Gaza: providing emergency care under fire
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 of Gaza’s hospitals are functional, millions are at imminent risk of famine and access to humanitarian assistance is minimal. I have been working in the Emergency Department in Khan Younis continuously since October 2...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Qandil, M. Tags: Open access The view from here Source Type: research
Abstracts from international emergency medicine journals
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. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research
Journal update monthly top five
This month’s update is by the Research in Emergency care, Avon Collaborative Hub based in Bristol. 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: Worth a peek—interesting, but not yet ready for prime time. Head turner—new concepts. Game changer—this paper could/should change practice. Low perfusion and missed diagnosis of hypoxemia b...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Hirst, R., Courtney, H., Dickinson, T., Milne, S., McDonnell, K., Wright, S., Hinds, F., Benger, J. Tags: Journal update Source Type: research
Cause of death in the ED of a major trauma centre in the UK
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 be improved and inform appropriate targeting of resource. In this paper, we aim to describe mortality patterns in our ED. This is a single-centre, retrospective, database review of all deaths occurring in our ED between 1 J...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: James, R. H., Jones, R., Wood, F. Tags: Research letter Source Type: research
Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study
Conclusion
This study identified four key themes related to workplace concerns and their associated barriers and opportunities for change. Culture, working environment and need for support echoed current narratives across healthcare settings. Leadership emerged more prominently than in prior studies as both a barrier and opportunity for well-being and retention in the EM workplace. Further work is needed to develop leadership skills early on in clinical training, ensure protected time to deliver the role, ongoing opportunities to refine leadership skills and a clear pathway to address higher levels of management. (Source: ...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Daniels, J., Robinson, E., Jenkinson, E., Carlton, E. Tags: Open access Original research Source Type: research
Prehospital T-MACS and HEART scores in the prediction of myocardial infarction: a prospective evaluation
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 are used to identify those at low risk of MI for consideration of early discharge. Recently, the history and ECG-only Manchester acute coronary syndrome (HE-MACS) decision aid3 and the HEAR (history, ECG, age and risk factors) sc...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Cooper, J. G., Donaldson, L. A., Coutts, A. J., Body, R., Mills, N. L. Tags: Research letter Source Type: research
Prehospital identification of acute ischaemic stroke with large vessel occlusion: a retrospective study from western Norway
Conclusion
The use of local G-FAST prehospital criteria by EMS personnel to identify patients with AIS with LVO is not suitable for selection of patients with LVO for direct transfer to a CSC. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Leto, N., Bjorshol, C. A., Kurz, M., Osteras, O., Fromm, A., Lindner, T. W. Tags: Open access Original research Source Type: research
Scoring systems for prediction of malaria and dengue fever in non-endemic areas among travellers arriving from tropical and subtropical areas
Conclusion
The presented scoring systems provide novel tools for structured assessment of patients with tropical fever in a non-endemic area and highlight clinical signs associated with a potential severe aetiology to direct the need for microbial investigation. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Satarvandi, D., van der Werff, S. D., Naucler, P., Hildenwall, H., Sonden, K. Tags: Open access Original research Source Type: research
An elderly man with chronic poor appetite
Clinical introduction A 77-year-old man with a 6-month history of poor appetite, nausea, weakness, and progressive weight loss presented to our outpatient department. He had no significant gastrointestinal or cardiovascular problems. Abdominal findings are pictured in figure 1. Question What is the most likely diagnosis? Omphalitis Umbilical abscess Urachal remnant Umbilical metastasis (Sister Mary Joseph’s nodule) Answer: D His abdominal findings showed conjunctival pallor and a firm, painless, blackish nodule on the umbilicus suggestive as umbilical metastasis (figure 2). Umbilical metastasis, also called Sister Ma...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Matsuura, H., Kageyama, H. Tags: EMJ Image Challenge Source Type: research
Which low urgent triaged febrile children are suitable for a fast track? An observational European study
Conclusion
We determined that febrile children triaged as low urgent with respiratory symptoms were most suitable for a fast track. This study provides evidence for which children could be triaged to a fast track, potentially improving overall patient flow at the ED. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Tan, C. D., Vermont, C. L., Zachariasse, J. M., von Both, U., Carrol, E. D., Eleftheriou, I., Emonts, M., van der Flier, M., Herberg, J., Kohlmaier, B., Levin, M., Lim, E., Maconochie, I. K., Martinon-Torres, F., Nijman, R. G., Pokorn, M., Rivero-Calle, I Tags: Open access Original research Source Type: research
Prevalence of invasive bacterial infection in febrile infants
Conclusion
COVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests.
PROSPERO registration number
CRD42022356507. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Perez-Porra, S., Granda, E., Benito, H., Roland, D., Gomez, B., Velasco, R. Tags: COVID-19 Systematic review Source Type: research
Older man with acute dyspnoea
Discussion Patients with aortic dissection (AD) can present with various symptoms, including syncope, altered consciousness, stroke or even absence... (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Chen, H.-A., Chang, B.-L., Chang, C.-J. Tags: EMJ Image Challenge Source Type: research
Is it time to incorporate viral testing results within clinical practice guidelines for febrile infants?
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 decreased, largely due to vaccination and maternal antibiotic prophylaxis. The role of viral testing in medical decision-making for febrile infants is not clearly established. Prior work has suggested that febrile infants with ...
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Money, N., Ramgopal, S. Tags: Commentary Source Type: research
Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score
Conclusion
The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Douillet, D., Riou, J., Morin, F., Mahieu, R., Chauvin, A., Gennai, S., Ferrant, L., Lopez, R., Sebbane, M., Plantefeve, G., Brice, C., Cayeux, C., Savary, D., Moumneh, T., Penaloza, A., Roy, P. M. Tags: COVID-19 Original research Source Type: research
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)
Conclusions
Return ED visits by patients with COVID-19 within 30 days were common during the first two pandemic years and were associated with multiple factors, many of which reflect known risk for worse outcomes. Future studies should assess reasons for revisit and opportunities to improve ED care and reduce resource use.
Trial registration number
ClinicalTrials.gov, NCT04702945. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - March 21, 2024 Category: Emergency Medicine Authors: Rosychuk, R. J., Khangura, J. K., Ortiz, S. S., Cheng, I., Bielska, I. A., Yan, J., Morrison, L. J., Hayward, J., Grant, L., Hohl, C. M., on behalf of the Canadian COVID-19 Rapid Response Network (CCEDRRN) for the Network of Canadian Emergency Researchers Tags: COVID-19 Original research Source Type: research
