5,425 results match your criteria Emergency Medicine Journal[Journal]


Epidemiology of traumatic injuries presenting to an ED in Central Haiti: a retrospective cohort study.

Emerg Med J 2019 Mar 15. Epub 2019 Mar 15.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Background: In Haiti, like many low-income countries, traumatic injuries are leading causes of morbidity and mortality. Yet, little is known about the epidemiology of traumatic injuries in Haitian EDs. Improved understanding of injury patterns is necessary to strengthen emergency services and improve emergency provider education. Read More

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http://dx.doi.org/10.1136/emermed-2018-207559DOI Listing

Major incident triage and the evaluation of the Triage Sort as a secondary triage method.

Emerg Med J 2019 Mar 15. Epub 2019 Mar 15.

Emergency Department, Derriford Hospital, Plymouth, UK.

Introduction: A key principle in the effective management of major incidents is triage, the process of prioritising patients on the basis of their clinical acuity. In many countries including the UK, a two-stage approach to triage is practised, with primary triage at the scene followed by a more detailed assessment using a secondary triage process, the Triage Sort. To date, no studies have analysed the performance of the Triage Sort in the civilian setting. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207986
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http://dx.doi.org/10.1136/emermed-2018-207986DOI Listing
March 2019
1 Read

Quality: more than just timeliness.

Authors:
Adrian A Boyle

Emerg Med J 2019 Mar 15. Epub 2019 Mar 15.

Emergency Department, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

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http://dx.doi.org/10.1136/emermed-2019-208419DOI Listing

Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out.

Emerg Med J 2019 Mar 6. Epub 2019 Mar 6.

West of England Academic Health Science Network, Bristol, UK.

Background: Early warning scores (EWS) were developed in acute hospital settings to improve recognition and response to patient deterioration. In 2012, the UK Royal College of Physicians developed the National Early Warning Score (NEWS) to standardise EWS across the NHS. Its use was also recommended outside acute hospital settings; however, there is limited information about NEWS in these settings. Read More

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http://dx.doi.org/10.1136/emermed-2018-208140DOI Listing

Mottled skin of the abdominal wall.

Emerg Med J 2019 Mar;36(3):170-196

Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207498
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http://dx.doi.org/10.1136/emermed-2018-207498DOI Listing
March 2019
6 Reads
1.776 Impact Factor

Elderly patient with mass on the right arm of sudden onset.

Emerg Med J 2019 Mar;36(3):153-162

Unidad de Gestión Clínica de Medicina Interna y Urgencias, Hospital del SAS San Carlos, Cádiz, Spain.

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http://dx.doi.org/10.1136/emermed-2018-207977DOI Listing

Impact of instructor professional background and interim retesting on knowledge and self-confidence of schoolchildren after basic life support training: a cluster randomised longitudinal study.

Emerg Med J 2019 Feb 16. Epub 2019 Feb 16.

Department of Anaesthesiology and Intensive Care, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.

Introduction: To increase the rate of bystander resuscitation, basic life support (BLS) training for schoolchildren is now recommended on a broad level. However, debate continues about the optimal teaching methods. In this study, we investigated the effects of a 90 min BLS training on female pupils' BLS knowledge and self-confidence and whether learning outcomes were influenced by the instructors' professional backgrounds or test-enhanced learning. Read More

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http://dx.doi.org/10.1136/emermed-2018-207923DOI Listing
February 2019

Canadian and UK/Ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis.

Emerg Med J 2019 Mar 6;36(3):148-153. Epub 2019 Feb 6.

Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.

Background: Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a lumbar puncture (LP), despite limited data for this practice and lack of clinical practice guidelines for this population. The primary objective was to investigate practice patterns in performance of LPs in the ED management of febrile infants aged ≤30 days with bronchiolitis. Read More

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http://dx.doi.org/10.1136/emermed-2018-208000DOI Listing
March 2019
1 Read

Accuracy of nature of call screening tool in identifying patients requiring treatment for out of hospital cardiac arrest.

Emerg Med J 2019 Feb 6. Epub 2019 Feb 6.

Faculty of Health Sciences, University of Southampton, Southampton, UK.

Background: A new pre-triage screening tool, Nature of Call (NoC), has been introduced into the telephone triage system of UK ambulance services which employ National Health Service Pathways (NHSP). Its function is to provide rapid recognition of patients who may need immediate ambulance dispatch for out-of-hospital cardiac arrest (OHCA) and withholding dispatch for other calls while further triage is undertaken. In this study, we evaluated the accuracy of NoC and NHSP in identifying patients with potentially treatable or imminent OHCA. Read More

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http://dx.doi.org/10.1136/emermed-2017-207354DOI Listing
February 2019
1 Read

BET 2: Safety and efficacy of low-dose ketamine versus opioids for acute pain management in the ED.

Emerg Med J 2019 Feb;36(2):128-129

McMaster University, Ottawa, Ontario, Canada.

A short cut review was carried out to establish whether low-dose ketamine is a safe and effective alternative to opioids in ED patients in acute severe pain. 76 papers were found using the reported searches, of which seven presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. Read More

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http://dx.doi.org/10.1136/emermed-2019-208441.2DOI Listing
February 2019

BET 1: Follow-up phone calls and compliance with discharge instructions in elderly patients discharged from the emergency department.

Emerg Med J 2019 Feb;36(2):126-127

Emergency Medicine and Hematology, McMaster University, Hamilton, Canada.

A short-cut review was carried out to establish whether follow-up phone calls improved compliance with follow-up and discharge instructions given to the elderly on discharge from the emergency department. 211 papers were found using the reported searches, of which 5 presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. Read More

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http://dx.doi.org/10.1136/emermed-2019-208441.1DOI Listing
February 2019
1 Read

Paediatric shoulder injury: don't get sucked in!

Emerg Med J 2019 Feb;36(2):77-88

Radiology, Wigan and Leigh Foundation Trust, Wigan, UK.

CLINICAL INTRODUCTION: A healthy 8-year-old boy presented to the ED with acute left shoulder pain. He had been playing football and his left arm was pulled by an opposition team member. He fell to the ground and landed on his left shoulder causing pain. Read More

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http://dx.doi.org/10.1136/emermed-2018-207987DOI Listing
February 2019
2 Reads

An image is worth a thousand words.

Emerg Med J 2019 Feb;36(2):65-71

Department of Plastic Surgery, Bradford Royal Infirmary, Bradford, UK.

Introduction: This case involved a 15-year-old boy, who slipped and impaled his left hand on a wooden beam. An initial anterior-posterior radiograph was obtained prior to referral to plastic surgery for further management (figure 1).emermed;36/2/65/F1F1F1Figure 1Clinical photographs and initial X-ray taken of the impalement injury. Read More

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http://dx.doi.org/10.1136/emermed-2018-207761DOI Listing
February 2019
9 Reads

Compliance with hand hygiene in emergency medical services: an international observational study.

Emerg Med J 2019 Mar 28;36(3):171-175. Epub 2019 Jan 28.

Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.

Introduction: Healthcare-associated infection caused by insufficient hygiene is associated with mortality, economic burden, and suffering for the patient. Emergency medical service (EMS) providers encounter many patients in different surroundings and are thus at risk of posing a source of microbial transmission. Hand hygiene (HH), a proven infection control intervention, has rarely been studied in the EMS. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207872
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http://dx.doi.org/10.1136/emermed-2018-207872DOI Listing
March 2019
2 Reads

Prehospital analysis of northern trauma outcome measures: the PHANTOM study.

Emerg Med J 2019 Jan 24. Epub 2019 Jan 24.

Research and Development team, Great North Air Ambulance Service, The Imperial Centre, Darlington, UK.

Objective: To compare the mortality and morbidity of traumatically injured patients who received additional prehospital care by a doctor and critical care paramedic enhanced care team (ECT), with those solely treated by a paramedic non-ECT.

Methods: A retrospective analysis of Trauma Audit and Research Network (TARN) data and case note review of all severe trauma cases (Injury Severity Score ≥9) in North East England from 1 January 2014 to 1 December 2017 who were treated by the North East Ambulance Service, the Great North Air Ambulance Service or both. TARN methods were used to calculate the number of unexpected survivors or deaths in each group (W score (Ws)). Read More

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http://dx.doi.org/10.1136/emermed-2017-206848DOI Listing
January 2019

BET 2: Diagnostic value of ultrasound in determining lateral ligament injury of the ankle.

Emerg Med J 2019 Jan;36(1):56-57

Medical and Sports Science Department, Manchester United Football Club Ltd, Manchester, UK.

A short cut review was carried out to establish whether diagnostic ultrasound can accurately diagnose integrity of the lateral ligament complex in comparison to MRI. Two studies were directly relevant to the question using the described search methodology. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. Read More

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http://dx.doi.org/10.1136/emermed-2018-208381.2DOI Listing
January 2019
9 Reads

BET 1: Oseltamivir use for quicker alleviation of symptoms, fewer hospital admissions and lower mortality in adult patients with influenza B.

Emerg Med J 2019 Jan;36(1):55-56

University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK.

A short cut review was carried out to establish whether Oseltamivir leads to faster alleviation of symptoms, fewer hospital admissions and lower mortality in adult patients with confirmed influenza B presenting to the Emergency Department. Two studies were directly relevant to the question using the described search methodology on Ovid Medline and Embase. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. Read More

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http://dx.doi.org/10.1136/emermed-2018-208381.1DOI Listing
January 2019
1 Read

When the factory shuts down.

Emerg Med J 2019 Jan;36(1):51-60

Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.

Clinical Introduction: A 56-year-old man without known medical history was brought to our ED after he was found next to his bed, agitated and with waxing and waning consciousness. He has been bedbound for 5 days after a long-standing period of malnutrition. Physical examination reveals Kussmaul breathing, heart rate of 62/min and blood pressure of 135/100 mm Hg, normal cardiac, abdominal and a non-focal neurological examination other than confusion and altered level of consciousness. Read More

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http://dx.doi.org/10.1136/emermed-2018-207676DOI Listing
January 2019
2 Reads

Elderly man with mandibular pain.

Emerg Med J 2019 Jan;36(1):17-32

Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York City, New York, USA.

Clinical Introduction: A 77-year-old man presented to the ED with a history of fevers, purulent drainage and right mandibular pain. He had been diagnosed with multiple myeloma 2 years previously and was receiving treatment with pamidronate. On presentation, the lower right lip and chin were anaesthetic, tooth number 31 had grade 2 mobility and a 15 mm long ulceration was present on the lingual aspect of the mandible (figure 1). Read More

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http://dx.doi.org/10.1136/emermed-2018-207623DOI Listing
January 2019
2 Reads
1.776 Impact Factor

Timely access to care for patients with critical burns in India: a prehospital prospective observational study.

Emerg Med J 2019 Mar 11;36(3):176-182. Epub 2019 Jan 11.

Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.

Background: Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207900
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http://dx.doi.org/10.1136/emermed-2018-207900DOI Listing
March 2019
6 Reads

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial.

Emerg Med J 2019 Mar 10;36(3):142-147. Epub 2019 Jan 10.

Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.

Objective: Nitrous oxide 70% (NO 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with NO 70% with and without INF. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207892
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http://dx.doi.org/10.1136/emermed-2018-207892DOI Listing
March 2019
13 Reads

Authors' response to letter entitled 'During a paediatric traumatic cardiac arrest, is ventricular fibrillation a reversible cause like any other?'

Emerg Med J 2019 Mar 10;36(3):191. Epub 2019 Jan 10.

Emergency Department, Bristol Royal Children's Hospital, Bristol, UK.

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http://dx.doi.org/10.1136/emermed-2018-208370DOI Listing
March 2019
1 Read

Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians.

Emerg Med J 2019 Jan 10. Epub 2019 Jan 10.

Emergency Department, Birmingham Children's Hospital, Birmingham, UK.

Introduction: Acute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207937
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http://dx.doi.org/10.1136/emermed-2018-207937DOI Listing
January 2019
8 Reads

Prospective study of the sensitivity of the Wood's lamp for common eye abnormalities.

Emerg Med J 2019 Mar 10;36(3):159-162. Epub 2019 Jan 10.

Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

Objective: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities.

Study Design: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. Read More

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http://dx.doi.org/10.1136/emermed-2018-208235DOI Listing
March 2019
1 Read

Patients want us to ask about their sexuality and gender.

Authors:
Aidan Baron

Emerg Med J 2019 Mar 10;36(3):134-135. Epub 2019 Jan 10.

Emergency, Cardiovascular, and Critical Care Research Group, Centre for Health and Social Care Research, Kingston University and St George's, University of London, London, UK.

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http://dx.doi.org/10.1136/emermed-2018-208240DOI Listing
March 2019
1 Read

During a paediatric traumatic cardiac arrest, is ventricular fibrillation a reversible cause like any other?

Emerg Med J 2019 Mar 10;36(3):191. Epub 2019 Jan 10.

Paris Fire Brigade Medical Emergency Department, Paris, France.

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http://dx.doi.org/10.1136/emermed-2018-208290DOI Listing
March 2019
2 Reads

Reliability of triage systems for paediatric emergency care: a systematic review.

Emerg Med J 2019 Jan 10. Epub 2019 Jan 10.

Instituto de Medicina Social (IMS) da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.

Objective: To present a systematic review on the reliability of triage systems for paediatric emergency care.

Methods: A search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0-18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207781
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http://dx.doi.org/10.1136/emermed-2018-207781DOI Listing
January 2019
5 Reads

Collecting sexual orientation and gender identity information in the emergency department : the divide between patient and provider perspectives.

Emerg Med J 2019 Mar 10;36(3):136-141. Epub 2019 Jan 10.

Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Background: In the USA, The Joint Commission and Institute of Medicine have called for collection of patient sexual orientation (SO) and gender identity (GI) information in healthcare. In a recent study, we reported that ED clinicians believe patients will refuse to provide this information; however, very few patients say they would refuse to provide SO/GI. As part of this study, we interviewed patients and providers regarding the importance of collecting this information. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207669
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http://dx.doi.org/10.1136/emermed-2018-207669DOI Listing
March 2019
12 Reads

Taking the stage: a development programme for women speakers in emergency medicine.

Emerg Med J 2019 Jan 10. Epub 2019 Jan 10.

Department of Emergency Medicine, Columbia University Medical Center, New York City, New York, USA.

Female physicians in the USA achieve associate and full professor rank at numbers disparate to their representation within emergency medicine (EM). The authors describe a novel curriculum aimed at developing women speakers as a step on the journey towards academic recognition. In this pilot programme, four female physicians at a single academic emergency department participated in a year-long Speaker Development Programme (SDP), and all presented in at least one national EM conference at SDP completion. Read More

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http://dx.doi.org/10.1136/emermed-2018-207818DOI Listing
January 2019
1 Read

Martial arts technique for control of severe external bleeding.

Emerg Med J 2019 Mar 5;36(3):154-158. Epub 2019 Jan 5.

Department of Bioengineering, University of Washington, Seattle, Washington, USA.

Objectives: Haemorrhage control is a critical component of preventing traumatic death. Other than the battlefield, haemostatic devices, such as tourniquets or bandages, may not be available, allowing for significant avoidable blood loss. We hypothesised that compression of vascular pressure points using a position adapted from the martial art of Brazilian Jiu-Jitsu could be adapted to decrease blood flow velocity in major extremity arteries. Read More

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http://dx.doi.org/10.1136/emermed-2018-207966DOI Listing
March 2019
2 Reads

Optimising antiplatelet utilisation in the acute care setting: a novel threshold for medical intervention in suspected acute coronary syndromes.

Emerg Med J 2019 Mar 5;36(3):163-170. Epub 2019 Jan 5.

Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.

Objectives: To construct a model to optimise and personalise recommendations for antiplatelet prescription for patients with suspected acute coronary syndrome (ACS). Acknowledging that emergency physicians work with diagnostic uncertainty, we sought to identify the point at which the probability of ACS is sufficiently high that the benefits of antiplatelet treatment outweigh the risks. Second, we evaluated the projected clinical impact of this approach by using a clinical prediction model (Troponin-only Manchester Acute Coronary Syndromes (T-MACS)) to calculate the probability of ACS. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207633
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http://dx.doi.org/10.1136/emermed-2018-207633DOI Listing
March 2019
6 Reads

Japan Triage and Acuity Scale needs to revise level 5 criteria.

Emerg Med J 2018 Dec 22. Epub 2018 Dec 22.

Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

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http://dx.doi.org/10.1136/emermed-2018-208200DOI Listing
December 2018
2 Reads

Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review.

Emerg Med J 2018 Dec 22. Epub 2018 Dec 22.

Dalhousie University, Halifax, Canada.

Introduction: Death due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Read More

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http://dx.doi.org/10.1136/emermed-2018-207534DOI Listing
December 2018
3 Reads

Factors influencing variation in investigations after a negative CT brain scan in suspected subarachnoid haemorrhage: a qualitative study.

Emerg Med J 2019 Feb 20;36(2):72-77. Epub 2018 Dec 20.

Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

Introduction: Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians' decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH.

Methods: We conducted an interview-based qualitative study informed by social constructionist theory. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207876
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http://dx.doi.org/10.1136/emermed-2018-207876DOI Listing
February 2019
13 Reads

From ED overcrowding to jail overcrowding: a cautionary tale of a Serial Inebriate Programme (SIP).

Emerg Med J 2019 Feb 6;36(2):92-96. Epub 2018 Dec 6.

Department of Operations Research, Naval Postgraduate School, Monterey, California, USA.

Introduction: Community-based programmes have been implemented to curtail ED use by individuals with chronic public intoxication. Among these programmes is the Serial Inebriate Programme (SIP), which aims to reduce use of ED and emergency medical services. We present the results of an evaluation of the SIP in Santa Cruz, California, including data on the participants' police and jail history, information not considered in prior analyses of SIPs. Read More

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http://dx.doi.org/10.1136/emermed-2017-207332DOI Listing
February 2019
2 Reads

Implementation of tranexamic acid for bleeding trauma patients: a longitudinal and cross-sectional study.

Emerg Med J 2019 Feb 8;36(2):78-81. Epub 2018 Dec 8.

Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, UK.

Objective: To describe the use of tranexamic acid (TXA) in trauma care in England and Wales since the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial results were published in 2010.

Methods: A national longitudinal and cross-sectional study using data collected through the Trauma Audit and Research Network (TARN), the clinical audit of major trauma care for England and Wales. All patients in the TARN database injured in England and Wales were included apart from those with an isolated traumatic brain injury, with a primary outcome of the proportion of patients given TXA and the secondary outcome of time to treatment. Read More

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http://dx.doi.org/10.1136/emermed-2018-207693DOI Listing
February 2019
1 Read

Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission.

Emerg Med J 2019 Feb 5;36(2):82-87. Epub 2018 Dec 5.

Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA.

Background And Objectives: Delayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis. Read More

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http://dx.doi.org/10.1136/emermed-2018-208032DOI Listing
February 2019
2 Reads
1.776 Impact Factor

UK's initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals.

Emerg Med J 2019 Feb 1;36(2):117-123. Epub 2018 Dec 1.

Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield, UK.

The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Read More

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http://dx.doi.org/10.1136/emermed-2018-207562DOI Listing
February 2019
3 Reads

Emergency medical services oxygen equipment: a fomite for transmission of MRSA?

Emerg Med J 2019 Feb 1;36(2):89-91. Epub 2018 Dec 1.

Objectives: The primary purpose of this study was to determine if methicillin-resistant (MRSA) was present on the surface of oxygen cylinders and regulators used in the prehospital setting and secondarily to assess other surfaces for MRSA within the ambulance compartment, as a comparison.

Methods: On 17 March 2018, the surface of oxygen cylinders and regulators located in ambulances at an emergency medical services (EMS) station in North Alabama (n=9) and at an offsite oxygen cylinder storage area (n=70) were swabbed using sterile cotton-tipped applicators saturated in an 0.9% NaCl solution. Read More

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http://dx.doi.org/10.1136/emermed-2018-207758DOI Listing
February 2019
2 Reads

Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers.

Emerg Med J 2019 Jan 1;36(1):27-31. Epub 2018 Dec 1.

Academic Department of Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.

Background: The Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation. Read More

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http://dx.doi.org/10.1136/emermed-2018-208004DOI Listing
January 2019
1 Read

A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze?

Emerg Med J 2019 Feb 3;36(2):97-106. Epub 2018 Dec 3.

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Objectives: Diverting patients away from the emergency department (ED) has been proposed as a solution for mitigating overcrowding. This systematic review examined the impact of interventions designed to either bypass the ED or direct patients to other alternative care after ED presentation.

Methods: Seven electronic databases and the grey literature were searched. Read More

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http://dx.doi.org/10.1136/emermed-2017-207045DOI Listing
February 2019
12 Reads

Variability of outcome measures in trials of intravenous therapy in acute severe paediatric asthma: a systematic review.

Emerg Med J 2018 Nov 27. Epub 2018 Nov 27.

Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.

Objective: To determine the variability of primary and secondary outcomes used in trials of intravenous bronchodilators in children with acute severe paediatric asthma.

Methods: Systematic search of MEDLINE, EMBASE, Cochrane CENTRAL and the WHO International Clinical Trials Registry Platform for randomised trials in children (less than18 years) with acute severe paediatric asthma comparing intravenous bronchodilator therapy to another treatment. Initial search was performed on 7 January 2016 with an updated search performed on 6 September 2018. Read More

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http://dx.doi.org/10.1136/emermed-2018-207929DOI Listing
November 2018
2 Reads

Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review.

Emerg Med J 2019 Mar 23;36(3):185-190. Epub 2018 Nov 23.

Welsh Centre in Emergency Medicine Research, Morriston Hospital, Swansea, UK.

Introduction: It is well-recognised that the detection of rib fractures is unreliable using chest radiograph. The aim of this systematic review was to investigate whether the use of lung ultrasound is superior in accuracy to chest radiography, in the diagnosis of rib fractures following blunt chest wall trauma.

Methods: The search filter was used for international online electronic databases including MEDLINE, EMBASE, Cochrane and ScienceDirect, with no imposed time or language limitations. Read More

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http://dx.doi.org/10.1136/emermed-2017-207416DOI Listing
March 2019
1 Read

Approach to syncope in the emergency department.

Emerg Med J 2019 Feb 23;36(2):108-116. Epub 2018 Nov 23.

Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. Read More

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http://dx.doi.org/10.1136/emermed-2018-207767DOI Listing
February 2019
2 Reads

BET 2: Missed diagnosis of ischaemic stroke in the emergency department.

Emerg Med J 2018 Dec;35(12):768-769

Emergency Medicine Residency Program, Spectrum Health/Michigan State University, East Lansing, Michigan, USA.

A short cut review was carried out to establish the rate and clinical characteristics of missed diagnosis of acute ischaemic stroke in the emergency department (ED). Two papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 1 It is concluded that acute ischaemic stroke is missed in approximately 9%-14% of patients with this diagnosis who present to the ED. Read More

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http://dx.doi.org/10.1136/emermed-2018-208261.2DOI Listing
December 2018
11 Reads

BET 1: Lenient or strict rate control for atrial fibrillation.

Emerg Med J 2018 Dec;35(12):765-768

McMaster University, Ontario, Canada.

A short cut review was carried out to establish whether the degree of rate control influences mortality in patients with atrial fibrillation. 22 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in the two tables. Read More

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http://dx.doi.org/10.1136/emermed-2018-208261.1DOI Listing
December 2018
8 Reads

Near-infrared spectroscopy monitoring during out-of-hospital cardiac arrest: can the initial cerebral tissue oxygenation index predict ROSC?

Emerg Med J 2019 Jan 16;36(1):33-38. Epub 2018 Nov 16.

Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.

Study Objectives: Near-infrared spectroscopy is a modality that can monitor tissue oxygenation index (TOI) and has potential to evaluate return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). This study's objectives were to evaluate whether TOI could be associated with ROSC and used to help guide the decision to either terminate CPR or proceed to extracorporeal CPR (ECPR).

Methods: In this observational study, we assessed the patients with out-of-hospital cardiac arrest with non-traumatic cause receiving CPR on arrival at our ED between 2013 and 2016. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207533
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http://dx.doi.org/10.1136/emermed-2018-207533DOI Listing
January 2019
17 Reads

Exploring parents' reasons for attending the emergency department for children with minor illnesses: a mixed methods systematic review.

Emerg Med J 2019 Jan 2;36(1):39-46. Epub 2018 Nov 2.

The School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.

Background: The number of EDs visit is on the increase, and the pressure on EDs is of significant concern worldwide. The usage of EDs by parents of children with minor illness is an important and still unresolved problem causing a burden to healthcare services. The aim of this study was to review the literature to summarise parental reasons for visiting ED for children with minor illness. Read More

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http://dx.doi.org/10.1136/emermed-2017-207118DOI Listing
January 2019
5 Reads

Analgesia in the emergency department: why is it not administered?

Emerg Med J 2019 Jan 30;36(1):12-17. Epub 2018 Oct 30.

Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia.

Objective: Pain management in the ED is often suboptimal, with many patients not receiving analgesia. We aimed to determine why some patients refuse it, why others do not receive it, and whether these variables impact on patient satisfaction with their pain management.

Methods: We undertook a prospective, observational study in a large, Australian, tertiary referral ED (February-May 2017). Read More

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http://dx.doi.org/10.1136/emermed-2018-207629DOI Listing
January 2019
1 Read