Lung point-of-care ultrasound in the assessment of pleural effusions
Case presentation A 19-year-old man presented to the ED for 1 week of fevers, headache, weight loss, and a non-productive cough. The patient immigrated to the USA from Nepal 3 months previously. Approximately 7 to 10 days prior to presentation, he developed fever, night sweats, frontotemporal headaches and a non-productive cough. He also endorsed right-sided chest pain with inspiration, poor appetite, and unintentional 3 kg weight loss in the past week. He denied haemoptysis, sensory or motor changes, abdominal pain, sick contacts or other significant previous medical history. On physical examination, he was well appearing...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Padrez, K. A., Graglia, S. Tags: Sono case series Source Type: research
Woman with cough and chest pain
Clinical Introduction An otherwise healthy 50-year-old woman presented to the ED with cough and intermittent low-grade fever for a couple of days. She also had mid-chest and upper back discomfort while coughing. She had received acupuncture a few weeks prior to this episode. On arrival, her vital signs were stable and physical examinations were unremarkable. Laboratory results showed leucocytosis (white cell: 19.97x109/L cells/μL) with a leftward shift (neutrophils: 81%). Chest radiography was obtained (figure 1) and gave the clue to advanced imaging. Question What is the most likely diagnosis? Massive pulmonary embolis...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Wu, C.-J., Sun, J.-T., Chang, C.-J. Tags: EMJ Image Challenge Source Type: research
High-potency benzodiazepine misuse in opioid-dependent patients: use naloxone with care
The misuse of highly potent benzodiazepines is increasing in the UK, particularly among the opioid-using population in Scotland. Differentiating opioid from benzodiazepine toxicity is not always straightforward in patients with reduced level of consciousness following drug overdose. Patients on long-term opioid substitution who present with acute benzodiazepine intoxication and are given naloxone may develop severe opioid withdrawal while still obtunded from benzodiazepines. This situation can be difficult to manage, and these patients may be at increased risk of vomiting while still unable to protect their airway. Fortuna...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Raman, R. Tags: Concepts Source Type: research
SNAPTIMED study: does the Scottish and Newcastle Antiemetic Protocol achieve timely intervention and management from the emergency department to discharge for paracetamol poisoning?
Conclusion
In this retrospective study, use of the SNAP reduced the duration of inpatient admissions and rate of anaphylactoid reactions. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Humphries, C., Roberts, G., Taheem, A., Abdel Kader, H., Kidd, R., Smith, J. Tags: Original research Source Type: research
Inverse association between blood pressure and pulse oximetry accuracy: an observational study in patients with suspected or confirmed COVID-19 infection
Conclusions
Care needs to be taken in interpreting pulse oximetry measurements in patients with lower systolic and diastolic BPs, and HRs, as oxygen saturation is overestimated as BP and HR decrease. Confirmation of the oxygen saturation with an ABG may be appropriate in some clinical scenarios. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Crooks, C. J., West, J., Morling, J., Simmonds, M., Juurlink, I., Briggs, S., Cruickshank, S., Hammond-Pears, S., Shaw, D., Card, T., Fogarty, A. W. Tags: COVID-19 Original research Source Type: research
Performance of three screening tools to predict COVID-19 positivity in emergency department patients
Conclusion
The ED attending PA had higher sensitivity and specificity than the other two methods, but none was accurate enough to replace a COVID-19 RT-PCR test in a clinical setting where transmission control is crucial. Therefore, we recommend universal COVID-19 testing prior to all admissions. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: DiLorenzo, M. A., Davis, M. R., Dugas, J. N., Nelson, K. P., Hochberg, N. S., Ingalls, R. R., Mishuris, R. G., Schechter-Perkins, E. M. Tags: COVID-19 Original research Source Type: research
Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan
Conclusions
Chart review frequently identified ED delirium in patients with COVID-19. Age, dementia, epilepsy and polypharmacy were significant predictors of ED delirium. Delirium was associated with an increased in-hospital mortality and with a reduced probability of being discharged home after hospitalisation. The findings of this single-centre retrospective study require validation in future studies. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Damanti, S., Bozzolo, E., Franchini, S., Frangi, C., Ramirez, G. A., Pedroso, C., Di Lucca, G., Scotti, R., Valsecchi, D., Cilla, M., Cinel, E., Santini, C., Castellani, J., Manzo, E., Vadruccio, S., Spessot, M., Borghi, G., Monti, G., Landoni, G., Rovere Tags: COVID-19 Original research Source Type: research
International practice patterns of IV magnesium in paediatric acute asthma
Guideline recommendations about discharge of children with acute asthma treated with IV magnesium (IV-Mg) are disparate and inconclusive (see ). The majority of children given IV-Mg in the emergency department (ED) are hospitalised, independent of asthma severity or degree of response to IV-Mg.1 The rationale for this practice is unknown but may be due to limited evidence whether children with a satisfactory response to IV-Mg can be safely discharged.2–4 We conducted this international survey of three paediatric emergency research networks in Canada (Paediatric Emergency Research Canada), Australia/New Zealand (Paedi...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Simone, L., Zemek, R., Roland, D., Lyttle, M. D., Craig, S., Dalziel, S. R., Gravel, J., Finkelstein, Y., Curtis, S., Freedman, S. B., Plint, A. C., Schuh, S., on behalf of the Pediatric Emergency Research Network Group, Poonai, Babl, Thompson, Ducharme, Tags: Research letter Source Type: research
Qualitative study of emergency clinicians to inform a national guideline on the management of children with mild-to-moderate head injuries
Conclusion
Information needs of ED clinicians, factors influencing use of head CT in children with head injuries and the role of guidelines were identified. These findings informed the scope and implementation strategies for an Australasian guideline for mild-to-moderate head injuries in children. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Tavender, E. J., Wilson, C. L., Dalziel, S., Oakley, E., Borland, M., Ballard, D. W., Cotterell, E., Phillips, N., Babl, F. E. Tags: Original research Source Type: research
Temperature threshold in the screening of bacterial infections in young infants with hypothermia
Conclusion
Young infants with SBI and IBI presented with lower temperatures than infants without infections. However, there was no temperature threshold to reliably identify SBI or IBI. Further research incorporating clinical and laboratory parameters, in addition to temperature, may help to improve risk stratification for these vulnerable patients. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Lo, Y. H. J., Graves, C., Holland, J. L., Rogers, A. J., Money, N., Hashikawa, A. N., Ramgopal, S. Tags: Original research Source Type: research
Paediatric acute non-traumatic limp presenting to the emergency department: a retrospective observational study
Conclusion
Although mostly due to benign disorders, an important number of limping children who presented to the ED had serious disease, with approximately one-third of these not diagnosed at the initial ED visit. There is large variation in workup including blood test, imaging and decisions regarding ED disposition. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Tu, J., Haines, M., Gowdie, P., Craig, S. Tags: Original research Source Type: research
Does pre-injury clopidogrel use increase the risk of intracranial haemorrhage post head injury in adult patients? A systematic review and meta-analysis
Conclusion
Included studies were vulnerable to confounding and several were small-scale studies. The results should be interpreted with caution given the ROB identified. This study does not provide statistically significant evidence that clopidogrel monotherapy patients are at increased risk of tICH after head injury compared with no antithrombotic controls.
PROSPERO registration number
CRD42020223541. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Moffatt, S., Venturini, S., Vulliamy, P. Tags: Systematic review Source Type: research
Wheezing for weeks: respiratory distress in an infant
Clinical introduction A previously healthy infant presented to the ED with 1 day of respiratory distress following 2 weeks of wheezing. Review of systems was negative for cough, congestion, fever and difficulty feeding. He had subcostal and intercostal retractions, grunting, shallow chest rise, tachypnoea (RR 70–80), HR of 157, BP 127/100 and normal temperature. He became lethargic, tachycardic (230) and BP dropped to 74/35. Left needle decompression was attempted without air return. BP and HR improved, but the patient remained tachypnoeic. CXR was performed (figure 1). Question Based on history and imaging findings,...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Wiersma, R., Kaila, R. Tags: EMJ Image Challenge Source Type: research
Prevalence of secondary insults and outcomes of patients with traumatic brain injury intubated in the prehospital setting: a retrospective cohort study
Conclusion
SIs were common in the early phase of prehospital care. The association of prolonged hypoxia and mortality in TBI is potentially more significant than previously recognised, and if corrected early, may improve outcomes. There may be a greater role for bystander intervention in prevention of early hypoxic insult in TBI. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Butterfield, M., Bodnar, D., Williamson, F., Parker, L., Ryan, G. Tags: Open access Original research Source Type: research
Diagnostic performance of S100B as a rule-out test for intracranial pathology in head-injured patients presenting to the emergency department who meet NICE Head Injury Guideline criteria for CT-head scan
Conclusion
Within 6 hours of injury, S100B performed well as a diagnostic test to exclude significant intracranial pathology in low-risk patients presenting with head injury. In theory, if used in addition to NICE HIGs, CT-head rates could reduce by one-quarter with a potential miss rate of <1%. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Rogan, A., Sik, A., Dickinson, E., Patel, V., Peckler, B., McQuade, D., Larsen, P. D., Endorsed by ACEM Emergency Department Epidemiology Network Tags: Editor's choice Original research Source Type: research
