In this August issue

We publish a valuable paper comparing management of primary spontaneous pneumothorax before and after completion of a multi-centre study that shows non-inferiority between conservative and interventional treatment for the condition.

Abdominal and pelvic pain accounted for 4.7% of ED presentations in Australia in 2022–2023. A survey of 8657 people living in NSW found prevalence rates of abdominal pain or discomfort in the preceding 3 months of 13% in individuals with diabetes mellitus (DM) compared with 10.8% in controls. The prevalence of type 2 DM in Australia increased from 1985 to 3429 per 100 000 population between 1990 and 2019. Incidence rates of type 1 DM remained stable between 2000 and 2018. We publish a comprehensive review of abdominal pain in patients with diabetes mellitus of relevance to the ED.

A fascinating, multicentre study reports on the current use of TEM in Australasia. The COVID-19 pandemic catapulted telehealth to the forefront of EM as an alternative way of assessing and managing patients, challenging the traditional idea that EM can only be practised in bricks-and-mortar EDs. Many clinicians may find the idea of practising TEM confronting, particularly without training and practice guidelines.

A team from Queensland report on ‘Deadly-RED’, a project aiming to improve culturally competent care to reduce the number of First Nations people presenting to a Queensland ED who ‘take own leave’ (TOL). They report significant discrepancies in the data points of TOL and the story of the First Nations peoples' experience of appropriate and completed care. Staff awareness and cultural capability improved significantly and yarning allowed knowledge translation and improved communication, contributing to better health care experiences for First Nations people attending an ED.

In overdose, gamma-hydroxybutyrate (GHB) and its precursors can cause decreased level of consciousness, coma, and death. A team from Sydney analysed the databases of four Sydney metropolitan EDs for presentations relating to GHB exposure between 2012 and 2021. 3510 GHB related presentations were recorded across the four hospitals. Data for all hospitals were only available from 2015 onwards; between 2015 and 2021 there was a 114% increase in annual presentations from 228 to 487. The proportion of them with a triage category one increased from 19.7% to 34.5%. These changes are a major public health concern.

Reducing perceived unnecessary resource use, a team from NSW modified their unit's tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. Their study reports interesting results. This new team structure was safe, reduced admissions, pathology and imaging, but led to an increased ED length of stay and time to surgical review.

Indonesia and French Guiana share some geographic and medical concerns regarding access to care. Organizational needs in emergency management, particularly in the pre-hospital phase, are similar. Whereas emergency medicine is an academic and specialty in France, it is still in development in Indonesia. Under French and Indonesian academic cooperation, the Medical school in Jakarta University and the French Guiana University in Cayenne signed a Memorandum of Understanding for education programs, research, and student and health professional exchanges in Emergency Medicine. The first class began in August 2022; fifty Indonesian doctors graduated in August 2023.

Vitamin B17 tablets are sold online as an alternative cancer therapy medication. Its use is not benign, given that it is metabolized into hydrogen cyanide which carries significant health risk and expenditure.

The focus in this issue is artificial intelligence and the rise of machine learning in medicine.