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
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.
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Emerg Med Australas · Jun 2020
General practitioner-type patients in emergency departments in metro North Brisbane, Queensland: A multisite study.
To estimate the proportion of ED patients in urban Queensland who are potentially suitable for general practitioner (GP) care. ⋯ There is considerable variation in what is considered GP-type ED presentations based on the three methods employed and this variation may have fuelled the debate surrounding what is 'avoidable' ED utilisation. Regardless, the study findings provide an interesting addition to defining and addressing appropriate utilisation of ED services.
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Emerg Med Australas · Jun 2020
Observational StudyEpidemiology and effects of fluid bolus administration in the paediatric emergency department.
Fluid bolus therapy (FBT) is recommended as the initial form of acute circulatory support for many disease processes. The epidemiology of its use in the ED is unknown. The aim of this study was to assess indications, use patterns and short-term effects of FBT in a paediatric ED. ⋯ Fluid bolus therapy is a commonly used intervention in the paediatric ED, most often for dehydration. Variability in indications, dose and effects of FBT warrant further exploration.