Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2020
ReviewReview article: A primer for clinical researchers in the emergency department: Part XI. Inertia before investigation: Pre-test probability in emergency medicine.
In this series, we address research topics in emergency medicine. Rational clinical decision making is based on knowledge of the disease prevalence, clinical assessment features and test characteristics such as sensitivity and specificity. The concept of pre-test probability is important as it will allow the clinician and patient decide together if a 'test threshold' or 'treatment threshold' has been reached, or if further investigations are required to make such a decision. This research primer uses three case scenarios to explore these concepts.
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Emerg Med Australas · Jun 2020
Multicenter Study Observational StudyComprehensive identification of medication-related problems occurring prior to, during and after emergency department presentation: An Australian multicentre, prospective, observational study.
Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. ⋯ Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.
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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.