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 - September 27, 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 Manchester University NHS Foundation Trust 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. Machine learning for ECG diagnosis and risk stratification of occlusi...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Sutton-Klein, J., Doherty, W. J., Jafar, A. J. N., Yates, G., Body, R., Carley, S. D., Prager, G. Tags: Journal update Source Type: research
Using clinical risk models to predict outcomes: what are we predicting and why?
Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically describes the potential impact of treatment effects in model development studies. Treatment effects may lead to models failing to achieve the aim of identifying the patients most likely to benefit from intervention, and may instead identify patients who are unlikely to benefit from intervention. The paper provides practical advice to help clinicians who wish to use clinical p...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Goodacre, S. Tags: Concepts Source Type: research
Tape it up: scientific experiment testing the best taping method for intercostal chest drains
This study was designed to determine the most secure method of affixing a chest drain to patients’ skin using a tape (tape used was Sleek tape). Tape is a common type of fixation method for a chest drain but there is no scientific study testing the success rates of different methods. This study aims to fill in this gap in research. Literature review provides a suggestion from BTS (British Thoracic Society) that a ‘mesentery method’ should be used.3 Note that this project deliberately excluded the most common methods of securing chest drain, that is, suture. This was due to designed reduction in confoundin...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Domanska, K., O'Sullivan, A., Mulcahy, N., Galvin, R., Cummins, F., O'Sullivan, L. Tags: Research letter Source Type: research
Pale man with recurrent epistaxis
Clinical introduction A 78-year-old man with a recent history of general fatigue, exertional dyspnoea and recurrent epistaxis presented to our ED. His medical history was mild hyperlipidaemia. He denied chest pain, dyspnoea, leg swelling, drug abuse or facial trauma. His vital signs were stable. Physical findings also revealed pale skin and conjunctival pallor. His oral exam is shown in figure 1. Laboratory examination showed a haemoglobin of 4.8 g/dL (reference range 13.7–16.8 g/dL) and decreased mean corpuscular volume of 74.1 fL (reference range 83.6–98.2 fL). Question What is the most likely cause? Maffucci...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Matsuura, H., Imajo, K. Tags: EMJ Image Challenge Source Type: research
Silver Trauma Review Clinic: a novel model of care to manage non-operative injuries in older patients
Conclusion The STRC is a novel approach allowing timely, patient-focused, comprehensive and collaborative trauma care of older patients following non-operative injuries. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Smyth, H., Breslin, D., Mullany, L., Ramiah, V., Riches, R., Laguna, R., Morgan, P., Byrne, C. Tags: Original research Source Type: research
Predictors of parental anxiety in a paediatric emergency department
Conclusion Over 40% of parents sampled endorsed clinically significant anxiety in the paediatric ED. Child temperament, specifically lower activity temperament, and poorer parental mental health were identified as contributors to parent anxiety, whereas clinical condition or severity did not influence parent anxiety. Current results may help identify families in need of additional intervention and may improve patient outcomes. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Martin, S. R., Hung, I., Heyming, T. W., Fortier, M. A., Kain, Z. N. Tags: Original research Source Type: research
A first seizure episode
Clinical introduction A middle-aged man is brought to your ED following a self-limiting generalised tonic–clonic seizure. He is a smoker, with a history of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease, but no previous seizures. He is on aspirin and clopidogrel. On assessment, you see no evidence of trauma. He is confused, with a Glasgow Coma Scale 14 (E4, V4, M6) and mild global limb weakness but no focal neurology. He is newly hypertensive (210/140 mm Hg). His laboratory investigations and CT-brain are normal. An urgent MRI-brain is performed (see figure 1). Question What is the most ...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: MacMahon, T. Tags: EMJ Image Challenge Source Type: research
Finding Voices: a survey of young peoples experiences of the ED
Conclusion Our findings underline the similarities between the two groups in terms of their expectations of care. Terminating the study early at the outset of the COVID-19 pandemic has precluded any further firm conclusions to be drawn. Further research is needed. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Keating, L., Wilson, S., Dainty, J., Jones, D., Hill, J. Tags: Open access Original research Source Type: research
Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial
Conclusion Therapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster. Trial registration number NCT04091334. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Arvig, M. D., Lassen, A. T., Gaede, P. H., Gärtner, S. W., Falster, C., Skov, I. R., Petersen, H. O., Posth, S., Laursen, C. B. Tags: Open access, Editor's choice Original research Source Type: research
Woman with sudden oral discomfort
Clinical introduction A 76-year-old woman presented to the ED from a French restaurant complaining of a sudden onset of oral discomfort that developed 1 hour after having a hot soup. Physical examination showed a 3x3 cm bullous haematoma on her soft palate (figure 1). She had repeated similar episodes of intraoral haematomas after meals, but other parts of the body had never been involved. Laboratory results were white blood cell count of 9000/mm3, haemoglobin 14.3 g/dL and platelet count 259 000/mm3. Coagulation tests of APTT and PT-INR were within the normal range. Question What is the most likely diagnosis? Angina bullo...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Asako, S., Suyama, Y., Sugita, M. Tags: EMJ Image Challenge Source Type: research
The emergency department or the emergency medicine service? Redefining the boundaries of responsibility for emergency care litigation in England
Clinical negligence claims allocated to emergency medicine (EM) now account for the equal-highest volume notified to NHS Resolution (NHS-R), the body responsible for handling negligence claims on behalf of NHS organisations, sponsored by the Department of Health and Social Care.1 NHS-R mandates the allocation of a responsible specialty within 48 hours of claim receipt, mostly allocated by medicolegal departments without clinician involvement.1 In England, >75% of acute admissions present via an emergency department (ED).2 Therefore, there is a risk that the ED (as a location) is used synonymously with EM (the specialty)...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Price, J., Barnard, E. B. G., Selway, J., Adcock, C., Dunk, E., Robinson, S. M. Tags: Research letter Source Type: research
Point-of-care ultrasound-guided regional anaesthesia: the superficial cervical plexus block for a patient with a clavicle fracture
Case presentation A right-hand dominant woman aged 46 years with a history of opiate use disorder presents to the ED following a right clavicle injury. While riding to work, the patient fell off her bicycle, landing on her right shoulder. She denies any other injury. On physical examination, she is tearful, cradling her right arm. Her vital signs are normal. Her right clavicle has an obvious deformity and associated bruising without overlying injury or tenting of the skin. She has severely reduced range of motion of the right shoulder due to pain but is neurovascularly intact distally. Plain radiography of her right clavic...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Graglia, S., Kornblith, A. Tags: Sono case series Source Type: research
'Plan A for ultrasound-guided regional anaesthesia in the Emergency Department
Emergency physicians are increasingly familiar with point-of-care ultrasound (POCUS) as an adjunct to clinical examination. Although once the preserve of a small number of enthusiasts, POCUS is now a fundamental part of practising emergency medicine. Unsurprisingly, this shift has been accompanied by advances in portable ultrasound devices and the emergence of formal governance structures, such as dedicated fellowship training in POCUS, curriculum sign-offs and ED ultrasound subspecialty leads. The Sono Case Series has been a popular feature of the EMJ for several years. In this issue, Graglia and Kornblith use a case-base...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Burckett-St Laurent, D., Metcalfe, D., Sutcliffe, E., Yap, C. Tags: Commentary Source Type: research
Misplaced attribution for malpractice claims further frays the safety net provided by emergency departments
The Emergency Department (ED) has long been considered a ‘safety net’ for healthcare. In the USA this term is often used to indicate that patients who cannot afford to go elsewhere can always receive care in the ED. But as many of us know, the ED is a safety net in almost every healthcare system, regardless of how that care is financed, as it provides a place for patients to be seen out of hours, when general practitioners are too busy, or the patient’s problem is considered too complex for an outpatient evaluation. Although the burden can at times be overwhelming, many of us are proud of the role that th...
Source: Emergency Medicine Journal - September 27, 2023 Category: Emergency Medicine Authors: Weber, E. J., Leech, C. Tags: Editorial Source Type: research