Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes
Conclusion
N2O can provide effective PED PPS. No SAEs were recorded. INF may be an effective PPS adjunct but remains limited by increased rates of vomiting. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 22, 2024 Category: Emergency Medicine Authors: Croughan, S., Barrett, M., O'Sullivan, R., Beegan, A., Blackburn, C. Tags: Original research Source Type: research
Environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia: how green is the 'green whistle?
Conclusions
This LCIA has shown that the overall ‘cradle-to-grave’ environmental impact of Penthrox device is better than nitrous oxide when looking specifically at climate change impact. The climate change impact for an equivalent dose of intravenous morphine was even lower. Switching to the use of inhaled methoxyflurane instead of using nitrous oxide in certain clinical situations could help the NHS to reach its carbon emission reduction target. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - January 22, 2024 Category: Emergency Medicine Authors: Martindale, A. E., Morris, D. S., Cromarty, T., Fennell-Wells, A., Duane, B. Tags: Editor's choice Original research Source Type: research
A green evidence base to drive environmentally sustainable practice
Worldwide, the healthcare sector is responsible for approximately 4.4% of the global carbon footprint.1 As a healthcare system we need to reduce our environmental footprint, along with the rest of society, to ensure a safe and liveable future. This must be done in an evidence-based way, to ensure that any changes we make in our practice do really reduce our environmental impact rather than working on a best guess. We need to build a body of evidence on the environmental impact of our practice so we, with our patients, can make informed decisions. According to NHS England, the UK’s healthcare system is responsible for...
Source: Emergency Medicine Journal - January 22, 2024 Category: Emergency Medicine Authors: Robertson, A. Tags: Commentary Source Type: research
Primary survey: highlights from this issue
Welcome to February 2024’s primary survey for the EMJ. I very much hope as we move into the second month of 2024, things can be as calm as possible in the world of emergency medicine (EM). Pain is one of the most common reasons that people present to the emergency department (ED). Therefore, it seems fitting this month’s journal is covering topics from sedation and pain management through to toxicology and critical care. The environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia. How green is the green whistle? Martindale et al explore an important issue around the environmental impa...
Source: Emergency Medicine Journal - January 22, 2024 Category: Emergency Medicine Authors: Edwards, S. Tags: Highlights from this issue 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 22, 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 Swansea Bay UHB ED team. 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. Emergency department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma pati...
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Pillai, S., Watson, O., Gregoire, J., Kakarla, S., Ellis, J., Ainsworth, J., Kumar, K., Oliver, G. Tags: Journal update Source Type: research
Refractory narrow complex tachycardia in pregnancy
Case A woman in her early 30s self-presents to her local ED at 03:00 hours and is brought from triage to resus due to a tachycardia of 220 beats per minute (bpm). She is 15 weeks into her first (twin) pregnancy, has no medical history and takes no regular medication. She reports a 2-day history of intermittent ‘palpitations’ which are now constant. She describes feeling presyncopal on standing with some mild chest discomfort and shortness of breath. Examination is unremarkable other than a tachycardia. Other vital signs are BP 93/67 mmHg, RR 24 breaths per minute, SpO2 99% on room air and temperature 36.3°C...
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Bloch, M. Tags: SAQs Source Type: research
Man with odynophagia
Discussion The diagnosis of extraluminal migratory fish bone was confirmed using CT (figure 2). The patient underwent surgical removal... (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Wu, H.-Y., Chong, W. S., Chang, C.-J. Tags: EMJ Image Challenge Source Type: research
Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial
Conclusions
Early mortality in men aged >75 years may be reduced by supporting individuals at risk of unplanned hospitalisation with a clear outreach, out-of-hospital nurse-led, telephone-based coaching care model. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Bull, L. M., Arendarczyk, B., Reis, S., Nguyen, A., Werr, J., Lovegrove-Bacon, T., Stone, M., Sherlaw-Johnson, C. Tags: Open access Original research Source Type: research
Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
Conclusions
Implementing the MEESSI-AHF risk stratification tool in the ED to guide disposition decision-making did not improve patient outcomes. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Miro, O., Llorens, P., Rossello, X., Gil, V., Sanchez, C., Jacob, J., Herrero-Puente, P., Lopez-Diez, M. P., Llauger, L., Romero, R., Fuentes, M., Tost, J., Bibiano, C., Alquezar-Arbe, A., Martin-Mojarro, E., Bueno, H., Peacock, F., Martin-Sanchez, F. J., Tags: Original research Source Type: research
Bright red ear
Clinical introduction A 96-year-old woman presented to the ED with a 3-day history of fever and facial redness. She had dementia and was constantly scratching her face with itching. On examination, her body temperature was 38.2℃. The erythema was tender and confined to her face and ears. Laboratory tests showed an absolute neutrophil count of 10,900/μL and a C reactive protein level of 115 mg/L. A photograph of the patient’s face and ears at the time of presentation is shown in figure 1. Question Which of the following is the most likely diagnosis? Seborrhoeic dermatitis Contact dermatitis Erysipelas Cellul...
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Fukushima, T., Hamai, A., Harada, Y. Tags: EMJ Image Challenge Source Type: research
Evaluation of a Community Emergency Medicine acute oncology pathway using 28-day follow-up
Community emergency medicine (CEM) is a model of pre-hospital care that delivers emergency department care to patients irrespective of their clinical environment.1 2 It is the clinical or situational complexity of the patient, rather than the acuity of illness, that best defines the cohort patients targeted by CEM. London’s physician response unit (PRU), established in 2001, has continually evolved its scope of practice. During the COVID-19 pandemic, the PRU rapidly developed novel care pathways that targeted patient cohorts felt to be at increased risk from traditional hospital systems.3 As part of this work, the &l...
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Scott, J., Moore, N. Tags: Research letter Source Type: research
How could online NHS 111 reduce demand for the telephone NHS 111 service? Qualitative study of user and staff views
Conclusion
Online 111 was perceived as a useful adjunct but not a replacement for telephone NHS 111 with potential for channel shift hindered by reduced confidence in the online service due to the lack of human interaction. Further development of OL111 algorithms will be required if it is to meet the needs of people with more complex health needs. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Sampson, F. C., Knowles, E. L., Long, J., Turner, J., Coster, J. Tags: Original research Source Type: research
What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling study
Conclusion
Reducing the proportion of low-acuity attenders at the ED could have an impact on the time in the ED for higher acuity patients due to their use of shared resources, but is insufficient alone to meet current targets. The simulation model could be adapted for further analyses to understand which other changes would be needed to meet current government targets. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Squires, H., Mason, S., O'Keeffe, C., Croft, S., Millington, G. Tags: Open access Original research Source Type: research
A clinical decision rule to rule out bloodstream infection in the emergency department: retrospective multicentric observational cohort study
Conclusion
The BAROC score safely identified patients at low risk of BSI and may reduce BC collection in the ED without the need for laboratory testing. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - December 22, 2023 Category: Emergency Medicine Authors: Pehlivan, J., Douillet, D., Jeremie, R., Perraud, C., Niset, A., Eveillard, M., Chenouard, R., Mahieu, R. Tags: Original research Source Type: research
