Emergency medicine Australasia : EMA
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Diabetic ketoacidosis, a life-threatening complication of type 1 diabetes mellitus, is a common cause of presentation to EDs. Two new drug classes have been found to cause ketoacidosis with distinctive presentations. The sodium-glucose transport protein 2 inhibitors used in the management of type 2 diabetes mellitus may present with ketoacidosis with normal glucose levels. ⋯ Other causes of metabolic acidosis with both high and normal anion gap need to be considered in the differential diagnosis of ketoacidosis. Diabetic ketoacidosis may also present with biochemical changes suggestive of myocardial ischaemia and pancreatitis in the absence of these pathologies. The present paper reviews ketone body metabolism, ketone testing and the causes and differential diagnosis of ketoacidosis with particular relevance to emergency medicine.
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Emerg Med Australas · Jun 2020
Paediatric intubation in Australasian emergency departments: A report from the ANZEDAR.
To describe the epidemiology, clinical practice and outcomes of paediatric ED intubation in Australia and New Zealand. ⋯ Paediatric intubation in Australasian EDs is rare from a departmental and individual provider viewpoint. Success rates are similar to contemporary international registries. Complications are common and ongoing collaborative multicentre audit with resultant quality improvement is desirable to facilitate improved success and reduced complications.
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Emerg Med Australas · Jun 2020
Clinical TrialEffect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non-randomised trial.
As the population of Australia ages, EDs will experience an increasing frequency of presentations of older adults from residential aged care facilities (RACFs). These presentations are often complex and time consuming in the chaotic and potentially hazardous ED environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to optimise the care of frail older adults, especially RACF residents, in the ED. The aim of the present study was to evaluate the effectiveness of the GEDI model on the primary outcomes of disposition (admission, discharge or death) and ED length of stay for residents of RACFs, presenting to an ED in regional Queensland, Australia. ⋯ There is a paucity of evidence to support the implementation of nurse-led teams in EDs designed to target older adults living in RACFs. The GEDI model was effective in reducing ED length of stay while increasing the likelihood of safe discharge for RACF residents.
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Emerg Med Australas · Jun 2020
Clinical and ethical challenges for emergency departments during communicable disease outbreaks: can lessons from Ebola Virus Disease be applied to the COVID-19 pandemic?
EDs fulfil a frontline function during public health emergencies (PHEs) and will play a pivotal role during the COVID-19 pandemic. This perspective article draws on qualitative data from a longitudinal, ethnographic study of an Australian tertiary ED to illustrate the clinical and ethical challenges faced by EDs during PHEs. ⋯ Given the narrow window of opportunity to prepare for a surge of COVID-19 presentations, there is an immediate need to reflect and learn from previous experiences. To maintain the confidence of ED clinicians, and minimise the risk of moral injury, hospital and public health authorities must urgently develop processes to support ethical healthcare delivery and ensure adequate resourcing of EDs.
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Emerg Med Australas · Jun 2020
Emergency department impact following the introduction of an electric scooter sharing service.
We aimed to describe the impact on the single ED serving Dunedin, New Zealand, following the introduction of an electric-scooter (e-scooter) sharing service. ⋯ The introduction of an e-scooter sharing service resulted in a new injury hazard. Our study presents the number of e-scooter related ED presentations relative to other vehicles related injury visits and describes the injury patterns associated with e-scooter use which may inform future public policy.