Primary survey: Highlights from this issue
The EMJ prides itself on being an international journal. Whilst submissions from the United Kingdom made up around 40% of our published work in 2022, we have readers from around the world and as an editorial team we encourage submissions from anywhere. Indeed, opening this month’s EMJ and looking at where publications have originated from does have a pleasingly international feel. It reads like the locations of top fashion boutiques; Milan, San Francisco, Boston, Melbourne (and Plymouth). This is the first time I recall that international emergency care research teams have outweighed UK based authors in an issue &nda...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Carlton, E. Tags: Highlights from this issue Source Type: research
Traumatic brain injury
Clinical introduction An adult patient with arterial hypertension had a witnessed loss of consciousness and a fall from a height of approximately 5 feet with head trauma; the patient was thus referred to the ED in unconscious state. A head CT scan was obtained (figures 1–4). Question Which kind of haemorrhage does the CT show? Subarachnoid haemorrhage Epidural haematoma Subdural haematoma All of the above For answer see page 02 For question see page 01 Answer:D The head CT scan demonstrated the simultaneous presence of subarachnoid haemorrhage (SAH), epidural haematoma (EDH) and subdural haematoma (SDH) (answer D). N...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Bernardi, E., Giamello, J. D., Lorenzati, B. Tags: EMJ Image Challenge Source Type: research
Unexpected cutaneous alterations in a patient with lower back pain
Clinical introduction An 84-year-old woman presented with permanent unbearable pruritic sensations in the lower back area. Clinical examination revealed reticular as well as coin-shaped, reddish-brown macules with a few single blister remnants affecting her lumbar and gluteal regions (figure 1). Several months ago, she had started to apply daily overnight a heated pad on the area to antagonise ongoing lower back pains. Question Which is the most likely diagnosis? Urticaria. Scabies. Toasted skin syndrome. Herpes zoster. For answer see page 02 For question see page 01 Answer C. Toasted skin syndrome. Itching sensations can ...
Source: Emergency Medicine Journal - February 23, 2023 Category: Emergency Medicine Authors: Schmidt, V., Demolli, P., Möhrenschlager, M. Tags: EMJ Image Challenge Source Type: research
The NHS is broken: We need to change how our healthcare system works and join the 21st century
The NHS is broken. The NHS workforce know this. When will politicians accept it? COVID-19 placed significant stress on the NHS. However, COVID-19 did not break the NHS. It was the final straw that broke an already creaking service. Before COVID-19, the NHS operated at greater than full capacity with no resilience in the system. This was evident every winter. To continue treating COVID-19, we created hospital capacity by cancelling elective work, increasing waiting times and creating a ‘pandemic’ of future elective care. This cannot be addressed unless the NHS changes its working practices. Emergency medicine co...
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Boyce, S. H. Tags: PostScript Source Type: research
Journal update monthly top five
This study investigated for such association using retrospective analysis of 5 years’ Trauma and Audit Research Network (TARN) data (2014–2019, n=7666) for... (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: van Oppen, J. D., Putnam, C., Leanage, N., Thornton, H., Knapp, S., Roland, D., Coats, T. J., Shanahan, T. A. G. Tags: Journal update 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 - January 24, 2023 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research
The use of TASER devices in UK policing: an update for clinicians following the recent introduction of the TASER 7
Taser was introduced into UK policing in 2003 to bridge the operational gap between use of incapacitant sprays and firearms. Use of force reporting in the UK indicates that Taser is relatively safe provided that it is used lawfully. Taser use can result in injuries and has been implicated in a small number of deaths. The latest version of the weapon, the TASER 7, has entered UK policing. The TASER 7 uses a novel probe that has implications for the medical community. A review of Taser medical effects and probe removal for TASER 7 are presented. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Bleetman, A., Hepper, A. E., Sheridan, R. D. Tags: Open access Practice review Source Type: research
Diagnostic accuracy of point-of-care ultrasound for paediatric testicular torsion: a systematic review and meta-analysis
Conclusion
The present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Mori, T., Ihara, T., Nomura, O. Tags: Systematic review Source Type: research
Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience
Conclusions
Pubertal age, symptoms duration of <7 hours, nausea/vomiting, palpated hard testis, abdominal pain and scrotal swelling are predictive factors for TT. Time lost between symptom onset and seeking medical care, and between arrival and US are associated with the need for orchiectomy. Preserved blood flow in USS does not rule out TT and may contribute to delays to surgery. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Lukosiute-Urboniene, A., Nekrosius, D., Dekeryte, I., Kilda, A., Malcius, D. Tags: Original research Source Type: research
Study of prehospital video telehealth for callers with mental health-related complaints
Conclusion
The use of video telehealth by MHNs was associated with fewer emergency ambulance dispatches when compared with voice-only triage by secondary triage practitioners, and increased referrals to alternative services. This cost-effective technology was viewed favourably by patients and MHNs. Expansion of video technology in EMS call taking warrants exploration. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Nehme, E., Magnuson, N., Mackay, L., Becker, G., Wilson, M., Smith, K. Tags: Original research Source Type: research
Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis
Conclusion
The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams.
PROSPERO registration number
CRD42020165234. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Atey, T. M., Peterson, G. M., Salahudeen, M. S., Bereznicki, L. R., Wimmer, B. C. Tags: Systematic review Source Type: research
Life-threatening chest drain insertion
Clinical introduction A fit, elderly patient was brought into the ED resuscitation area following a fall while riding a bicycle, having sustained obvious head and chest injuries. A whole-body CT showed a large left pneumothorax, a small haemothorax component and fractures of left ribs 3–10. During chest drain insertion, as the pleural cavity was entered, the patient’s oxygen saturation decreased to between 78% and 85% on a 15 L non-rebreather mask with a falling BP to a systolic of 90 mm Hg. A portable chest radiograph was immediately performed (figure 1). Question What is the most likely diagnosis? Tension pne...
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Martins Mondim, P. D., Ward, K., Townsend, E. Tags: EMJ Image Challenge Source Type: research
Improving domestic violence screening practices in the emergency department: an Australian perspective
Conclusion
This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Sweeny, A. L., Bourke, C., Torpie, T. M., Sargeant, S., Hughes, J., Watson, J., Conroy, S., Carrasco, A., Tighe, K., Thornton, N. S., Cumner, A.-S., Baird, K. Tags: Original research Source Type: research
Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis
Conclusions
This review suggests that the AHA and ESC contraindications are not supported by evidence. Key limitations include all studies having concomitant inferior and RVMI, not evaluating beneficial effects and very low certainty of evidence. As adverse events are transient and easily managed, nitrates are a reasonable treatment modality to consider during RVMI on current evidence.
PROSPERO registration number
CRD42020172839. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Wilkinson-Stokes, M., Betson, J., Sawyer, S. Tags: Systematic review Source Type: research
Impact of prehospital opioid dose on angiographic and clinical outcomes in acute coronary syndromes
Conclusions
Opioid use was not associated with 30-day MACE. There were higher rates of TIMI 0/1 flow pre-PCI in patients with STEMI prescribed opioids. Future prospective research is required to verify these findings and investigate alternative analgesia for ischaemic chest pain. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Fernando, H., Nehme, Z., Dinh, D., Andrew, E., Brennan, A., Shi, W., Bloom, J., Duffy, S. J., Shaw, J., Peter, K., Nadurata, V., Chan, W., Layland, J., Freeman, M., Van Gaal, W., Bernard, S., Lefkovits, J., Liew, D., Stephenson, M., Smith, K., Stub, D. Tags: Original research Source Type: research
