Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2020
Observational StudyUtility of calcium, magnesium and phosphate testing in the emergency department.
To determine how frequently calcium (Ca), magnesium (Mg) and phosphate (PO4 ) tests change ED patient management. ⋯ Ca, Mg and PO4 testing is common. However, the yield of clinically significant abnormal levels is low and patient management is rarely changed. Testing of these electrolytes needs to be rationalised.
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Emerg Med Australas · Feb 2020
Letter Case ReportsWhen fantasy fades: A case of severe delirium due to GHB withdrawal.
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Emerg Med Australas · Feb 2020
Anxiety and alcohol in the working-age population are driving a rise in mental health-related emergency department presentations: 15 year trends in emergency department presentations in Western Australia.
To evaluate age, gender and disease-specific trends in ED for mental health presentations over 15 years. ⋯ The present study demonstrates that increased rates of mental health-related ED presentations are driven by increased rates of presentation for stress and anxiety-related and alcohol-related presentations in both genders across the working-age population.
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Emerg Med Australas · Feb 2020
Comparative StudyImpact of a ketamine sedation protocol on intubation rates and undesirable outcomes in the transport of patients with acute behavioural disturbance.
To identify the effects of the introduction of a ketamine sedation protocol on the rates of intubation and adverse events associated with retrieval of patients with acute behavioural disturbance. Transport of patients with acute behavioural disturbance poses clinical and logistical management difficulties, as well as risks. Remote Australian communities are separated by vast distances. Risks to aircraft and crew, and patient and community must be balanced. Ketamine has received increasing attention in recent years for pre-hospital sedation of behaviourally disturbed patients, predominantly with psychiatric illness. This paper explores the benefits and suitability of ketamine in undifferentiated presentations, using data from the retrieval service in Alice Springs, Australia. ⋯ The introduction of a ketamine protocol is associated with a decrease in intubation, and accordingly, a decrease in adverse events, though it is not without its risks. Further analysis is required to establish the likely cost saving to health systems.
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Emerg Med Australas · Feb 2020
Observational StudyOne single large intramuscular dose of naloxone is effective and safe in suspected heroin poisoning.
Naloxone is an established antidote for the treatment of heroin poisoning; however, dosing regimens vary widely, with a current trend towards small titrated intravenous dosing. This study aims to characterise naloxone use in the treatment of patients presenting with suspected heroin poisoning. ⋯ In this retrospective observational study, a single large i.m. dose of naloxone reversed the toxicity of suspected heroin overdose in the majority of patients. In addition, patients were less likely to require repeated intermittent doses or naloxone infusion than those treated solely with i.v. naloxone. Further comparison in a prospective study is warranted to validate these observations in confirmed heroin overdose. Requirement for sedation secondary to acute behavioural disturbance was rare regardless of the route.