Emergency Medicine Journal

DECEMBER 30, 2024

Introduction Emergency doctors routinely face uncertainty—they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored.

Outcomes 98

Outcomes Wellness Research 98

PulmCCM

DECEMBER 30, 2024

PEERLESS, ABC-SEPSIS, IV vs IO, BALANCE, FAST, SAHARA, TESLA/LASTE, Epic sued, ChatGPT vs MDs, more

Sepsis 52

Sepsis 52

Emergency Medicine Journal

DECEMBER 30, 2024

The authors are an Emergency Physician and a Midwife on board the Geo Barents, Médecins Sans Frontières’ search and rescue ship in the Central Mediterranean Sea. Médecins Sans Frontières depends on private donations to support its work— www.msf.org.uk We are handed a little girl, maybe 3-year old and wrapped tight in winter clothes.

Operations 52

Operations 52

Core Ultrasound

DECEMBER 30, 2024

In part two of this series on using ultrasound during cardiac arrest, we dive into advanced strategies to further optimize your resuscitation care. Building on the foundation from part one, this video focuses on actionable tips to take your ultrasound skills to the next level during cardiac arrest scenarios. Cardiac Arrest Part 1 RUSH exam Courses The post Cardiac Arrest Update 2024 (Part 2) first appeared on Core Ultrasound.

Ultrasounds 40

Ultrasounds Resuscitation 40

Emergency Medicine Journal

DECEMBER 30, 2024

Trauma and emergency care is a national priority in Uganda due to the high burden of injury, impacting a primarily young and rural population. With a significant gap in qualified emergency medicine professionals, a need exists to rapidly upskill the current health workforce and to strengthen access to learning for non-specialist emergency care providers nationally.

52

52

PEMBlog

DECEMBER 30, 2024

Guess who’s back? Back again. Epi Pen. Jab a friend. Give that EpiPen even if you think it might possibly be anaphylaxis! Lyrics His palms are sweaty, knees weak, arms are heavy, He’s allergic, it’s anaphylaxis already. He’s chokin’, his throat’s closin’, hives all over, IgE mediated, peanut exposure Mucosa swollen, he’s gaspin’ for breath, Heart poundin’ like a drum, he’s scared to death. multi system reaction, puking and wheezin

Anaphylaxis 52

Anaphylaxis 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ among ED staff.

Ambulance Services 52

Ambulance Services Emergency Department Research Hospitals 52

Emergency Medicine Journal

DECEMBER 30, 2024

Happy New Year and welcome to the first primary survey for the Emergency Medicine Journal of 2025. I hope there was an opportunity to rest over the holiday period and for those that were working, thank you. A new year brings us straight into another exciting edition of the journal. This month, the journal brings a prehospital extravaganza of papers, along with global health and staff well-being.

Emergency Department 52

Emergency Department Wellness 52

Sensible Medicine

DECEMBER 30, 2024

The debate of the week on social media centered on the role of immigrants working on US visa programs. Dr Ashish Jha posted on X an observational study in the BMJ that he co-authored, which found that international medical graduates outperformed US doctors. The flawed study offers many lessons in critical appraisal. First a note on Dr. Jha, whom I have not met and mean no malice.

Academics 111

Academics Leadership Outcomes Radiology 111

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke). However, little is known about their usefulness for other patients and the processes involved in ED responses to them.

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

Emergency Medicine Journal

DECEMBER 30, 2024

Does your emergency department (ED) feel like a constant battle? Has the function of your ED been destroyed by external forces? It might strike the reader as extreme to use words related to battle regarding current working conditions in EDs but for most of us this is probably not far from the truth. When you think about battles, you think about frontline casualties (an irony given the origins of emergency medicine (EM)) and how there must be sacrifice for the majority to succeed.

EMS 52

EMS Emergency Department Hospitals 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background Ambulance clinicians use pre-alert calls to inform emergency departments (EDs) about the arrival of critically ill patients. However, there is variation in guidance between local ambulance service policies in terms of what should be pre-alerted and how pre-alerts should happen. We conducted a national online survey to understand the use of ambulance pre-alerts and to inform recommendations for practice and guidance.

Ambulance Services 52

Ambulance Services Emergency Department 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background The Emergency Department(ED) team need to make sense of an ever-changing dynamic environment. The stories people tell about everyday occurrences are central to how sense-making occurs. These stories also contribute to organisational culture, with the frequently told narratives maintaining organisational identity and shaping behaviour. By capturing stories in the ED, valuable insights can be gained into organisational culture and identity.

Emergency Department 52

Emergency Department Hospitals 52

Emergency Medicine Journal

DECEMBER 30, 2024

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.

Research 52

Research 52

Emergency Medicine Journal

DECEMBER 30, 2024

This month’s update is by the Aberdeen Royal Infirmary Emergency Department in Scotland. 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.

EKG/ECG 52

EKG/ECG Emergency Department Outcomes 52

Emergency Medicine Journal

DECEMBER 30, 2024

Introduction Stress and burnout are prevalent among emergency department (ED) staff in the UK. The concept of well-being interventions for ED staff is a growing area of interest and research worldwide. Various interventions are described in the literature, yet little is known about the experience of ED staff in the UK of interventions designed to support their well-being.

Emergency Department 52

Emergency Department Wellness Research 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background Patients with traumatic out-of-hospital cardiac arrest (t-OHCA) require on-scene airway management to maintain tissue oxygenation. However, the benefits of prehospital endotracheal intubation remain unclear, particularly regarding neurological outcomes. Therefore, this study aimed to evaluate the association between prehospital intubation and favourable neurological outcomes in patients with t-OHCA.

Outcomes 98

Outcomes Hospitals Airway Management 98

Emergency Medicine Journal

DECEMBER 30, 2024

Background On-scene improvised and interim decontamination protocols in the Initial Operational Response to chemical incidents aim for rapid intervention to minimise injury before specialist capabilities arrive. This study examines the effectiveness of UK improvised and interim protocols conducted in sequence. Method A simulant with methyl salicylate (MeS) in vegetable oil and a fluorophore was applied to participants’ shoulders, arms and legs.

Operations 98

Operations Research 98

Emergency Medicine Journal

DECEMBER 30, 2024

We would like to thank the author for their comments. We would be happy to provide some further explanation regarding the questions and comments regarding our paper. 1 A correction has now been issued for points (2) and (3). (1) In regards to the cost discrepancy of andexanet alfa, we cited and referenced the correct cost of the medication as of 2019, at the time of the study.

52

52

Emergency Medicine Journal

DECEMBER 30, 2024

In a recent article by Sadek et al ( Sadek E, et al. Emerg Med J 2024; 41: 162 – 7 ), we noted several incorrect statements and respectfully ask the authors to correct the following points: In the introduction of their article (Sadek et al , p163), 1 Sadek et al 1 stated the following: "The costs of low dose and high dose of andexanet alfa are approximately $29 040 and $58 080, respectively.

52

52

Emergency Medicine Journal

DECEMBER 30, 2024

Clinical Introduction A 13-year-old girl fell while horseback riding and landed on her right shoulder. She experienced immediate pain and swelling over her right shoulder. On clinical examination, a skin dimple was noted over the bruised area of her swollen right shoulder ( figure 1 ). The ‘badge area’ sensation and distal neurovascular status were normal.

Fractures 52

Fractures 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background Pulse oximetry measures oxygen saturation non-invasively by using differential absorption of infrared signals which are dependent on the oxyhaemoglobin:deoxyhaemoglobin ratio. We tested the hypothesis that pulse oximetry error in measurements of blood oxygen saturations may be associated with blood haemoglobin levels. Methods The study design was an observational study of all adult patients admitted to a large teaching hospital with suspected or confirmed COVID-19 infection from Febru

Hospitals 52

Hospitals 52

Emergency Medicine Journal

DECEMBER 30, 2024

Clinical introduction A 65-year-old man presented to the ED after experiencing syncope during a flight. On arrival, his vital signs were stable, including normal oxygen saturation while breathing ambient air. Physical examination revealed normal respiration, the absence of a heart murmur and no lower extremity oedema. Laboratory examination, chest radiography and electrocardiography were unremarkable.

52

52