Woman with sudden oral discomfort
Clinical introduction A 76-year-old woman presented to the ED from a French restaurant complaining of a sudden onset of oral discomfort that developed 1 hour after having a hot soup. Physical examination showed a 3x3 cm bullous haematoma on her soft palate (figure 1). She had repeated similar episodes of intraoral haematomas after meals, but other parts of the body had never been involved. Laboratory results were white blood cell count of 9000/mm3, haemoglobin 14.3 g/dL and platelet count 259 000/mm3. Coagulation tests of APTT and PT-INR were within the normal range. Question What is the most likely diagnosis? Angina bullo...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Asako, S., Suyama, Y., Sugita, M. Tags: EMJ Image Challenge Source Type: research
The emergency department or the emergency medicine service? Redefining the boundaries of responsibility for emergency care litigation in England
Clinical negligence claims allocated to emergency medicine (EM) now account for the equal-highest volume notified to NHS Resolution (NHS-R), the body responsible for handling negligence claims on behalf of NHS organisations, sponsored by the Department of Health and Social Care.1 NHS-R mandates the allocation of a responsible specialty within 48 hours of claim receipt, mostly allocated by medicolegal departments without clinician involvement.1 In England, >75% of acute admissions present via an emergency department (ED).2 Therefore, there is a risk that the ED (as a location) is used synonymously with EM (the specialty)...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Price, J., Barnard, E. B. G., Selway, J., Adcock, C., Dunk, E., Robinson, S. M. Tags: Research letter Source Type: research
Point-of-care ultrasound-guided regional anaesthesia: the superficial cervical plexus block for a patient with a clavicle fracture
Case presentation A right-hand dominant woman aged 46 years with a history of opiate use disorder presents to the ED following a right clavicle injury. While riding to work, the patient fell off her bicycle, landing on her right shoulder. She denies any other injury. On physical examination, she is tearful, cradling her right arm. Her vital signs are normal. Her right clavicle has an obvious deformity and associated bruising without overlying injury or tenting of the skin. She has severely reduced range of motion of the right shoulder due to pain but is neurovascularly intact distally. Plain radiography of her right clavic...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Graglia, S., Kornblith, A. Tags: Sono case series Source Type: research
'Plan A for ultrasound-guided regional anaesthesia in the Emergency Department
Emergency physicians are increasingly familiar with point-of-care ultrasound (POCUS) as an adjunct to clinical examination. Although once the preserve of a small number of enthusiasts, POCUS is now a fundamental part of practising emergency medicine. Unsurprisingly, this shift has been accompanied by advances in portable ultrasound devices and the emergence of formal governance structures, such as dedicated fellowship training in POCUS, curriculum sign-offs and ED ultrasound subspecialty leads. The Sono Case Series has been a popular feature of the EMJ for several years. In this issue, Graglia and Kornblith use a case-base...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Burckett-St Laurent, D., Metcalfe, D., Sutcliffe, E., Yap, C. Tags: Commentary Source Type: research
Misplaced attribution for malpractice claims further frays the safety net provided by emergency departments
The Emergency Department (ED) has long been considered a ‘safety net’ for healthcare. In the USA this term is often used to indicate that patients who cannot afford to go elsewhere can always receive care in the ED. But as many of us know, the ED is a safety net in almost every healthcare system, regardless of how that care is financed, as it provides a place for patients to be seen out of hours, when general practitioners are too busy, or the patient’s problem is considered too complex for an outpatient evaluation. Although the burden can at times be overwhelming, many of us are proud of the role that th...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Weber, E. J., Leech, C. Tags: Editorial Source Type: research
Primary survey: highlights from this issue
Welcome to this month’s Primary survey. This month’s journal has a variety of topics from trauma, paediatrics, ultrasound and malpractice. I’ll take you through some of the highlights. Editor’s choice: The impact of serial cardiopulmonary point of care ultrasound (PoCUS) exams in patients with acute dyspnoea: a randomised controlled trial This paper investigates if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS examinations and usual care could reduce the severity of dyspnoea. The multicentre RCT set in Denmark recruited 206 patients. 102 in the PoCUS g...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Edwards, S. Tags: Highlights from this issue Source Type: research
Correction: An introduction to power and sample size estimation
Jones SR, Carley S, Harrison M. An introduction to power and sample size estimation. Emerg Med J 2003;20:453–8. doi: 10.1136/emj.20.5.453.
Following recent feedback from a reader, the authors have corrected this article. The original version of this paper stated that: ‘Strictly speaking, "power" refers to the number of patients required to avoid a type II error in a comparative study.’ However, the formal definition of "power" is that it is the probability of avoiding a type II error (rejecting the alternative hypothesis when it is true), rather than a reference to the number of patients. Power is, howeve...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Tags: Correction Source Type: research
Correction: The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary
Javidan AP, Hansen K, Higginson I et al. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. Emerg Med J 2021;38:245–46.
Since first publication the provenance and peer review statement has been added to this article. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Tags: Open access Miscellaneous Source Type: research
Standardising intubation position terminology
We recently published a systematic review of the impact of patient positioning in Emergency Medicine Journal.1 A significant challenge to completing this review and to conducting research to understand this topic is the lack of standardisation of positioning terminology. The 10 studies included in our review used five different terms to denote patient position including ‘head-elevated’, ‘inclined’, ‘non-supine’, ‘ramped’ and ‘upright’. In some cases, terms varied within a single article. Other times, studies conflated body positioning with head and neck position. ...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Turner, J. S., Kirschner, J. M. Tags: PostScript Source Type: research
Point-of-care ultrasound for the diagnosis of Fournier gangrene
Case presentation A 57-year-old man with a history of recently diagnosed diabetes mellitus presented to the ED with 2 weeks of perineal pain and swelling. He was seen at an urgent care centre approximately 1 week prior to presentation, where he was diagnosed with cellulitis and prescribed trimethoprim-sulfamethoxazole. A few days prior to presentation to the ED, the swelling had increased significantly and was now associated with chills, diaphoresis and purulent drainage. On physical examination, the patient is uncomfortable-appearing with vital signs notable for tachycardia at 104 beats per minute and tachypnoea at 22 bre...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Chen, F., Neill, E., Graglia, S. Tags: Sono case series 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 - August 23, 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 University Department of Emergency Medicine in Reading. 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 have 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. High-flow oxygen therapy in moderate to severe bronchio...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Akrama, O., Armstrong, L., Desai, M. K., Horner Le Riche, A., Keating, L., Knowles, C., Perera, Y., Porter, T., Hirst, R. Tags: Journal update Source Type: research
Fluid biomarkers and neuroimaging in mild traumatic brain injury: current uses and potential future directions for clinical use in emergency medicine
Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%–40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome. Owing to the requirement for improved diagnostic and prognostic mechanisms, there has been increasing evidence concerning the utility of both imaging and blood biomarkers.
Blood biomarkers offer the poten...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Newcombe, V., Richter, S., Whitehouse, D. P., Bloom, B. M., Lecky, F. Tags: Practice review Source Type: research
Refreshing the emergency medicine research priorities
Conclusion
We have redefined the priorities for emergency medicine research in the UK using robust and established methodology, which will inform the agenda for the coming years. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Cottey, L., Shanahan, T. A. G., Gronlund, T., Whiting, C., Sokunbi, M., Carley, S. D., Smith, J. E., On behalf of the James Lind Alliance (JLA) Emergency Medicine (EM) Priority Setting Partnership (PSP) Refresh Steering Group, Dunford, Findlay, Gager, Hen Tags: Open access Original research Source Type: research
Isopropyl alcohol inhalation for the treatment of nausea in adult emergency department patients: a systematic review and meta-analysis
Conclusion
This review suggests that IPA likely has a modest effect in reducing nausea in adult ED patients, compared with placebo. Larger multicentre trials are needed, as the evidence is limited by few trials and patients.
PROSPERO registration number
CRD42022299815 (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Lee, S. Y., Tamale, J. R. Tags: Systematic review Source Type: research
