The Advanced Fellowship in Emergency Medicine Revision Course
Advanced Fellowship in Emergency Medicine Revision Course
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SAQ 4
i.
BMI <12 (or rapid weight loss >1kg per week for many weeks)HR < 40 or > 120
BP <80
Postural drop >20
Temp <35
ECG – arrhythmia, QTc prolonged, ST deviation or repolarization abn
BSL <2.5
Na <125
K <3
Mg<0.7
PO4 <0.8
eGFR <60
ALT >500
Albumin <30
Neutrophil <1
 
Pass mark 6/8
 
ii.
Capacity – establish if she understands the outcomes of refusing care – she is unlikely to have capacity as she is suffering from starvation due to anorexia nervosa.
 
Consent – a mature minor may be able to give consent without parental involvement
 
Gillick competence – a mature minor may have the competence to give consent
 
But Refusal of consent is not allowed in life threatening cases in case of minors 
 
Emancipated Minor – a mature minor (>14 years) living out of home and independent of parents may be treated as an adult in the eyes of the law – not clesr if this patient would be considered such
3/4
 
Commentary
 At 15 this pt may be able to give consent for required treatment without her parents’ consent - need to assess patient’s capacity to make decisions about treatment and investigation of her anorexia nervosa.
 
she must be able to understand the nature of her medical condition (potentially life threatening)
weigh up the options for treatment and their consequences (no investigation or treatment vs recommended investigation and treatment (medical or psychiatric treatment)
 
Landmark cases in recognizing that mature minors can give consent without parental consent are Gillick (UK),  Marion (Australia). 
Refusalto consent to treatment is not covered by Gillick and treatment that is life-saving and urgent can be performed without patient or parental consent
 
Don’t have to disclose her medical information to her parents. However, in most cases it would be beneficial for parents to be involved and in this case it would be extremely prudent to try to persuade patient to inform her parents about her psychiatric illness as they will be key to supporting her through treatment.
 
References:
  1. http://www.racgp.org.au/download/documents/AFP/2011/March/201103bird.pdf- Consent to medical treatment – the mature minor
  2. http://www.healthlawcentral.com/decisions/consent-minors/
  1. UpToDate : Consent in Adolescent Health care
 
References
  1. Queensland Health Guidelines for Eating Disorders (available on APEM website)
  2. http://www.rch.org.au/clinicalguide/guideline_index/Anorexia_Nervosa/
  1. RANZCP Clinical Practice Guidelines for Eating Disorders. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(11) 1–62 (APEM website)
REFUND POLICY: All refunds are considered at the discretion of the AFEM Executive. Refunds of a maximum of 60% of the course fee is payable with valid reasons with a notice period of 8 weeks  prior to the course. Thereafter,   refunds are managed on a case by case basis.  No refunds are offered within 2 weeks of the course date. No course transfers to individuals or other courses are permitted.