114 Comprehensive geriatric assessment in the emergency department: a prospective cohort study of process, clinical and patient-reported outcomes
Conclusion
CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on integration of services across the healthcare system. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: OShaughnessy, I., Ryan, D., Robinson, K., Whiston, A., Barry, L., Synnott, A., McCarthy, A., Jones, B., Moriarty, E., Carroll, I., Leahy, A., OConnor, M., Devlin, C., Corey, G., Hartigan, D., Steed, F., Carey, L., Shanahan, E., Shchetkovskyy, D., Galvin, Tags: Oral Presentations Source Type: research
84 Implementation of emergency department discharge diagnosis coding - a national pilot
Conclusion
Discharge diagnoses can be assigned by emergency medicine clinicians at the point of patient discharge or referral using a standardised list of diagnoses and current information technology infrastructure. The results of the study support the proposed model of ABF for EDs, and will be used to inform further roll-out of discharge diagnosis coding. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: MacMahon, T., Gallagher, E., Eager, R. Tags: Oral Presentations Source Type: research
1 A descriptive cross-sectional study of 'alternative pre-hospital pathway team activity on patients aged 75 and over
Conclusion
The APP Team provides a valuable service by diverting elderly adults away from busy Emergency Departments. The main skills provided by the service depend on having a Doctor on board, however this study highlights some areas for Paramedic upskilling including providing them with more options for analgesia. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Rajesh, J., Deasy, C. Tags: Oral Presentations Source Type: research
Current status of emergency medicine in Kazakhstan
Kazakhstan is the ninth largest country in the world in terms of area. It is divided into 14 geographical regions and 3 big cities and has a population of 19.1 million people as of January 2021. People that live in cities comprise 58% of the total population. Kazakhstan gained its independence from the Soviet Union in 1991. Having been a part of the Soviet Union in the past, Kazakhstan’s education and science naturally mirrored those of Russia. Many generations of regional scientists have been nurtured under the influence of Russian handbooks, monographs, dissertations and seminal articles published in the central pr...
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Dolek, U. C., Gokce, M. K., Yermakhanova, Z. Tags: 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 - October 26, 2023 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 Division of Emergency Medicine, Faculty of Health Sciences, at the University of Cape Town, South Africa. 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 highlighted 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. Associatio...
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Hendrikse, C., Stassen, W., Dickerson, R., Craig, W., Khan, W., Jafar, A. J. N. Tags: Journal update Source Type: research
Murmur in a man with acute myocardial infarction
Clinical introduction A man in his 60s with history of smoking presented to the emergency room 10 days after an epigastric pain and progressive worsening dyspnoea. Vital signs were normal. Examination revealed bibasilar crackles and a murmur in the left sternal border. ECG shows an inferior wall myocardial infarction with Q-waves and T-wave inversion. The murmur and transthoracic echocardiography image are shown in figure-video 1. Physical examination and echocardiographic findings are consistent with: acute mitral regurgitation left ventricular free-wall rupture aortic regurgitation ventricular septal rupture (VSR) Answer...
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Ezquerra-Osorio, A., Lopez-Lizarraga, M. A., Baeza-Herrera, L. A. Tags: EMJ Image Challenge Source Type: research
Diagnosis of cauda equina syndrome in the emergency department
This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Metcalfe, D., Hoeritzauer, I., Angus, M., Novak, A., Hutton, M., Woodfield, J. Tags: Practice review Source Type: research
Multicentre prospective observational study to evaluate healthcare impacts of e-scooters on emergency departments
E-scooters have emerged as an environmentally friendly mode of inner-city transportation,1 and e-scooter-associated injuries are a growing area of concern.2 In the UK, rental e-scooter trial schemes were introduced in 2020; alongside these trials, illegal private e-scooter use in public spaces has also increased.3 There is little UK data outlining the healthcare impact of e-scooters, although work has examined the impact in Europe.4 The primary objective was to quantify the prevalence and nature of injuries sustained by individuals involved in accidents associated with e-scooters across multiple cities. Secondary objective...
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: TERN, T. E. R. N. Tags: Research letter Source Type: research
Transthoracic echocardiography showing pulmonary arteries and arch of aorta
Clinical introduction An 18-year-old male patient with a history of Hodgkins lymphoma came to emergency department with complaint of breathlessness. His respiratory rate was 26/min, room air saturation was 98%, heart rate 120. On examination, his trachea was shifted towards right side and there was decreased air entry on right lung. Chest X-ray (figure 1) and point of care ultrasound were performed (figure 2). Question What is the tubular structure seen in the ultrasound image? Septate pleural effusion Lung cavitation Arch of aorta Lung abscess Answer C: Arch of aorta The X-ray shows complete opacity of the right lung, sug...
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Chouhan, R., Bhoi, S., Raveendran, A. Tags: EMJ Image Challenge Source Type: research
Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study
Conclusion
Pre-hospital clinicians make decisions about bleeding and transfusion which are recognition-primed and incorporate significant uncertainty. Decisions are influenced by experience and are subject to bias. Improved understanding of the decision-making processes provides a theoretical perspective of how decisions might be supported in the future. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Marsden, M. E. R., Kellett, S., Bagga, R., Wohlgemut, J. M., Lyon, R. L., Perkins, Z. B., Gillies, K., Tai, N. R. Tags: Open access Original research Source Type: research
Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study
Conclusion
No strategy is ideal but using NEWS2 alongside paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2.
Trial registration number
researchregistry5268, https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/5de7bbd97ca5b50015041c33/ (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Goodacre, S., Sutton, L., Thomas, B., Hawksworth, O., Iftikhar, K., Croft, S., Fuller, G., Waterhouse, S., Hind, D., Bradburn, M., Smyth, M. A., Perkins, G. D., Millins, M., Rosser, A., Dickson, J. M., Wilson, M. J. Tags: Open access Original research Source Type: research
Trends in survival from out-of-hospital cardiac arrest with a shockable rhythm and its association with bystander resuscitation: a retrospective study
Conclusion
In a two-tiered rescue system, survival from OHCA at hospital discharge doubled over a 13-year study period. Concomitantly, the system implemented an OHCA patient registry and increased T-CPR frequency, despite a consistently low rate of public defibrillator use. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Hong Tuan Ha, V., Jost, D., Bougouin, W., Joly, G., Jouffroy, R., Jabre, P., Beganton, F., Derkenne, C., Lemoine, S., Frederic, L., Lamhaut, L., Loeb, T., Revaux, F., Dumas, F., Trichereau, J., Stibbe, O., Deye, N., Marijon, E., Cariou, A., Jouven, X., Tr Tags: Original research Source Type: research
Hospital-administered ECPR for out-of-hospital cardiac arrest: an observational cohort study
Conclusions
Half of the ECPR protocol activations did not lead to ECMO treatment. However, every fourth ECPR candidate and every third patient who received ECMO-facilitated resuscitation at the hospital survived with a good neurological outcome. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Puolakka, T., Salo, A., Varpula, M., Nurmi, J., Skrifvars, M. B., Wilkman, E., Lemström, K., Kuisma, M. Tags: Original research Source Type: research
Biases in the collection of blood alcohol data for adult major trauma patients in Victoria, Australia
Conclusion
Biases in the collection of blood alcohol data likely impact the surveillance of alcohol-related injuries. Routine alcohol testing after major trauma is needed to accurately inform epidemiology and the subsequent implementation of strategies for reducing alcohol-related injuries. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - October 26, 2023 Category: Emergency Medicine Authors: Lau, G., Gabbe, B., Mitra, B., Dietze, P., Reeder, S., Cameron, P., Read, D. J., Symons, E., Beck, B. Tags: Editor's choice Original research Source Type: research
