Will you review this patient with an open ankle injury?
Clinical introduction This patient presented with pain and deformity to the left ankle following a road traffic collision (RTC). The patient had been riding an electric scooter and been knocked off by a van pulling out of a side street. The patient reported feeling his ankle was crushed under the scooter. On examination the ankle was grossly deformed with a deep laceration over the lateral malleolus. The foot was neurovascularly intact, and the patient was sent for plain films of the ankle (figure 1) Question What injury has the patient sustained? Subtalar dislocation Hawkins type II injury Total talar dislocation Marti/We...
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: McCoy, C. A., Hughes, R. Tags: EMJ Image Challenge Source Type: research
Factors affecting providers comfort and fear during intubations of patients with COVID-19
Conclusion
A higher degree of comfort in intubating patients suspected of or confirmed with COVID-19 was demonstrated in more senior physicians, members of intubation teams, providers who performed a higher number of intubations and providers who reported adequate PPE. These findings highlight potential targets for improving the experience of providers in this setting. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Lee, E., Al Shabeeb, R. Q., El Shatanofy, M., Mulcahy, C. F., Yamane, D. P., Sherman, M. L., Heinz, E. R. Tags: COVID-19 Original research Source Type: research
Emergency medicine resident perspectives on well-being during COVID-19: a qualitative study
Conclusions
This qualitative study elucidated factors inside and outside of the clinical environment which impacted EM resident well-being. The findings suggest that programme and health system leadership can focus on supporting peer-to-peer and faculty connections, structured guidance and mentorship on resident career development and develop programmes which bolster resident on-shift support and acknowledgement. These lessons can be used by training programmes to better support residents, but the generalisability is limited due to the single-centre design and participation. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Agarwal, A., Sangha, H., Deutsch, A., Spadaro, A., Gonzales, R., Goldenring, J., Mamtani, M., Conlon, L. W., Scott, K. Tags: COVID-19 Original research Source Type: research
Humans not heroes: Canadian emergency physician experiences during the early COVID-19 pandemic
Conclusions
Canadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study’s findings could guide future interventions to protect emergency physicians against pandemic-related distress. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Tran, A., Wallner, C., de Wit, K., Gerin-Lajoie, C., Ritchie, K., Mercuri, M., Clayton, N., Boulos, M., Archambault, P., Schwartz, L., Gray, S., Chan, T. M.-Y., for the Network of Canadian Emergency Researchers Tags: Editor's choice, COVID-19 Original research Source Type: research
Looking after the emergency medicine workforce: lessons from the pandemic
In this month’s EMJ, there are two reports looking at the well-being of emergency medicine staff during the early stages of the pandemic.1 2 These are both small qualitative studies, one from Canada and one from the USA, but the findings will resonate with many clinicians worldwide. The authors have performed a useful service to document and archive their findings to inform better responses in future pandemics. This qualitative research compliments existing quantitative work.3 Data collection was at the beginning of the pandemic, where the great uncertainty about the course was a trigger for all sorts of anxiety. The...
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Boyle, A. A., Bhardwaj, S. Tags: Commentary Source Type: research
Primary survey: Highlights from this issue
Welcome to the February 2023 issue of the Emergency Medicine Journal. This issue is brimming with collections of complimentary articles that promise to enrich your daily clinical practice. The psychological impact of COVID-19 on our workforce The early stages of the COVID-19 pandemic were scary for all of us. We had the unprecedented national lockdowns, the fear of an unknown and lethal infection and (for those of us working in Emergency Departments) the challenge of treating so many seriously unwell patients amid so much uncertainty about how to do it. In this issue, we have three papers exploring the psychological impact...
Source: Emergency Medicine Journal - January 24, 2023 Category: Emergency Medicine Authors: Body, R. Tags: Highlights from this issue Source Type: research
In reply to: 'Use TRIPOD when validating clinical prediction models
We thank Candel and Nissen for their interest1 in our recently published article on triage systems in the Netherlands.2 These authors discuss many difficulties inherent to ED triage and disagree with our conclusions that the Modified Early Warning Score (MEWS) could be used instead of the Netherlands Triage System (NTS) to triage patients. First, Candel and Nissen suggest that we could have strengthened our methods by following the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) guidelines. We agree that TRIPOD provides excellent guidance, but, as suggested by the Em...
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Schinkel, M., Holleman, F. Tags: PostScript Source Type: research
Use TRIPOD when validating clinical prediction models
It is with great interest that we have read the article from Schinkel et al in which the Netherlands Triage System (NTS) was compared with the Modified Early Warning Score (MEWS) to predict hospital admission and 30-day mortality in Emergency Department (ED) patients.1 Although the results showed that the MEWS performed better than complaints-based triage in terms of discrimination, we disagree with the conclusion that MEWS may replace the NTS score for triage of patients. The authors could have strengthened the methodology and conclusions by following the ‘transparent reporting of a multivariable prediction model fo...
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Candel, B. G., Nissen, S. K. Tags: PostScript Source Type: research
Journal update monthly top five
Introduction This month’s update is from the Academic Department of Military Emergency Medicine and University Hospitals Plymouth NHS Trust. 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 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—this paper could/should change practice. Can ED c...
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Cottey, L., Wood, F., Humphries, C., Seden, B., Peachey, J., Clymer, J., Barham, F., Smith, J. 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 - December 16, 2022 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research
Pulmonary embolism management in the emergency department: part 2
Pulmonary embolism (PE) can present with a range of severity. Prognostic risk stratification is important for efficacious and safe management. This second of two review articles discusses the management of high-, intermediate- and low-risk PE. We discuss strategies to identify patients suitable for urgent outpatient care in addition to identification of patients who would benefit from thrombolysis. We discuss specific subgroups of patients where optimal treatment differs from the usual approach and identify emerging management paradigms exploring new therapies and subgroups. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Serebriakoff, P., Cafferkey, J., de Wit, K., Horner, D. E., Reed, M. J. Tags: Practice review Source Type: research
Thromboprophylaxis in ambulatory emergency department patients managed with lower limb immobilisation after injury: a national survey
Symptomatic venous thromboembolism (VTE) occurs in 1%–2% of ambulant patients managed with lower limb immobilisation after injury.1 2 Pharmacological thromboprophylaxis can approximately halve this risk, but questions remain about selection of patients, modality of prophylaxis and duration of therapy.3 In the UK, the National Institute for Health and Care Excellence (NICE)4 recommends VTE risk assessment to determine prescribing, but is not prescriptive on method and advocates only parenteral prophylaxis. To date, there have been no prospective comparisons of prescribed thromboprophylaxis agents and limited external ...
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Crainie, C. A., Cooper, J. G., Horner, D. Tags: Research letter Source Type: research
Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study
Conclusion
In comparison with PESI and sPESI, NEWS adequately predicted 7-day ICU admission as well as 30-day mortality, supporting its potential relevance for clinical practice. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Bavalia, R., Stals, M. A. M., Mulder, F. I., Bistervels, I. M., Coppens, M., Faber, L. M., Hendriks, S. V., Hofstee, H. M. A., Huisman, M. V., van der Hulle, T., Mairuhu, A. T. A., Kruip, M. J. H. A., Middeldorp, S., Klok, F. A., Hutten, B. A., Holleman, Tags: Original research Source Type: research
Optimising ambulance conveyance rates and staff costs by adjusting proportions of rapid-response vehicles and dual-crewed ambulances: an economic decision analytical modelling study
Conclusion
At current overall conveyance rates, there is no benefit in increasing the relative proportions of RRVs to DCAs unless additional benefits can be realised that bring the conveyance rates down. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Ridyard, C., Smith, M., Spaight, R., Law, G. R., Siriwardena, A. N. Tags: Original research Source Type: research
Predefibrillation end-tidal CO2 and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study
Conclusion
Predefibrillation ETCO2 measurement is not associated with VF termination or ROSC when basic and advanced airways are included in the analysis. The role of predefibrillation ETCO2 requires careful consideration of the type of airway used during resuscitation. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 16, 2022 Category: Emergency Medicine Authors: Kwong, J. L., Drennan, I. R., Turner, L., Cheskes, S. Tags: Original research Source Type: research
