Does corrected QT interval correlate with serum ionised calcium in the ED setting?
The main ECG changes caused by calcium (Ca) abnormalities have been classified as HR corrected QT interval (QTc) prolongation (hypocalcaemia) and shortening (hypercalcaemia).1 Hypocalcaemia and hypercalcaemia are considered potentially life-threatening conditions, partly because of the theoretical risk of arrhythmia. An experimental study with healthy individuals suggested a relationship between serum ionised calcium (Ca2+) and QTc.2 Only smaller and older clinical studies have, however, tested the correlation of QTc and Ca in patients3–6 and more often using serum total Ca rather than ionised Ca.2 3 5 Although the e...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Cherkaoui, M., Lassen, A. T., Brabrand, M., Kildegaard, H., Forberg, J. L. Tags: Research letter Source Type: research
Girl with epigastric pain
Clinical introduction An 8-year-old previously healthy girl presented to the ED due to the intermittent epigastric pain, nausea and vomiting for 2 days. The appetite and activity were decreased. On physical examination, a palpable mass was noted over left upper quadrant with local tenderness. Laboratory investigations revealed white cell count of 10.7 X109/L. Abdominal radiography was performed (figure 1). Question What is the most likely diagnosis? Carcinoma of the stomach Lymphoma Giant gastric trichobezoar Gastric ulcer Answer: C Rapunzel syndrome: a giant gastric trichobezoar Abdominal radiography showing a large elong...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Huang, C.-Y., Lee, W.-J. Tags: EMJ Image Challenge Source Type: research
Prospective study of retention in opioid agonist treatment and contact with emergency healthcare following release from prisons in Victoria, Australia
Conclusion We found lower rates of contact with emergency healthcare after release among people retained in OAT, but not among people reporting interrupted OAT use, underscoring the benefits of postrelease OAT retention. Strategies to improve accessibility and support OAT retention after leaving prison are important for men who inject drugs. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Curtis, M., Wilkinson, A. L., Dietze, P., Stewart, A. C., Kinner, S. A., Cossar, R. D., Nehme, E., Aitken, C., Walker, S., Butler, T., Winter, R. J., Smith, K., Stoove, M. Tags: Open access Original research Source Type: research
A man with left-sided weakness and numbness
Clinical introduction A 63-year-old right-handed man presented for evaluation of left leg stiffness and sensory change. He had a medical history of remote prostate cancer (status post resection in 2011). The patient reported that one week prior, he began noticing left leg stiffness and numbness, as well as left hand weakness and discoordination. He went to see his internist where he had a fall while the physician was testing his gait. He was sent to the emergency room (figure 1). He denied episodes of loss of consciousness, shaking, or headaches. He had no recent weight loss, night sweats, or previous falls. Question What ...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Gheihman, G., Paradis, X. G., ONeal, M. A. Tags: EMJ Image Challenge Source Type: research
Relationship of hepatitis C risk to hepatitis C test acceptance among adult patients participating in an ED hepatitis C screening programme
Conclusion HCV risk factors were self-reported by more than one-third of ED patients but were not more commonly present among those who accepted HCV screening. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Cowan, E., Brandspiegel, S., Araki, B., O'Brien-Lambert, C., Merchant, R., Buckler, D. G., Eiting, E., Calderon, Y. Tags: Open access Original research Source Type: research
Barriers and facilitators to guideline-recommended care of benign paroxysmal positional vertigo in the ED: a qualitative study using the theoretical domains framework
Conclusion Several modifiable barriers and facilitators to the management of BPPV in the ED have been identified. Differences were observed between the professional groups, and these findings will guide a future intervention to improve the use of guideline-recommended assessment and treatment techniques for BPPV in ED. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Bradshaw, S., Graco, M., Holland, A. Tags: Original research Source Type: research
A preliminary study of the effect of menstruation on the incidence of acute mountain sickness
Over 50% of those engaging in high altitude activities are women.1 Nonetheless, women have historically been neglected in scientific literature regarding backcountry environments. Acute mountain sickness (AMS), a condition triggered by hypoxia, is common at altitudes >2500 m above sea level, and prior studies suggest that women are particularly vulnerable to it due to hormonal changes associated with menstruation.2–4 Therefore, this study assessed the association of menstruation and AMS incidence during a high-altitude expedition to Mount Kilimanjaro. This retrospective study involved a review of records from the ...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Paul, M. E., Wagner, T. D., Tukel, C. A., Levin, D. R. Tags: Research letter Source Type: research
Sudden vision loss in a 68-year-old man: the life-saving value of funduscopy
Clinical introduction A 68-year-old man awoke with severe vision loss in the right eye. Three days later, he sought medical attention in the ED. Vision was no light perception in the right eye and 6/6 in the left eye with right brisk relative afferent pupillary defect. Fundus examination is shown in figure 1. Inflammatory markers were ordered and were normal. Question What is the diagnosis? Haemorrhage related to age-related macular degeneration Central retinal artery occlusion Retinal detachment Proliferative diabetic retinopathy Answer:B (B) Central retinal artery occlusion (CRAO). While the centre of the macula, the fov...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Donaldson, L., Tayeb, S., Margolin, E. Tags: EMJ Image Challenge Source Type: research
Emergency department visits and emergency-to-inpatient admissions for abnormal uterine bleeding in the USA nationwide
Conclusions Our study highlights the ED as an essential place of care for women with AUB while also demonstrating the importance of access to outpatient gynaecology services as some AUB-related ED visits may be preventable with outpatient care. The significant demographic and hospital system differences, as well as expected clinical differences, between women with AUB admitted to inpatient and women discharged from the ED imply structural biases impacting AUB-related ED care and add to the deepening understanding of health disparities. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Grubman, J., Hawkins, M., Whetstone, S., Autry, M., Lazar, A., Sawaya, G. F., Jacoby, V. Tags: Original research Source Type: research
Rates of perceived medical errors and its correlation with work-related factors and personal distress among emergency physicians in China: a national cross-sectional study
Conclusion Self-perceived medical errors are prevalent among physicians working in EDs and are associated with their workplace environment and personal distress. Targeted interventions are required to reduce physicians’ workload and improve their working environment. Accounting for healthcare providers’ distress is imperative for reducing the incidence of medical errors and improving their health. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Yan, S., Wang, J., Yin, X., Lv, C., Wu, J., Jiang, N., Chen, Z., Mu, K., Zhang, G., Gong, Y. Tags: Editor's choice Original research Source Type: research
How does it feel? The system-person paradox of medical error
There are two viewpoints on medical errors: one that focuses on the person, the other that focuses on the system. James Reason taught us to reject the person viewpoint, which focuses on the errors and violations of individual people.1 The focus on the person leads us to direct remedial efforts at people on the front line of patient care. It also justifies blaming the individual who errs. Instead, Reason helped us don system lenses and pull back to accommodate a system viewpoint that traces causal factors back to the system as a whole. This approach persuades us to direct remedial effort at situations and organisations. The...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Wu, A. W., Pham, J. C. Tags: Commentary Source Type: research
Primary survey: Highlights from this issue
Welcome to this month’s EMJ containing a range of diverse papers to influence your clinical management or change your thinking. Not every published manuscript is a game changer but there are certainly some valuable papers here to enable you to reflect on your current management and guide quality improvements in your Emergency Department. This month’s ‘Editors Choice’ This month’s paper and the associated commentary, features a survey of over ten thousand emergency physicians (EP) in China who were asked to self-report medical errors in the last 3 months and their current levels of occupational...
Source: Emergency Medicine Journal - April 21, 2023 Category: Emergency Medicine Authors: Leech, C. 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 - March 20, 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 Lancashire Teaching Hospitals 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. Biomarkers and their association with bacterial illnesses in hypothermic infants by Holland et al.T...
Source: Emergency Medicine Journal - March 20, 2023 Category: Emergency Medicine Authors: Challen, K., Ravichandran, A., Chiu, M. C. B., Ludlow, T., Rosser, M., Hirst, R. Tags: Journal update Source Type: research
Drink and injection spiking: how to approach an increase in presentations?
In 2021, there was a significant increase in the number of reported drink spiking incidents across the UK. The new phenomenon of spiking via injection also emerged, which gained significant media attention. Campaigns encouraged potential spiking victims to attend an ED for testing. However, there is limited published research on drink spiking and no published studies on injection spiking. One UK guideline for the management of spiking exists, advising testing ‘if clinically indicated’ and is likely underused. Therefore, patients are often managed without drug testing, psychological support or a clear onward ref...
Source: Emergency Medicine Journal - March 20, 2023 Category: Emergency Medicine Authors: Blandamer, T., Daniels, J., Dear, J., Birse, F., Carlton, E., Burgess, K., Roberts, T. Tags: Practice review Source Type: research