Management of self-harm
Self-harm refers to any act of self-poisoning or self-injury carried out by a person, irrespective of motivation.1 Paramedics are often the first health professionals in contact with those who self-harm, but their contribution to care of these patients is under-researched. Romeu et al have conducted a cross-sectional questionnaire exploring the experiences of paramedics of caring for people who self- harm.2 Understanding the views of paramedics to caring for patients who self-harm is important as it may determine the quality of care these patients receive. While the response rate of the questionnaire is very low, the paper...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: McCabe, A. Tags: Commentary Source Type: research
Primary survey: highlights from this issue
Much needed attention is being focused on disparities in healthcare delivery and health status, issues that were highlighted and exacerbated by the Covid pandemic. Emergency medicine has historically acknowledged its disparities in treatment for pain related to age and race but less on the effects of language and culture. This month’s Reader’s Choice and Global abstract is from Australia, where Chen et al compared the management of non-serious back pain given to culturally and linguistically diverse (CALD) populations and non-CALD patients. Despite similar triage codes and diagnoses, CALD patients were more lik...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Weber, E. J. Tags: EMJ Primary survey 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 - May 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 South East Scotland 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. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension by Shapiro et a...
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Clarke, B., Alawiye, S., Anderson, R., Moceivei, C., Cox, T. J., Sharpe, J., Reed, M. J., Jafar, A. J. N. Tags: Journal update Source Type: research
Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with COVID-19 assessed in emergency departments in England: a retrospective matched cohort study
Conclusions
These findings indicate that for patients assessed in ED, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation. However, possible selection biases might limit the generalisability to other populations. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Beaney, T., Clarke, J., Alboksmaty, A., Flott, K., Fowler, A., Benger, J., Aylin, P. P., Elkin, S., Darzi, A., Neves, A. L. Tags: Open access, Editor's choice, COVID-19 Original research Source Type: research
Error in respiratory rate measurement by direct observation impacts on clinical early warning score algorithms
Respiratory rate(RR) is the only vital sign that is currently measured by direct observation in many high-income countries in many healthcare settings. However, when relying on direct observation by humans, values may be susceptible to measurement error. In particular, a continuous variable like RR may be inadvertently semicategorised due to rounding and/or multiplying up counts from shorter periods to give estimated counts for a full minute. This could have an important impact on early warning scores, as these scores rely on the aggregation of accurately measured physiological parameters to trigger specific warning thresh...
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Fogarty, A. W., Card, T., Shaw, D., West, J., Simmonds, M., Crooks, C. J. Tags: Research letter Source Type: research
Elderly man with periumbilical and lower extremity ecchymosis
Clinical introduction A 91-year-old nursing home resident presented with sudden onset of ecchymosis over his bilateral lower limbs and periumbilical region 4 hours before arrival at the emergency department (figure 1). He had a history of atrial fibrillation, hypertension, right hemiparesis and motor aphasia due to an old cerebrovascular accident. Physical examination revealed bilateral non-palpable femoral, popliteal, dorsalis pedis and posterior tibial pulses, and cold bilateral lower extremities. He had a platelet count of 264 109/L and an international normalised ratio of 1.22. Question What is the most likely diagnosi...
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Hu, K.-C., Liu, Y.-K., Hsu, Y.-P. Tags: EMJ Image Challenge Source Type: research
External validation of Glasgow-Blatchford, modified Glasgow-Blatchford and CANUKA scores to identify low-risk patients with upper gastrointestinal bleeding in emergency departments: a retrospective cohort study
Conclusions
In patients with UGIB, the use of a GBS≤1 or CANUKA score ≤2 appears to be safe for identifying patients at low risk of death or need for intervention. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Pognonec, C., Dirhoussi, Z., Cury, N., Moreau, M., Billard, C., Yordanov, Y., Thiebaud, P.-C. Tags: Original research Source Type: research
Early clinical outcome prediction based on the initial National Early Warning Score + Lactate (News+L) Score among adult emergency department patients
Conclusion
The NEWS+L Score has acceptable to excellent performance for risk estimation among undifferentiated adult ED patients, and outperforms NEWS alone. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Jo, S., Jeong, T., Park, B. Tags: Original research Source Type: research
Healthcare cost burden of acute chest pain presentations
Conclusions
Total annual costs for acute chest pain presentations are increasing, and a significant proportion of the cost burden relates to low-risk patients and non-specific pain. These data highlight the need to improve the cost-efficiency of chest pain care pathways. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Dawson, L., Nehme, E., Nehme, Z., Zomer, E., Bloom, J., Cox, S., Anderson, D., Stephenson, M., Lefkovits, J., Taylor, A., Kaye, D., Cullen, L., Smith, K., Stub, D. Tags: Original research Source Type: research
Male adolescent with left knee pain after sports injury
Discussion Tibial tubercle is the secondary ossification centre of the proximal tibia, where complete bony fusion occurs by age 15 years in females and 17 years in males.1 Tibial tubercle avulsion fracture accounts for <1% of epiphysial injuries and typically results from a forced extension of the knee opposed to fixed leg. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Liu, J.-K., Sun, J.-T., Chang, C.-J. Tags: EMJ Image Challenge Source Type: research
External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting
Conclusion
Neither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to ‘rule in’ or ‘rule out’ NSTEMI alone. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Alotaibi, A., Alghamdi, A., Martin, G. P., Carlton, E., Cooper, J. G., Cook, E., Siriwardena, A. N., Phillips, J., Thompson, A., Bell, S., Kirby, K. L., Rosser, A., Pennington, E., Body, R. Tags: Open access Original research Source Type: research
Association between the number of prehospital defibrillation attempts and a sustained return of spontaneous circulation: a retrospective, multicentre, registry-based study
Conclusions
We observed no significant increase in ROSC after five defibrillations, and no absolute increase in ROSC after seven defibrillations. These data provide a starting point for determination of the optimal defibrillation strategy prior to consideration for prehospital extracorporeal cardiopulmonary resuscitation (ECPR) or conveyance to a hospital with an ECPR capability.
Trial registration number
NCT03222999 (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Ko, B. S., Kim, Y.-J., Han, K. S., Jo, Y. H., Shin, J., Park, I., Kang, H., Lim, T. H., Hwang, S., Kim, W. Y. Tags: Original research Source Type: research
Bystander cardiopulmonary resuscitation and cardiac rhythm change over time in patients with out-of-hospital cardiac arrest
Conclusion
Bystander CPR was associated with a higher VF/VT likelihood and a lower likelihood of pulseless electrical activity at first documented rhythm analysis. Our results support early CPR for OHCA and highlight the need for further research to understand whether and how CPR modifies the cardiac rhythm after arrest. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Shibahashi, K., Kato, T., Hikone, M., Sugiyama, K. Tags: Original research Source Type: research
Man with neck pain
Clinical introduction A 43-year-old man without medical history presented to ED with a 10-day history of neck pain. At triage, his body temperature was 39.6oC and blood pressure was 95/55 mm Hg. On physical examination, there was posterior neck swelling and stiffness without neurological deficit. Blood tests revealed white cell count of 35 930/mm3 and C reactive protein of 29.6 mg/dL. Neck plain radiography was performed (figure 1). Question What is the most likely diagnosis? Cervical spine fracture Oesophageal rupture Meningitis Necrotising fasciitis Answer: D. Necrotising fasciitis (NF) The plain film showed multiple het...
Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Liu, C.-I., Hsu, Y.-P., Kuo, C.-L. Tags: EMJ Image Challenge Source Type: research
