Ultrasound Directed Reduction of Colles type distal radial fractures in ED (UDiReCT): a feasibility randomised controlled trial
Conclusion
A definitive study of a similar design would be feasible within UK ED practice but organisational factors and research staff availability should be considered when estimating the predicted recruitment rate and required sites. 6-week surgical fixation rate was the most reliable outcome measure.
Trial registration
ClinicalTrials.gov (NCT03868696). (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Malik, H., Wood, D., Stone, O., Gough, A., Taylor, G., Knapp, K. M., Heggs, D., Appelboam, A. Tags: Original research Source Type: research
Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial
Conclusion
This study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts.
Trial registration number
The Netherlands Trial Register (NTR7934). (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Haak, S. L., Borgstede, M. G., Stolmeijer, R., Bens, B. W., Boendermaker, A. E., van der Kolk, B. Y., ter Maaten, J. C., ter Avest, E., Lameijer, H. Tags: Original research Source Type: research
Child with left eye pain
Discussion Grade 4 hyphema, or a total hyphema, means a completely blood-filled anterior chamber, also known as ‘eight-ball’ hyphema.1 Under penlight examination, the anterior chamber of the injured eye could be seen to be completely filled with blood (figure 2). In approaching traumatic hyphema, open globe injury must be ruled out first, the anterior... (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Sun, J.-T., Chang, C.-J., Sim, S.-S. Tags: EMJ Image Challenge Source Type: research
Ultrasonography in thoracic and abdominal stab wound injury: results from the FETTHA study
Conclusions
In patients admitted with stab wounds to the torso, eFAST was not sensitive enough to diagnose pneumothorax and haemoperitoneum, but performed better in the detection of cardiac tamponade and haemothorax than the other injuries. More robust multicentre studies are needed to better define the role of eFAST in this specific population. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Bouzid, D., Tran-Dinh, A., Lortat-Jacob, B., Atchade, E., Jean-Baptiste, S., Tashk, P., Snauwaert, A., Zappella, N., Augustin, P., Pellenc, Q., Castier, Y., Ribeiro, L., Gaudemer, A., Khalil, A., Montravers, P., Tanaka, S., on behalf of the Bichat stab wo Tags: Original research Source Type: research
Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models
Conclusion
ML-based models might help EMS identify patients with SARS-CoV-2 infection, and in guiding EMS allocation of hospital resources based on prespecified criteria. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Spina, S., Gianquintieri, L., Marrazzo, F., Migliari, M., Sechi, G. M., Migliori, M., Pagliosa, A., Bonora, R., Langer, T., Caiani, E. G., Fumagalli, R., AREU 118 EMS Network Collaborators, Caresani, Rizzini, Canevari, Sforza, Franchi, Alberti, Brancaglio Tags: Open access, COVID-19 Original research Source Type: research
Man with progressive dyspnoea
Clinical introduction A 74-year-old man presented to the ED with progressively worsening dyspnoea for 10 days. The patient was diagnosed with small cell lung carcinoma (stage IVb) 2 months prior to presentation but declined intervention. He experienced intermittent barking cough, hoarseness and haemoptysis without fever, and later developed dyspnoea. Physical examination revealed mild expiratory stridor, and laryngoscopy showed right vocal cord palsy without upper airway obstruction. Laboratory test results were unremarkable except for anaemia. Chest radiography was performed (figure 1). Question What is the most likely di...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Liu, E.-J., Liu, Y.-Y., Chiu, Y.-H. Tags: EMJ Image Challenge Source Type: research
Are there differences in the relationship between respiratory rate and oxygen saturation between patients with COVID-19 and those without COVID-19? Insights from a cohort-based correlational study
Conclusion
The RR/SpO2 relationship before oxygen administration does not differ between patients with COVID-19 and those without COVID-19, except in elderly patients. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Laredo, M., Vandiedonck, C., Miro, O., Gonzalez del Castillo, J., Alquezar-Arbe, A., Jacob, J., Pinera, P., Megarbane, B. Tags: Editor's choice, COVID-19 Original research Source Type: research
Silent hypoxia in COVID-19: easy to recognise but hard to define
Emergency physicians who worked during the COVID-19 pandemic are likely to remember the term ‘silent hypoxia’ (or ‘happy hypoxia’) being used to describe patients with marked hypoxia, potentially to a level incompatible with life, without any other clinical signs such as confusion, decreased conscious level or shortness of breath.1 2 However, silent hypoxia (or hypoxaemia) is surprisingly difficult to define, characterise or explain. Studies have generally defined silent hypoxia as presentation without signs of dyspnoea despite low oxygen saturation.1–4 Authors do not usually define dyspnoea i...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Trimble, A., Goodacre, S. Tags: COVID-19 Commentary Source Type: research
Primary survey: highlights from this issue
Four years ago this month, something was brewing in Wuhan that would change not only the world as we knew it, but also the face of medical literature. A quick search of PubMed shows well over 1/4 of a million unique publications with COVID in the title have been published to date. So, with that in mind, is there still learning to be had from this disease for emergency clinicians? One of the most fascinatingly terrifying aspects of COVID emergency management remains the concept of "silent hypoxia." It is therefore important that we publish an original research manuscript from Laredo and colleagues (our Editor’s Choice...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Carlton, E. Tags: Highlights from this issue Source Type: research
190 Can the qSofa score predict mortality in major trauma?
Conclusion
The qSOFA is potentially useful in predicting mortality of Major Trauma patients. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Sihaq, A., Cronin, J. Tags: Oral Presentations Source Type: research
185 A thematic analysis of 'What Matters Most to patients assessed by a frailty intervention team in an urban emergency department
Conclusion
Recorded WMTY in this frail older population centred around home, family, health and independence. The question was either not asked or answered in a significant minority. Personal concerns revealed important individual concerns that occasionally merited specific attention.
As familiarity grows with WMTY within patient populations, and within teams who ask that question, more meaningful answers should emerge. This should help direct compassionate care for this group of patients. Next steps are to support the team in further teasing out WMTY, and incorporating into patient care in the wider ED. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Brennan, A., OShea, L., Mupada, B., Allen, S., Coakley, E., Condon, F., Cronin, L., Leonard, A., Pillay, I. Tags: Oral Presentations Source Type: research
178 Exploring barriers and enablers to simulation based training in emergency departments: an international qualitative study (BEST-ED study)
Conclusion
Potential barriers and enablers to SBT and in-situ simulation for Emergency Departments were identified through interviews conducted in this study. The central themes in terms of barriers and enablers were local culture, leadership, individual needs, resources and optimisation. A tailored approach is vital for establishing a successful SBT and in situ simulation program. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Poh Hock, M. J., Murphy, E. Tags: Oral Presentations Source Type: research
171 The impact of frailty screening of older adults with multidisciplinary assessment of those at risk during emergency hospital attendance on the quality and safety of care (SOLAR): a randomised controlled trial
Conclusion
Multidisciplinary assessment of older frail adults in the ED setting conferred a statistically significant improvement in ED waiting times at index visit and lower rates of ED re-attendance, nursing home admission, quality of life and function at 180 days. Further multi-centre trials are warranted to explore the external validity of the findings. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Leahy, A., Barry, L., Corey, G., Whiston, A., Purtill, H., Shchetkovskyy, D., Ryan, D., Shanahan, E., OConnor, M., Galvin, R. Tags: Oral Presentations Source Type: research
150 Reversal of fortunes: right arm-left arm ECG lead misplacement
Conclusion
Highly statistically significant ECG features of RA-LA misplacement are inverted P waves and inverted QRS complexes in lead I and the presence of R waves in lead aVR Their absence does not exclude the diagnosis. In this study ECG machines failed to detect almost half of all RA-LA misplacements. Education and training is required to recognise ECG lead misplacements. ECG interpretative software should incorporate these findings into their diagnostic algorithms.
Abstract #150 Table 1 Inverted P waves Inverted QRS lead I Inverted T waves lead I R in aVR 95% CI 95% CI 95% CI 95% CI Sensitivity 88.0% ...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Lynch, R., Sleator, J., Obeida, L., Kuan, S. Tags: Oral Presentations Source Type: research
115 Establishing the core elements of a frailty at the front door model of care using a modified real-time Delphi technique
Conclusion
Development of a consensus-derived FFD model of care represents an important step in generating national standards, implementation of a service model as intended and enhances opportunities for scientific impact. Future research should focus on the development of a core outcome set for studies involving older adults in the ED. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: OShaughnessy, I., Ryan, D., Ahern, E., Harnett, P., Fitzgerald, C., Robinson, K., Shchetkovskyy, D., Galvin, R. Tags: Oral Presentations Source Type: research
