in all languages were included) and examination of bibliographies. Published papers including animal studies, in vitro studies, human case reports, case series and retrospective studies were reviewed. Our search identified 115 publications, all of which were retrieved. Human studies included eight case reports, four case series, one controlled study and two retrospective chart reviews. No randomized controlled human trials were found. Twelve animal studies were identified that investigated pH manipulation or saline load and their effects on physiological parameters in tricyclic antidepressant toxicity. The practice of alkalinization for tricyclic antidepressant toxicity is based on animal studies, case reports and opinion. The mechanism of action appears to be multifaceted and may vary between different tricyclic antidepressants. Significant interspecies variation makes extrapolation from animal studies to humans difficult. Alkalinization therapy appears reasonable in patients with compromising dysrhythmias and shock when supportive interventions have been ineffective; however, the available evidence does not support prophylactic alkalinization in the absence of life-threatening cardiovascular toxicity.

Journal of Quality in Clinical Practice, Sep 1, 1999

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner ... more In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a reopened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

Http Www Libreriasaulamedica Com, 2009

Tienda online donde Comprar Examination Emergency Medicine A Guide to the ACEM Fellowship Examina... more Tienda online donde Comprar Examination Emergency Medicine A Guide to the ACEM Fellowship Examination al precio 77,69 € de Joseph Ting | Carole Foot | Bronwyn Peirce | Garry Wilkes, tienda de Libros de Medicina, Libros de Urgencias y Emergencias - Medicina de urgencias y emergencias

Emergency Medicine, Dec 1, 1996

Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocard... more Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio-ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30-50%. Kussmaul's sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient. Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarction is increased by right ventricular infarction, but may be lessened by thrombolytic therapy in eligible patients.

Journal of Quality in Clinical Practice, 1999

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner ... more In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a reopened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

Emergency Medicine Australasia, 2009

Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocard... more Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio-ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30–50%. Kussmaul‘s sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient. Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarchon is increased by righ...

BACKGROUND: Many patients presenting to the emer-gency department (ED) for assessment of possible... more BACKGROUND: Many patients presenting to the emer-gency department (ED) for assessment of possible acute coronary syndrome (ACS) have low cardiac troponin concentrations that change very little on repeat blood draw. It is unclear if a lack of change in cardiac troponin concentration can be used to identify acutely presenting patients at low risk of ACS. METHODS: We used the hs-cTnI assay from Abbott Di-agnostics, which can detect cTnI in the blood of nearly all people. We identified a population of ED patients being assessed for ACS with repeat cTnI measurement who ultimately were proven to have no acute cardiac disease at the time of presentation. We used data from the repeat sampling to calculate

Research in veterinary science, Jan 20, 2018

The aim of this study was to compare sedation of sheep with acepromazine and buprenorphine or mor... more The aim of this study was to compare sedation of sheep with acepromazine and buprenorphine or morphine. Twenty merino sheep received acepromazine (0.03mg/kg) with buprenorphine (0.02mg/kg, AB, n=10) or morphine (0.3mg/kg, AM, n=10) by intramuscular injection. Sedation was scored (SS) on a scale from 0 (no sedation) to 10 (heavy sedation). Response to restraint was scored (RS) on a scale from 0 (agitated) to 4 (relaxed). Three independent blinded observers and a single blinded observer determined the SS and RS, respectively. The SSs were summed (maximum 30). Data were compared using a t-test. Data is mean±SD (95% confidence interval). Each group comprised 2 wethers and 8 ewes. There was no difference between the AB and AM groups: weight 44±3.1kg and 44.7±3kg (p=0.58); SS 4.6±3.2 (2.4-6.9) and 6.6±3.5 (4.1-9.1) (p=0.21); and RS 1.6±1.3 (0.5-2.7) and 2±1.5 (0.7-3.3) (p=0.6). No adverse effects of the drugs were observed. Sedation with AB or AM at these doses is similar in sheep without...

The Medical journal of Australia, Jan 2, 1997

We administered a record eight ampoules of antivenom over one week to a 55-year-old woman with a ... more We administered a record eight ampoules of antivenom over one week to a 55-year-old woman with a red-back spider bite on her chronically lymphoedematous right arm. She had severe local signs of envenomation but relatively little systemic effect. The final antivenom dose, injected subcutaneously at the bite site, had a good effect.

Emergency Medicine Australasia, 2005

To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Re... more To compare the efficacy of intravenous versus intramuscular antivenom (AV) in the treatment of Red-back spider (RBS) envenoming. Randomized, double-dummy, double-blind, multicentre trial of patients with red-back spider envenoming requiring AV treatment recruited from five hospital EDs in Western Australia. Thirty-five patients were recruited; two were excluded; 33 were available for initial analysis, but two who were unblinded after one ampoule of trial AV and given i.v. AV had limited data; 31 remained in the study and had more complete data. After AV, pain scores for both i.m. and i.v. groups improved rapidly. At 24 h, the i.v. group was better with a 55% absolute difference (76% vs. 21%; 95% CI 25-85% difference) in the proportion pain-free. There were no safety issues. Red-back spider antivenom was initially effective by both i.m. and i.v. routes. The study generates the hypothesis that at 24 h, significantly more patients are pain-free with i.v. administration. Definitive recommendations on the optimal route of administration of RBS AV await the results of further studies.

Emergency Medicine Journal, 2011

Journal of Quality in Clinical Practice, 1999

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner ... more In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

ABSTRACT The pain and disability associated with musculoskeletal conditions represent a significa... more ABSTRACT The pain and disability associated with musculoskeletal conditions represent a significant and increasing health burden worldwide. Musculoskeletal conditions of acute onset and short duration occur commonly, affect all age groups, and are usually idiopathic. Successful management of acute pain is paramount if chronic pain conditions are to be avoided.This article focuses on interventions for five areas of acute musculoskeletal pain (acute low back pain, acute thoracic spinal pain, acute neck pain, acute shoulder pain and anterior knee pain). It summarizes the results of a multidisciplinary evidence review recently conducted by the Australian Acute Musculoskeletal Pain Guidelines Group.