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RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-06 Christopher Humphries, Marianne Gillings
Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS. Considerations regarding recognition, investigation and communication
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Navigating the shadows: unmasking racial inequalities in the lingering wake of COVID-19 Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-06 Anukiran Ravichandran, Sivanthi Sivanadarajah, David Chung
‘It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.’ –Audre Lorde It has been over 4 years since 14 November 2019 when the first documented case of COVID-19 emerged. As the world slowly recovers from the pandemic, it has equally exposed the vulnerability in our healthcare systems. A pivotal study conducted by Khosla et al 1 illuminates
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Nurses in the eye of the storm: a study of violence against healthcare personnel working in the emergency department Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-06 Arian Zaboli, Serena Sibilio, Gabriele Magnarelli, Michael Mian, Francesco Brigo, Gianni Turcato
Episodes of physical and verbal violence, as well as psychological humiliation, are experienced daily by ED staff.1 These incidents are increasing exponentially and can cause workplace disaffection contributing to severe burnout of ED healthcare personnel.1 2 Several studies have investigated aggression and violence in the ED, focusing on the characteristics of patients who assault healthcare personnel
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Understanding RCEM Best Practice Guidelines Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-06 Christopher Humphries, Adrian A Boyle, James France, Paul Hunt
Royal College of Emergency Medicine (RCEM) Best Practice Guidelines are produced by a variety of special interest groups or convened expert advisory groups which sit under the umbrella of the College’s Quality in Emergency Care Committee (QECC).1 They are produced to bridge the gap between systematically derived evidence-based recommendations and the need for emergency clinicians to provide quality
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Determination of a whole-blood single-test low-risk threshold for a point-of-care high-sensitivity troponin assay Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 John W Pickering, Laura Hamill, Sally Aldous, Laura Joyce, R Alex Stothart, Otis Williams, Christopher M Florkowski, Martin Than
High-sensitivity troponin (hsTn) is used with ECG and clinical evaluation to stratify patients attending ED as low risk for acute myocardial infarctions (AMI). Diagnostic pathways incorporate a single test threshold for stratification with these assays. The Siemens Atellica VTLi Point-Of-Care-hsTnI assay (POC-hsTnI) has an 8 min turn-around which may expedite decision-making. Although a single-test
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Pandemic phase-related racial and ethnic disparities in COVID-19 positivity and outcomes among patients presenting to emergency departments during the first two pandemic waves in the USA Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Shaveta Khosla, Marina Del Rios, Makini Chisolm-Straker, Saadiyah Bilal, Timothy B Jang, Hao Wang, Molly Hartley, George T Loo, James P d'Etienne, Craig D Newgard, D Mark Courtney, Esther K Choo, Michelle P Lin, Jeffrey A Kline
Background In many countries including the USA, the UK and Canada, the impact of COVID-19 on people of colour has been disproportionately high but examination of disparities in patients presenting to ED has been limited. We assessed racial and ethnic differences in COVID-19 positivity and outcomes in patients presenting to EDs in the USA, and the effect of the phase of the pandemic on these outcomes
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Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-22 Michael F Bath, Laura Hobbs, Katharina Kohler, Isla Kuhn, William Nabulyato, Arthur Kwizera, Laura E Walker, Tom Wilkins, Daniel Stubbs, RM Burnstein, Angelos Kolias, Peter John Hutchinson, P John Clarkson, Sara Halimah, Tom Bashford
Background Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity. Methods We performed a systematic review to explore
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Prehospital T-MACS and HEART scores in the prediction of myocardial infarction: a prospective evaluation Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-20 Jamie G Cooper, Lorna A Donaldson, Amanda J Coutts, Richard Body, Nicholas L Mills
Chest pain suspicious for an acute myocardial infarction (MI) is a common reason for emergency ambulance contact. Most patients have a non-diagnostic ECG and transport to hospital for troponin testing is the rule. In the emergency department, tools such as the troponin-only Manchester acute coronary syndrome (T-MACS) decision aid1 and the HEART (history, ECG, age, risk factors and troponin) score2
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Primary survey: highlights from this issue Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Edward Carlton
Many medical journals run themed issues where authors are invited to submit articles, usually around a specific clinical condition, and coordinated by guest editors. We have long debated whether we should take this approach at the Emergency Medicine Journal . Perhaps the sheer variety of conditions we see on a day-to-day basis in emergency medicine means that a broader approach to publication of our
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Finding the needle in the haystack: towards better diagnosis of acute aortic syndromes Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Peter Jones
McLatchie and colleagues present observational data on the prevalence of acute aortic syndromes (AAS) in 27 emergency departments (ED) in the UK, over 2–55 days.1 They found that the prevalence of AAS was around 1 in 300 patients presenting to ED with chest, back or abdominal pain; or ‘malperfusion’ (defined as stroke, myocardial infarction, bowel or limb ischaemia), while the CT aortogram rate was
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Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Rachel McLatchie, Matthew J Reed, Nicola Freeman, Richard A Parker, Sarah Wilson, Steve Goodacre, Alicia Cowan, Jessica Boyle, Benjamin Clarke, Ellise Clarke
Background The diagnosis of acute aortic syndrome (AAS) is commonly delayed or missed in the ED. We describe characteristics of ED attendances with symptoms potentially associated with AAS, diagnostic performance of clinical decision tools (CDTs) and physicians and yield of CT aorta angiogram (CTA). Methods This was a multicentre observational cohort study of adults attending 27 UK EDs between 26 September
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Mortality and risk factors associated with misdiagnosis of acute aortic syndrome in Ontario, Canada: a population-based study Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Robert Ohle, David W Savage, Joseph Caswell, Sarah McIsaac, Krishan Yadav, Michael Conlon
Introduction Acute aortic syndrome (AAS) is a life-threatening aortic emergency. It describes three diagnoses: acute aortic dissection, acute intramural haematoma and penetrating atherosclerotic ulcer. Unfortunately, there are no accurate estimates of the miss rate for AAS, risk factors for missed diagnosis or its effect on outcomes. Methods A population-based retrospective cohort study of anonymously
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Survey of current policy regarding the recognition and management of acute aortic syndrome in Great Britain Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Salma Alawiye, Graham Cooper, Catherine Fowler, Matthew J Reed
Acute aortic syndrome (AAS) is a life-threatening condition constituting acute aortic dissection (AAD), intramural haematoma and penetrating aortic ulcer.1 2 The diagnosis of AAS is plagued by uncertainty,3 up to 38% of cases are missed at first ED presentation and up to 25% are diagnosed 24 hours after ED presentation.4 The Aortic Dissection Detection Risk Score5 and the Canadian Clinical Practice
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Consensus statement on the interhospital transfer of patients with acute aortic syndrome: TRAVERSING Delphi study Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Aleksandra Staniszewska, Kamran Gaba, Benjamin Patterson, Sarah Wilson, Rachel Bell, Colin Bicknell, Marcus Brooks, Mark Callaway, Stephen Goode, Scott Grier, Alex Hobson, Ronelle Mouton, Simon Neequaye, Gareth Owens, Cha Rajakaruna, Emma Redfern, Geoffrey Tsang, Robert Hinchliffe
Background Standardisation of referral pathways and the transfer of patients with acute aortic syndromes (AAS) to regional centres are recommended by NHS England in the Acute Aortic Dissection Toolkit. The aim of the Transfer of Thoracic Aortic Vascular Emergencies to Regional Specialist INstitutes Group study was to establish an interdisciplinary consensus on the interhospital transfer of patients
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Four-factor prothrombin complex concentrate versus andexanet alfa for the reversal of traumatic brain injuries Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Erin Sadek, William Curtiss, Jessica Andrews, Jason Hecht
Background Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. The objective of this study is to evaluate outcomes of reversal with these agents in patients with isolated traumatic brain injuries (TBI). Methods This is a retrospective review
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Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Chartelin Jean Isaac, Lynne Moore, Mélanie Bérubé, Étienne Belzile, Christian Malo, Marianne Giroux, Amina Belcaid, Godwill Abiala, David Trépanier, Marcel Émond, Clermont E Dionne
Background Patients >64 years of age now represent more than 51% of injury hospitalisations in Canada. The tools used to identify older patients who could benefit the most from an interdisciplinary approach include complex parameters difficult to collect in the ED, which suggests that better tools with higher accuracy and using items that can be derived from routinely collected data are needed. We
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Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Yuanwei Xu, Nabeela Malik, Saisakul Chernbumroong, James Vassallo, Damian Keene, Mark Foster, Janet Lord, Antonio Belli, Timothy Hodgetts, Douglas Bowley, George Gkoutos
Background Major incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients—those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have limited evidence supporting their use. This study employs machine learning (ML) to develop and validate models for novel primary and secondary triage tools
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Thematic analysis of ‘Prevention of Future Deaths’ reports related to emergency departments in England and Wales 2013–2022 Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Sarah Hodgson, Keiran O'Mahony, James Nicholson, Pete Williams
Since 2013, coroners in England and Wales have issued ‘Prevention of Future Deaths’ (PFD) reports to individuals or organisations if, following an inquest, they believe action should be taken to prevent further avoidable deaths. The Chief Coroner’s annual report details the operation of the coroner’s service and does not collate PFD findings.1 By contrast, Australia’s coronial system collates all inquest
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Comparison of diuretics and fluid expansion in the initial treatment of patients with normotensive acute pulmonary embolism: a systematic review and meta-analysis Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Cláudia Febra, Ana Rita Santos, Isabel Cabrita, Joana Bento, João Pacheco, Mariana Mendes, Michael Isidro, Rafael Batista, Ana Margarida André Febra Moita Macedo
Background Right ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic review and meta-analysis focused on the comparison of diuretics and fluid expansion in patients with acute PE presenting with RV dysfunction and haemodynamic stability. Methods A systematic
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Journal update monthly top five Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Gabrielle Prager, Robert Hirst, Daniel Darbyshire, Patricia Van Den Berg, Govind Oliver, Thomas Alexander Gerrard Shanahan, Simon David Carley
This month’s update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: ### Topic:
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Abstracts from international emergency medicine journals Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 EMJ Production
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication. No data are available.
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Seventy-five-year-old woman with month-long fever, cavity lung lesions and cutaneous ulcer Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Chang-Han Wu, Chi-Wei Chen
An elderly Asian woman presented to the ED with month-long fever, rhinorrhea and productive cough. She subsequently developed tender bruise-like skin nodules over her trunk and limbs, which quickly progressed to form cavity ulcers 2 weeks before ED visit (figure 1). Despite various antimicrobial therapies, her symptoms did not improve. Laboratory tests showed leukocytosis, elevated C reactive protein
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Unusual cause of recurrent aspiration pneumonia Emerg. Med. J. (IF 3.1) Pub Date : 2024-03-01 Hiroki Matsuura, Ryota Imamura
An 88-year-old man with intermittent fever, cough, vomiting and progressive dysphagia was transferred to our ED. His medical history was moderate hypertension and hyperlipidaemia. His family disclosed he had frequent repeated aspiration pneumonia within 3 months. A chest radiograph showed an obvious consolidation of the right lower lobe. Lateral radiograph of cervical spine was shown in figure 1. Figure
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Characteristics and outcomes of patients with COVID-19 who return to the emergency department: a multicentre observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-16 Rhonda J Rosychuk, Jaspreet K Khangura, Sylvia S Ortiz, Ivy Cheng, Iwona A Bielska, Justin Yan, Laurie J Morrison, Jake Hayward, Lars Grant, Corinne M Hohl
Objective Unplanned return emergency department (ED) visits can reflect clinical deterioration or unmet need from the original visit. We determined the characteristics and outcomes of patients with COVID-19 who return to the ED for COVID-19-related revisits. Methods This retrospective observational study used data for all adult patients visiting 47 Canadian EDs with COVID-19 between 1 March 2020 and
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Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-16 Delphine Douillet, Jérémie Riou, François Morin, Rafaël Mahieu, Anthony Chauvin, Stéphane Gennai, Lionel Ferrant, Raphaëlle Lopez, Mustapha Sebbane, Gaëtan Plantefeve, Christian Brice, Coralie Cayeux, Dominique Savary, Thomas Moumneh, Andrea Penaloza, Pierre Marie Roy
Background The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. Methods A revised HOME-CoV
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Best Evidence Topic report: Antithrombotic therapy and endovascular intervention for blunt cerebrovascular injury Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-15 Luke Cutts, Chris Gray, Navdeep Gill, Daniel Horner
A short cut review of the literature was carried out to examine the evidence supporting antithrombotic treatment and/or endovascular therapy to reduce mortality and/or prevent future stroke following blunt cerebrovascular injury (BCVI). Five papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study
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Scoring systems for prediction of malaria and dengue fever in non-endemic areas among travellers arriving from tropical and subtropical areas Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-14 Donya Satarvandi, Suzanne Desirée van der Werff, Pontus Nauclér, Helena Hildenwall, Klara Sondén
Background Fever is a common symptom among travellers returning from tropical/subtropical areas to Europe, and promptly distinguishing severe illnesses from self-limiting febrile syndromes is important but can be challenging due to non-specific clinical presentation. Methods A cross-sectional study enrolled adults and children who sought care during 2015–2020 at Karolinska University Hospital, Stockholm
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Diagnostic accuracy of venous system ultrasound for subtypes of acute kidney injury Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-14 Mehmet Ali Aslaner, Özant Helvacı, Korbin Haycock, İsa Kılıçaslan, Emre Yaşar, Mahi Nur Cerit, Halit Nahit Şendur, Galip Güz, Ahmet Demircan
Background Management of acute kidney injury (AKI) in the ED can be difficult due to uncertainty regarding the aetiology. This study investigated the diagnostic value of venous system ultrasound for determining the aetiological subtypes of AKI in the ED. Methods This multidisciplinary prospective cohort study was conducted in a single academic ED over the course of a year. Adult patients with AKI were
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Gaza: providing emergency care under fire Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-11 Mohammed Qandil
Dr Mohammed Qandil, an Emergency Medicine and Critical Care consultant and member of the Royal College of Emergency Medicine, is head of the Emergency Department at the Nasser Medical Complex in Khan Younis which is in the south of Gaza. At the time of writing and since the beginning of October 2023 there have been over 24 000 reported Palestinian fatalities with over 61 000 injured. Less than one-third
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Trends in the mortality of intra-abdominal infections in adults over 25 years in the USA, 1999–2021 Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-05 Yi Liu, Jamil S Samaan, Youssef M Essanaa, Fan Lv, Fanpu Ji, Kamran Samakar, Yee Hui Yeo
Intra-abdominal infections are the second most common source of severe sepsis and successful treatment relies on early intervention and appropriate resources.1–3 The COVID-19 pandemic has disrupted the global healthcare system as evidenced by a national study in England showing reduced admissions and higher 90-day mortality for common acute surgical conditions.4 5 We examined intra-abdominal infection-related
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External validation of a rapid algorithm using high-sensitivity troponin assay results for evaluating patients with suspected acute myocardial infarction Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-05 Louise Cullen, Jaimi H Greenslade, Laura Stephensen, Isuru Ranasinghe, Niranjan Gaikwad, Maryam Khorramshahi Bayat, Ehsan Mahmoodi, Martin Than, Fred Apple, William Parsonage, SAMIE study group 2022
Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI). Methods This was a multicentre prospective observational study of adult ED patients presenting to five Australian hospitals
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High-sensitivity troponin testing at the point of care for the diagnosis of myocardial infarction: a prospective emergency department clinical evaluation Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Jemima May Curran, Aleksandra Mergo, Sarah White, Bernard L Croal, Jamie G Cooper
In the ED, laboratory high-sensitivity cardiac troponin (hs-cTn) tests facilitate ‘rule-out’ of myocardial infarction (MI).1 Contemporary point-of-care (POC) troponin tests have inferior analytical sensitivity,2 preventing rapid ‘rule-out’ strategies in near-patient settings. The new Siemens Atellica VTLi POC test meets hs-cTn criteria.3 Between June and September 2022, adult ED patients (≥16 years)
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Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-22 Silvia Pérez-Porra, Elena Granda, Helvia Benito, Damian Roland, Borja Gomez, Roberto Velasco
Background Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI). Objective To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test. Methods MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February
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Primary survey: highlights from this issue Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Sarah Edwards
Welcome to February 2024’s primary survey for the EMJ . I very much hope as we move into the second month of 2024, things can be as calm as possible in the world of emergency medicine (EM). Pain is one of the most common reasons that people present to the emergency department (ED). Therefore, it seems fitting this month’s journal is covering topics from sedation and pain management through to toxicology
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A green evidence base to drive environmentally sustainable practice Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Alexander Robertson
Worldwide, the healthcare sector is responsible for approximately 4.4% of the global carbon footprint.1 As a healthcare system we need to reduce our environmental footprint, along with the rest of society, to ensure a safe and liveable future. This must be done in an evidence-based way, to ensure that any changes we make in our practice do really reduce our environmental impact rather than working
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Environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia: how green is the ‘green whistle’? Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Aleksis EV Martindale, Daniel S Morris, Thomas Cromarty, Amarantha Fennell-Wells, Brett Duane
Background The NHS has the target of reducing its carbon emission by 80% by 2032. Part of its strategy is using pharmaceuticals with a less harmful impact on the environment. Nitrous oxide is currently used widely within the NHS. Nitrous oxide, if released into the atmosphere, has a significant environmental impact. Methoxyflurane, delivered through the Penthrox ‘green whistle’ device, is a short-acting
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Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Sean Croughan, Michael Barrett, Ronan O'Sullivan, Aidan Beegan, Carol Blackburn
Background Nitrous oxide (N2O) has multiple benefits in paediatric procedural sedation (PPS), but use is restricted by its limited analgesic properties. Analgesic potency could be increased by combining N2O and intranasal fentanyl (INF). We assessed safety and efficacy data from 10 years (2011–2021) of our N2O PPS programme. Methods Prospectively collected data from a sedation registry at a paediatric
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Effect of intranasal sufentanil on acute post-traumatic pain in the emergency department: a randomised controlled trial Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Stefano Malinverni, Bernard Kreps, Thibault Lucaccioni, Fatima-Zohra Bouazza, Magali Bartiaux, Alain Plumacker, Andreea Pascu, Pierre Youatou Towo
Background Intranasal sufentanil is a potent opioid which can be used in patients with traumatic injuries presenting to the ED. Although previous studies have demonstrated the superiority of intranasal sufentanil over intravenous morphine in terms of pain relief, its clinical superiority in patients with traumatic injuries receiving adequate multimodal analgesia with acetaminophen and non-steroidal
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Is there an optimal place for holding the tracheal tube during intubation? A proof-of-concept randomised clinical trial Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Manisha Sahoo, Swagata Tripathy, Nitasha Mishra, Dona Saha
Background The optimal way to hold an endotracheal tube (ETT) during intubation has not been studied. In this randomised clinical trial, we examined the effect of site—holding the ETT in two different positions on time and ease of intubation by anaesthesia trainees. Methods A single-centre, randomised trial of intubations of stable patients with uncomplicated airways was conducted from 15 September
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High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Naazia Siddiqua, Roshan Mathew, Ankit Kumar Sahu, Nayer Jamshed, Jyothiswaroop Bhaskararayuni, Praveen Aggarwal, Akshay Kumar, Maroof Ahmad Khan
Objectives Sympathetic crashing acute pulmonary edema (SCAPE) is a subset of heart failure with a dramatic presentation. The unique physiology of this condition requires a different management strategy from the conventional practice. The trial objective was to compare the efficacy of high-dose and low-dose GTN in patients with SCAPE. Methods This was an open-label randomised control trial conducted
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Balanced crystalloids (RInger’s lactate) versus normal Saline in adults with diabetic Ketoacidosis in the Emergency Department (BRISK-ED): a pilot randomised controlled trial Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Justin W Yan, Ahmed Slim, Kristine Van Aarsen, Yun-Hee Choi, Christopher Byrne, Naveen Poonai, Haley Collins, Kristin K Clemens
Background Current diabetic ketoacidosis (DKA) treatment guidelines recommend using normal saline (NS); however, NS may delay DKA resolution by causing more hyperchloremic metabolic acidosis compared with balanced crystalloids. This study’s objective was to determine the feasibility of a future multicentred randomised controlled trial (RCT) comparing intravenous Ringer’s lactate (RL) with NS in managing
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Trip-killers: a concerning practice associated with psychedelic drug use Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Gregory Yates, Emily Melon
Psychedelic drugs such as lysergic acid diethylamide (LSD) and psilocybin (‘magic mushrooms’) induce hallucinations and distort thought-processes. The intensity of a psychedelic ‘trip’ can cause distress, agitation, and even psychosis. A recent report showed that at least 8.4% of drug-related presentations to European emergency departments involve psychedelics.1 This proportion may increase as the
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Outcomes and resource utilisation of patients presented to the emergency department with opioid and benzodiazepine poisoning Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Christine Ramdin, Michael Makutonin, Lewis S Nelson, Andrew C Meltzer, Maryann Mazer-Amirshahi
Many overdose deaths are associated with patient co-use of opioids and other substances, such as benzodiazepines.1–3 However, the literature is sparse surrounding the characteristics, treatment, outcomes, costs, disposition and resource utilisation of people who co-use compared with those who use opioids alone. This is an Institutional Review Board-exempt retrospective review of de-identified ED data
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Increasing the use of anxiolysis and analgesia for paediatric procedures in a community emergency department network: a quality improvement initiative Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Mariann Nocera Kelley, Willliam Lynders, Emily Pelletier, Megan Petrucelli, Beth Emerson, Gunjan K Tiyyagura, Michael Paul Goldman
Prior reports describe the care children receive in community EDs (CEDs) compared with paediatric EDs (PEDs) as uneven. The Emergency Medical Services for Children (EMSC) initiative works to close these gaps using quality improvement (QI) methodology. Project champion from a community hospital network identified the use of safe pharmacological and non-pharmacological anxiolysis and analgesia (A&A)
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Best Evidence Topic report: does blood group type O decrease the risk of severe COVID-19 infection? Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Mostafa Alavi-Moghaddam, Zohreh Tajabadi, Sogand Najafpour
A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In patients with COVID-19 infection, does blood group type O versus non-O blood groups lead to a lower risk of severe COVID-19 infection? MEDLINE, Embase, and Cochrane databases were searched for relevant evidence. Altogether, 238 papers were found using the search strategy developed. Seventeen
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Journal update Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Robert Hywel James, Felix Wood, Jonathon Lowe, Mathias Ferrari, Kara Hole, Ed Benjamin Graham Barnard, Laura Cottey
This month’s update is by the Academic Department of Military Emergency Medicine and University Hospitals Plymouth NHS Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line
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Abstracts from international Emergency Medicine journals Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 EMJ Production
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication. No data are available.
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Man with swollen arm Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Shih-Chia Yang, Chi-Wei Lee
A previously healthy 39-year-old male presented to the emergency department with intermittent right arm swelling for 1 month, which worsened over 4 days (figure 1). He is a right-handed chef and often raised his right arm at work. He denied fever or recent trauma. On examination, radial artery pulse was palpable. There was no cervical or axillary lymphadenopathy. His vital signs were stable, while
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A child with rare post-traumatic bilateral shoulder deformities Emerg. Med. J. (IF 3.1) Pub Date : 2024-02-01 Joo Ken Au Yong, Michael Barrett, Clare Brenner
A 13-year-old boy was brought to the ED after being hit by an oncoming car. As the car approached him from his side, he tried to stop the car by turning around and put both his hands in front of him. He tried to break the subsequent fall by stretching both arms outwards before hitting the road. On arrival in the ED, he held both shoulders in an abducted position above his head. Any attempt to move
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Which low urgent triaged febrile children are suitable for a fast track? An observational European study Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-18 Chantal D Tan, Clementien L Vermont, Joany M Zachariasse, Ulrich von Both, Enitan D Carrol, Irini Eleftheriou, Marieke Emonts, Michiel van der Flier, Jethro Herberg, Benno Kohlmaier, Michael Levin, Emma Lim, Ian K Maconochie, Federico Martinon-Torres, Ruud G Nijman, Marko Pokorn, Irene Rivero-Calle, Aleksandra Rudzāte, Maria Tsolia, Werner Zenz, Dace Zavadska, Henriette A Moll
Background The number of paediatric patients visiting the ED with non-urgent problems is increasing, leading to poor patient flow and ED crowding. Fast track aims to improve the efficiency of evaluation and discharge of low acuity patients. We aimed to identify which febrile children are suitable for a fast track based on presenting symptoms and management. Methods This study is part of the Management
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Can acutely ill patients predict their outcomes? A scoping review Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-18 Elisabeth Margaretha Mols, Harm Haak, Mark Holland, Bo Schouten, Stine Ibsen, Hanneke Merten, Erika Frischknecht Christensen, Prabath W B Nanayakkara, Christian Hans Nickel, Immo Weichert, John Kellett, Christian Peter Subbe, Marjolein N T Kremers
Introduction The full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients’ estimates of their likely prognosis have been explored in chronic care settings and can contribute to the improvement of clinical outcomes and patient satisfaction. This scoping review aimed to identify studies of acutely ill patients’ estimates of their outcomes and potential
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Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection to radiologist levels Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-17 Pranav Warman, Anmol Warman, Roshan Warman, Andrew Degnan, Johan Blickman, David Smith, Paul McHale, Zachary Coburn, Sean McCormick, Varun Chowdhary, Dev Dash, Rohit Sangal, Jason Vadhan, Tulio Bueso, Thomas Windisch, Gabriel Neves
Background Tools to increase the turnaround speed and accuracy of imaging reports could positively influence ED logistics. The Caire ICH is an artificial intelligence (AI) software developed for ED physicians to recognise intracranial haemorrhages (ICHs) on non-contrast enhanced cranial CT scans to manage the clinical care of these patients in a timelier fashion. Methods A dataset of 532 non-contrast
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Cause of death in the ED of a major trauma centre in the UK Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-12 Robert Hywel James, Rhiannon Jones, Felix Wood
No body collects data on cause of death in UK EDs. While the literature contains some reports of causes of death in EDs, the methodology used does not lend itself to complete capture of causes of deaths. Also, the reports in the literature are from health systems not analogous to the UK’s.1 2 An accurate understanding of the cause of death in ED populations may highlight areas of care that need to
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Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-09 Jo Daniels, Emilia Robinson, Elizabeth Jenkinson, Edward Carlton
Background Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating to working conditions and working practices in Emergency Departments (EDs). Methods A qualitative approach was taken, using focus groups with ED staff (doctors, nurses, advanced care practitioners)
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Is it time to incorporate viral testing results within clinical practice guidelines for febrile infants? Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-04 Nathan Money, Sriram Ramgopal
The prevalence of bacteraemia and bacterial meningitis (commonly referred to as invasive bacterial infections or IBIs) among febrile infants informs ED clinician management decisions about the need for testing, treatment or hospitalisation. Using increasingly sophisticated risk stratification technologies, the management of these infants has evolved over time. Concurrently, the prevalence of IBI has
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Primary survey: highlights from this issue Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-01 Richard Body
Happy New Year and welcome to the January 2024 issue. We have an enticing array of articles on offer to kick start your new year and rekindle your enthusiasm for our wonderful specialty. Acute behavioural disturbance (ABD) has gained a lot of attention in recent years, following a number of high profile cases covered by the media. This is a challenging presentation riddled with pitfalls in the emergency
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When is a diagnosis not a diagnosis? Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-01 Aileen O'Brien
The term ‘acute behavioural disturbance’ (ABD) is contentious, tensions around its use being apparent across and between health and criminal justice agencies in the UK. This raises interesting questions. If it is not a diagnosis, what is it? And who gets to decide? This Delphi study by Humphries et al 1 goes some way to clarify the views of professionals and hopefully opens the door to the collaborative
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Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-01 Christopher Humphries, Anthony Kelly, Aws Sadik, Alison Walker, Jason Smith
Background Acute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff groups to support the identification, prioritisation and delivery of care to this group of patients. The terminology currently used is inconsistent and confusing. This study aimed to reach a consensus on the
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Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-01 Todd A Florin, Octavio Ramilo, Russell K Banks, David Schnadower, Kimberly S Quayle, Elizabeth C Powell, Michelle L Pickett, Lise E Nigrovic, Rakesh Mistry, Aaron N Leetch, Robert W Hickey, Eric W Glissmeyer, Peter S Dayan, Andrea T Cruz, Daniel M Cohen, Amanda Bogie, Fran Balamuth, Shireen M Atabaki, John M VanBuren, Prashant Mahajan, Nathan Kuppermann
Objective The lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants. Study design Secondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency
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A clinical decision rule to rule out bloodstream infection in the emergency department: retrospective multicentric observational cohort study Emerg. Med. J. (IF 3.1) Pub Date : 2024-01-01 Jonathan Pehlivan, Delphine Douillet, Riou Jérémie, Clément Perraud, Alexandre Niset, Matthieu Eveillard, Rachel Chenouard, Rafael Mahieu
Background We aimed to identify patients at low risk of bloodstream infection (BSI) in the ED. Methods We derived and validated a prediction model to rule out BSI in the ED without the need for laboratory testing by determining variables associated with a positive blood culture (BC) and assigned points according to regression coefficients. This retrospective study included adult patients suspected