Accuracy of ultrasound in diagnosing ankle injuries in emergency care
Conclusion Ultrasound has the potential to be a reliable method for diagnosing foot and ankle injuries, however, higher grade evidence is needed. PROSPERO registration number CRD42020215258. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Deutekom, F. E., Ridderikhof, M. L., Van Etten-Jamaludin, F., Schepers, T. Tags: Systematic review Source Type: research
Evaluation of microMend wound closure device in repairing skin lacerations
Conclusion microMend appears to be an acceptable alternative for closing skin lacerations in the ED, providing good cosmetic results, with high levels of satisfaction by patients and providers. Randomised trials are needed to compare microMend with other wound closure products. Trial registration number NCT03830515. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Nizami, T., Beaudoin, F., Suner, S., Aluisio, A., Bhatt, R. A., Jay, G. D. Tags: Open access Original research Source Type: research
Man with worsening odynophagia
Clinical introduction A 48-year-old man came to the emergency department (ED) due to a lump sensation in his throat after dinner. Neither obvious pharyngeal/laryngeal foreign body was seen with flexible nasopharyngoscopy nor apparent oesophageal abnormalities on the lateral neck radiograph (figure 1A). Due to persistent discomfort, he underwent oesophagogastroduodenoscopy without findings of upper gastrointestinal lesions. The patient returned to the ED with worsening odynophagia 5 days after the initial presentation. Another lateral neck radiograph was taken (figure 1B). Question What is the most likely diagnosis? Migrato...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Yeh, P., Lo, W.-C., Chang, C.-M. Tags: EMJ Image Challenge Source Type: research
Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis
Conclusions Reviewing automated external defibrillator (AED) locations and increasing BCPR through DAI-CPR may help prevent pandemic-associated decreases in survival rates for patients with cardiac OHCAs. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Ushimoto, T., Yao, S., Nunokawa, C., Murasaka, K., Inaba, H. Tags: Open access, COVID-19 Original research Source Type: research
Who to escalate during a pandemic? A retrospective observational study about decision-making during the COVID-19 pandemic in the UK
Conclusions Decisions who to escalate to critical care in settings with limited resources pose moral distress on clinicians. 4C score, age and CFS did not change significantly between the two surges but differed significantly between patients deemed suitable for escalation and those deemed unsuitable by clinicians. Risk prediction tools may be useful in a pandemic to supplement clinical decision-making, even though escalation thresholds require adjustments to reflect changes in risk profile and outcomes between different pandemic surges. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Beresford, S., Tandon, A., Farina, S., Johnston, B., Crews, M., Welters, I. D. Tags: Editor's choice, COVID-19 Original research Source Type: research
CXR: old school but always useful
Clinical Introduction An 80-year-old man with a medical history of hypertension, dyslipidaemia, coronary artery disease, alcohol consumption and atrial fibrillation, not anticoagulated, presented to the emergency department with sudden onset of pleuritic chest pain, dyspnoea and fever. Initial blood pressure was 165/93 mm Hg, with a heart rate of 100 beats/min, peripheral oxygen saturation of 91% (FiO2 21%) and an otherwise unremarkable physical examination. Electrocardiography showed sinus tachycardia, without other relevant changes. A CXR was performed (figure 1). Question Which diagnosis is most likely? Pneumonia. Acute...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Neto, V. D. Tags: EMJ Image Challenge Source Type: research
Role of hospital strain in determining outcomes for people hospitalised with COVID-19 in England
Conclusions High levels of bed-strain were associated with higher in-hospital mortality rates, although the effect was relatively modest and may not fully explain increased mortality rates during winter 2020/21 compared with earlier months. Shorter hospital stay during periods of greater strain may partly reflect changes in patient management over time. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Gray, W. K., Navaratnam, A. V., Day, J., Heyl, J., Hardy, F., Wheeler, A., Eve-Jones, S., Briggs, T. W. R. Tags: COVID-19 Original research Source Type: research
Every second counts: giant ECG abnormality after every second beat
Clinical introduction The patient had recently been diagnosed with heart failure and dilated cardiomyopathy (left ventricular ejection fraction: 20%). Medication included furosemide, spironolactone, bisoprolol, perindopril, indapamide. The patient was found with a cardiac arrest. After successful basic life support and stabilized circulation, the following ECG was recorded (see figure 1). Question What is the possible explanation for these ECG features? Giant TU waves due to proarrhythmic effect of propafenone (Class 1/c antiarrhythmic drug) the patient was given as paroxysmal atrial fibrillation rhythm control. Hypokalaem...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Tomcsanyi, J., Aranyi, P. Tags: EMJ Image Challenge Source Type: research
Revisiting the humble ankle sprain
Ankle injuries are one of the most common presentations to the Emergency Department (ED), but few emergency physicians would consider them to represent a diagnostic challenge. In our armoury, we already have the Ottawa ankle rules (which are highly sensitive for bony injury) and access to plain radiographs. However, Deutekom et al present a systematic review of studies evaluating the diagnostic accuracy of ultrasound for ankle injuries.1 Why should we consider another diagnostic modality for such a straightforward injury? There are three good reasons. First, plain radiographs do not detect all fractures around the ankle. A...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Metcalfe, D., Lancaster, S., Keene, D. Tags: Commentary Source Type: research
Primary survey: highlights from this issue
Not just a minor injury The term minor in the vernacular of emergency medicine is relative, often a misnomer can serve to downplay and underestimate the complexity of some injuries and the potential adverse ramifications and outcomes for patients with some minor injuries. Rightly, the primary focus for emergency medicine is saving lives; nonetheless, I was delighted to see two papers in this issue on very common non-life threatening presentations to the ED, ankle injuries and scaphoid injuries. Excluding fractures is a priority but it’s often more difficult to exclude soft tissue ruptures in a very swollen ankle, the...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Dawood, M. Tags: Highlights from this issue Source Type: research
Response to: The rSIG for trauma: one size fits all?
We thank Shi and Mao for their interest1 in our recently published article on The age-adjusted Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG/A) in prehospital assessment of trauma patients and their allocation to trauma centres or trauma team activation.2 The authors point out some shortcomings in our manuscript. We would like to take the opportunity to address them. While we agree with Shi and Mao that considering site of trauma in general is an important contributor in advanced prediction model, we feel the need to emphasise that the aim was not to determine the best possible prediction model, but to fin...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Frieler, S., Lefering, R., Gerstmeyer, J., Drotleff, N., Schildhauer, T. A., Waydhas, C., Hamsen, U., the TraumaRegister DGU Tags: PostScript Source Type: research
The rSIG for trauma: one size fits all？
We read with great interest the article by Frieler et al.1 The authors validated the accuracy of the rSIG (SBP/HRxGCS) in predicting the risk of mortality in trauma patients. The results of this study are positive. However, we have some concerns before rSIG is commonly used in the prehospital setting. First, the site of the trauma is a significant contributor to the large degree of heterogeneity in trauma; hence, anatomical variables should be considered in clinical prediction models.2 For example, there was a U-shaped relationship between SI values and mortality in patients with head injuries, which means that hypertensio...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Shi, Q., Mao, Z. Tags: PostScript Source Type: research
Top research priorities in prehospital critical care
We thank Mark Hodkinson1 for his encouraging comments regarding our recently published modified Delphi study and we agree that the output will help to expand the evidence base underlying prehospital critical care delivery.2 We would like to respond to the points raised within the letter. The author rightly notes that a considerably lower proportion of paramedics participated than doctors. We stipulated a minimum of 6 months in a prehospital critical care role for clinicians to be eligible to participate but other than this, participation was open to all for rounds 1 and 2. The study was advertised through social media, cir...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Ramage, L., McLachlan, S. Tags: PostScript Source Type: research
Top research priorities in prehospital critical care
It is pleasing to see that the long-awaited update to the top research priorities for prehospital critical care has been published,1 and the authors should be commended on their study and its valuable contribution to the literature and developing prehospital critical care. The Delphi process,1 as described by the authors, was not without its limitations. It is unfortunate that there were not more paramedics involved in the later stages of the study: 24% of subject matter experts were paramedics, compared with 76% doctors.1 The paramedic profession, particularly growth within prehospital critical care and research, has a we...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Hodkinson, M. E., Thames Valley Air Ambulance Tags: PostScript 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 - June 22, 2023 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research