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ED staff are able to perform resuscitation procedures in PPE without adverse physiological effects or impact on performance. Subjective concerns regarding task performance were not reflected in objective measurements. This might indicate that appropriate training and feedback could reduce the negative impression associated with activities undertaken while wearing PPE.

Background Metoclopramide is a commonly used drug in the emergency department for managing nausea, vomiting and migraines. There are currently no reported studies of the rates of metoclopramide‐induced akathisia in the emergency department. Aim To determine the risk and severity of metoclopramide‐induced akathisia. Method This was an observational study of emergency department patients who were administered metoclopramide parenterally and matched controls who were administered parenteral medications not known to cause akathisia (e.g. normal saline or antibiotics). Akathisia was assessed by a blinded interviewer at least one hour after drug administration, using a modified version of the Prince Henry Hospital Akathisia Rating Scale. Results 232 patients were enrolled, 26 were excluded due to missing data or protocol violations. 99 were in the control group and 107 in the metoclopramide group. The mean age was 45.4 ± 19.4 years and 109/206 (53%) were male. 18 patients (16.6%, 95%CI 10.5–25.6) who received metoclopramide developed akathisia compared to 9 patients (9.1%, 95%CI 4.5–17.0) who received a control drug; the risk ratio was 1.85 (95%CI 0.87–3.92, p = 0.10). Conclusion This study showed a trend towards an increased incidence of akathisia following metoclopramide administration in the emergency department. As this is a commonly administered drug in emergency departments, staff should be aware of the potential for akathisia to develop and should consider monitoring patients for this adverse effect.

SUMMARY The assessment of self-harm in adolescence should include identifying medical complications and any underlying psychiatric conditions Changes in the frequency, type, and severity of self-harm can signify increasing suicidality and progression towards lethal action. As 30% of adolescent self-harm involves an overdose of prescription drugs, prescribing limited quantities and having the parents hold the supply can decrease this risk Individual psychological therapies are first line. They can be combined with school and parental involvement There is very little evidence supporting the use of psychotropic drugs for treating adolescent self-harm

Background: While drug interactions are reported to be common, there are no published reports of the prevalence of such interactions among Australian emergency department (ED) patients. Aim: To determine the prevalence and characteristics of potential drug interactions among Australian ED patients, the drugs most frequently involved and identify high-risk patient groups. Method: An analytical cross-sectional survey of 409 patients who were taking at least two drugs. Drug lists were compiled from a range of resources. Analyses of potential interactions were made using Micromedex Drug-Reax software. Multivariate analysis was used to determine factors associated with potential drug interactions. Results: 855 potential drug interactions were identified among 254 (62.1%, 95%CI 57.2-66.8) patients. The mean number of potential interactions among all patients was 2.1 ± 2.7 per patient. The most common potential interactions were between angiotensin converting enzyme inhibitors and loop diuretics (11.3% of patients at risk), beta-blockers and antidiabetics (7.3%) and frusemide and aspirin (9.1%). Drugs most commonly involved were aspirin (27.7% of potential interactions), beta-blockers (11.1%) and warfarin (9.9%). Only the number of drugs taken correlated significantly with the number of potential interactions (p < 0.001). Conclusion:The possibility of potential drug interactions should be considered when prescribing and ED pharmacists should target patients on multidrug regimens for specific evaluation.

In this adolescent with co-morbid ADHD and OCD, we observed that the adjunctive use of methylphenidate resulted in enhanced treatment response to both psychological and pharmacological interventions for OCD. This case highlights the need to identify and treat co-morbid ADHD in OCD cases where progress has stalled.

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