Journal update monthly top five
Introduction This month’s update is from the emergency department and critical care unit at Salford Care Organisation, within the Northern Care Alliance NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and focused literature searches. We identified the five most interesting and relevant papers (decided by consensus, with editorial oversight) 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...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Horner, D., Ambrose, C., Mills, L., Blevings, R., Raza, S., Ibrahim, E., Kilgour, P. M., Prager, G. Tags: Journal update Source Type: research
Point-of-care ultrasound in the assessment of appendicitis
Case presentation A 15-year-old boy presents to the ED with 1 day of periumbilical non-radiating abdominal pain. The pain, described as a stinging sensation, started gradually 1 day prior to presentation after eating lunch and increased to an intensity of 8 out of 10 at its worst over the day. The patient reports that the pain has since improved to 4 out of 10. He does not have fevers, chills, anorexia, nausea, emesis, urinary symptoms, stool changes, testicular pain or swelling, and prior abdominal surgery. The patient has no significant medical or surgical history, takes no medications and has no allergies. He is afebril...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Boyle, M. J., Lin-Martore, M., Graglia, S. Tags: Sono case series Source Type: research
Engaging, empowering and educating the waiting patient
While emergency departments are open to anyone without appointment, the need for prioritisation results in periods of waiting that are both wasteful and frustrating. However, value can be added to patient care by (1) engaging the waiting patient, (2) empowering the waiting patient and (3) educating the waiting patient. If these principles are implemented, they will benefit both the patient and the healthcare system. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Mohammed, A., Lockey, A. S. Tags: Concepts Source Type: research
How did the use of ED change during the first wave of the SARS-CoV-2 pandemic in the UK? An observational study
Conclusions The study suggests that the decision to use the ED has a discretionary component. This could potentially contribute to unnecessary visits, and raises concerns that some patients who should present at the ED do not go. More effective communication about who should visit EDs during a pandemic, and the safety of doing so, is needed. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Calastri, C., Hess, S., Wilson, B. Tags: COVID-19 Original research Source Type: research
External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study
Conclusion No risk score outperformed existing clinical decision-making in determining the need for inpatient admission based on prediction of the primary outcome in this setting. Use of the PRIEST score at a threshold of one point higher than the previously recommended best approximated existing clinical accuracy. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Marincowitz, C., Sbaffi, L., Hasan, M., Hodkinson, P., McAlpine, D., Fuller, G., Goodacre, S., Bath, P. A., Omer, Y., Wallis, L. A. Tags: Open access, COVID-19 Original research Source Type: research
Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis
Conclusion In patients presenting to the ED with a diverse range of pain conditions, IVP provides similar levels of pain relief compared with opiates/opioids or NSAIDs at T30 post administration. Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative. PROSPERO registration number CRD42021240099. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Qureshi, I., Abdulrashid, K., Thomas, S. H., Abdel-Rahman, M. E., Pathan, S. A., Harris, T. Tags: Systematic review Source Type: research
A man with right flank pain
Clinical introduction A healthy, obese 38-year-old man had acute flank pain for 2 days. He also complained of a fever for 1 day. He denied haematuria, nausea, vomiting or constipation. A point-of-care abdominal ultrasound was obtained (figure 1). Question What is the diagnosis? Diverticulitis Appendicitis Epiploic appendagitis Urolithiasis Answer: C Epiploic appendagitis (EA) is an inflammation in the epiploic appendages, which is caused by spontaneous torsion or thrombosis of the central draining vein.1 EA is a rare occurrence but a benign and self-limited condition. However, the mimics of EA include appendicitis and dive...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Lee, H.-Y., Lien, W.-C., Wang, H.-P. Tags: EMJ Image Challenge Source Type: research
Methocarbamol versus diazepam in acute low back pain in the emergency department: a randomised double-blind clinical trial
Conclusions In patients with LBP, the pain was relieved in the methocarbamol and diazepam groups after 60 min. Although diazepam was more effective, its use was associated with a slightly higher risk of drowsiness. Trial registration number The protocol of this clinical trial was prospectively registered in the irct.ir (IRCTID: IRCT20151113025025N4; https://irct.ir/trial/50148) . (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Sharifi, M., Abdorazzaghnejad, A., Yazdchi, M., Bahreini, M. Tags: Original research Source Type: research
Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021
Conclusion Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Chen, Q., Maher, C. G., Rogan, E., Machado, G. Tags: Original research Source Type: research
Can you assess the Clinical Frailty Scale in the HEMS setting? A Feasibility Study
Patients living with frailty are at risk of worse outcomes.1 The Clinical Frailty Scale (CFS) is a tool that has been developed to assess a patient’s level of frailty.2 It is determined by a patient’s baseline health (status two weeks prior to hospital admission), with a score of 1 being very fit and 9 being terminally ill.2 Prior to the COVID-19 pandemic, frailty screening was part of the National Health Service England commissioning tariff, although there is no current agreement on when this should be assessed in the patient’s journey, and this has ceased since the pandemic.3 Helicopter emergency medica...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Morton, S., Gough, C. Tags: Research letter Source Type: research
Understanding prehospital care for self-harm: views and experiences of Yorkshire Ambulance Service clinicians
This study aims to explore the views and experiences of Yorkshire Ambulance Service (YAS) clinicians of prehospital care for self-harm. This is a cross-sectional questionnaire using an online platform (Online Surveys, www.onlinesurveys.ac.uk; Jisc). The questionnaire was designed by the research team and piloted by four YAS academic paramedics (see ). It was open from 5 to 30 September 2022 and shared with ambulance clinicians (clinicians working on ambulances) employed by YAS using social media and email bulletins. Multiple-choice... (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Romeu, D., Guthrie, E., Mason, S. M. Tags: Editor's choice Research letter Source Type: research
Performance of a prehospital HEART score in patients with possible myocardial infarction: a prospective evaluation
Conclusions A HEART score derived by paramedics in the prehospital setting, even when modified to harness the precision of a high-sensitivity assay, does not allow safe rule-out of myocardial infarction or enhanced rule-in compared with cardiac troponin testing alone. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Cooper, J. G., Ferguson, J., Donaldson, L. A., Black, K. M. M., Livock, K. J., Horrill, J. L., Davidson, E. M., Scott, N. W., Lee, A. J., Fujisawa, T., Lee, K. K., Anand, A., Shah, A. S. V., Mills, N. L. Tags: Original research Source Type: research
Why not re-evaluate? The value of chest radiography
Clinical introduction A 67-year-old woman presented to the ED with a 1-week history of dyspnoea on exertion. She did not report fever or cough. Her medical history only included hyperlipidaemia. She was a never-smoker. Physical examination revealed the following findings: BP, 148/98 mm Hg; HR, 112/min; body temperature, 35.8℃; RR, 20/min; and oxygen saturation, 94% on ambient air. Lung sounds were clear; cardiac auscultation revealed a loud second heart sound. There was no leg oedema. Chest radiography was performed (figure 1). Question What is your diagnosis? Congestive heart failure Acute intestinal pneumonia Acut...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Tomiyama, S., Harada, Y., Shimizu, T. Tags: EMJ Image Challenge Source Type: research
Management of self-harm
Self-harm refers to any act of self-poisoning or self-injury carried out by a person, irrespective of motivation.1 Paramedics are often the first health professionals in contact with those who self-harm, but their contribution to care of these patients is under-researched. Romeu et al have conducted a cross-sectional questionnaire exploring the experiences of paramedics of caring for people who self- harm.2 Understanding the views of paramedics to caring for patients who self-harm is important as it may determine the quality of care these patients receive. While the response rate of the questionnaire is very low, the paper...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: McCabe, A. Tags: Commentary Source Type: research
Primary survey: highlights from this issue
Much needed attention is being focused on disparities in healthcare delivery and health status, issues that were highlighted and exacerbated by the Covid pandemic. Emergency medicine has historically acknowledged its disparities in treatment for pain related to age and race but less on the effects of language and culture. This month’s Reader’s Choice and Global abstract is from Australia, where Chen et al compared the management of non-serious back pain given to culturally and linguistically diverse (CALD) populations and non-CALD patients. Despite similar triage codes and diagnoses, CALD patients were more lik...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Weber, E. J. Tags: EMJ Primary survey Highlights from this issue Source Type: research