The Trauma Pro

NOVEMBER 28, 2023

The November issue of the Trauma MedEd newsletter will be sent out soon! It’s chock full of tips and tricks dealing with trauma practice guidelines This issue is being released over the weekend. If you are already a subscriber, you will receive it automatically. If not and you sign up any time before then, you will receive it, too. Otherwise, you’ll have to wait until it goes out to the general public a week or two later.

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Emergency Medicine Cases

NOVEMBER 28, 2023

On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine immobilization controversies and techniques, Navpreet Sahsi on the difference between humanitarian and development work The post EM Quick Hits 53

EMS 113

EMS Pediatrics Resuscitation 113

Sensible Medicine

NOVEMBER 28, 2023

For many doctors in academic medicine, publishing in peer reviewed journal is an important part of their careers. Fortunately, over the last 25 years, promotions criteria have matured so it is not quite publish or perish anymore. People can rise through the academic ranks as gifted clinicians, creative and effective educators, and talented administrators.

Stroke 82

Stroke Academics Outcomes Administration 82

Emergency Medicine Journal

NOVEMBER 28, 2023

Clinical introduction A 9-year-old boy visited our ED with left eye pain with visual loss. His left eye was hit by a rope while he was watching his friend jumping with the rope 2 days ago. The injured eye is shown in figure 1. The intraocular pressure of the injured eye was 23.3 mm Hg, with only light perception. Question What is the most likely diagnosis?

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Ziqitza HealthCare Ltd

NOVEMBER 28, 2023

Pongal, a popular South Indian festival, is not only a celebration of harvest but also a celebration of traditional South Indian cuisine. The mouthwatering dishe­s whipped up during Pongal aren’t just about taste, the­y’re packed with health be­nefits too. Join us on a culinary journey as we e­xplore the nutritional boons of South Indian cuisine and ge­ar you up with tips for healthier twists on classic Pongal recipe­s.

Ambulance Services 52

Ambulance Services Wellness 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives The novel ED triage tool was developed after the authors found that 3 current triage tools for older adults injured by low level falls had very low specificity, resulting in significant over-triage. A Delphi study with experienced EM clinicians was subsequently carried out to create the novel tool. The triage tool utilised their responses.

EMS 75

EMS 75

EMergucate

NOVEMBER 28, 2023

The facial x-rays are from an adult with right cheek swelling, bruising & cough.

EMS 52

EMS 52

American Medical Compliance

NOVEMBER 28, 2023

The following course is designed to teach healthcare providers the necessary tools in order to show empathy to patients suffering from dementia. Understanding the causes and symptoms of various forms of dementia will be helpful in providing support on an individual basis. There are four types of dementia. These include Alzheimer’s disease, frontotemporal dementia, Lewy body dementia, and vascular dementia.

Outcomes 52

Outcomes 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Introduction The ECG is one of the most frequently performed diagnostic tests in Emergency Medicine. Electrode misplacement can lead to incorrect diagnoses, initiation of incorrect or withholding appropriate treatment. Right arm – left arm (RA-LA) misplacement is the most common and most recognisable limb lead misplacement. Inverted P waves and QRS complexes in lead I are characteristic features of RA-LA misplacement.

EKG/ECG 71

EKG/ECG Emergency Department Research 71

NRC Health

NOVEMBER 28, 2023

When a healthcare team respects a patient’s uniqueness, the patient, in turn, receives the safest care with the best outcomes. During October’s Becker’s Healthcare podcast, two prominent pediatric leaders discussed the critical nature of intentional practices and the importance of family-centered care. The post Children’s Colorado: Empowering pediatric families with intentional care appeared first on NRC Health.

Pediatrics 52

Pediatrics Outcomes 52

EMergucate

NOVEMBER 28, 2023

70 year old man presented with reduced level of consciousness. His venous blood gas showed the following: PH = 7.

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Emergency Medicine Journal

NOVEMBER 28, 2023

Background The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR).

Operations 52

Operations EMS Hospitals Outcomes 52

Mind The Bleep

NOVEMBER 28, 2023

What is it? Restorative yoga is a type of yoga that emphasises deep relaxation techniques and the importance of the balance between the mind and body. It encompasses yoga poses that are held for a specific amount of time with the assistance of yoga props and deep breathing techniques. It aids in physical, mental and emotional relaxation through yoga possess and passive stretching.

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Emergency Medicine Journal

NOVEMBER 28, 2023

Background Physicians have observed patients with COVID-19 without respiratory distress despite marked hypoxaemia and extensive radiographic abnormalities, a controversial phenomenon called ‘silent hypoxaemia’ We aimed to compare the relationship between RR and peripheral oxygen saturation (SpO 2 ) in patients with COVID-19 versus patients without COVID-19 when breathing air on admission.

Administration 52

Administration 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Introduction Alternative pre-hospital pathways (APPs) are a relatively new model of healthcare delivery. The Cork APP Team was founded in November 2019 and consists of a Registrar and Emergency Medical Technician. The Team responds to low acuity 999/112 calls or Paramedic referrals, responding to life-threatening calls only when absolutely necessary.

Hospitals 52

Hospitals Emergency Department Research 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Decompression sickness (DCS) occurs due to inert gas bubble formation in tissues and can cause serious injury. Hyperbaric oxygen therapy (HBOT) is the definitive treatment. Dive physicians advocate early therapy, believing it will produce the greatest patient benefit. This audit aims to investigate the relationship between time delay to treatment and its effect on HBOT efficacy and novelly, 30-day patient outcomes, to better support recommendations for healthcare providers.

Outcomes 40

Outcomes Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Crowding is the most pressing issue currently faced by UK emergency departments (ED). When departments are crowded then hospital admissions are delayed, and the risk of mortality is increased. Professionals working in crowded departments feel unable to provide high quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to analyses of service outcomes rather than more detailed understanding of perspectives.

Emergency Department 40

Emergency Department Research Outcomes Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Renal colic is often extremely painful, and existing analgesic regimes frequently provide insufficient relief. There is biological plausibility that metoclopramide, a prokinetic antiemetic with activity at multiple receptor types, may be a useful treatment for renal colic pain. This review identifies and evaluates the relevant evidence concerning its use for this indication.

Outcomes 40

Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Emergency physicians are expected to know a little about a lot - to be the "Jack of all trades, and master of resuscitation" (Cunningham, 2021). From major trauma to urinary tract infections, practitioners need a breadth of knowledge that allows them to respond effectively to diverse crises occurring in different specialties. In our increasingly digital age this knowledge base needs to encompass the novel digital pathologies that have begun affecting patients, however at pres

Resuscitation 40

Resuscitation Research 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives JDs frequently report that they are unable to attend regular teaching due to departmental clinical pressures, representing lost opportunities for their training and development. There is need for development of training methods which minimise impact on clinical service delivery. Therefore, our aim was to develop a simulation training model for Emergency Department (ED) JDs which would a) have minimal impact upon ED service provision and b) deliver tailored learning objectives

Emergency Department 40

Emergency Department 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives The digitalisation of patient data and the adoption of electronic health records (EHRs) has changed the patient-doctor encounter. A growing body of evidence suggests EHRs reduce efficiency and negatively impact cognitive load, ultimately reducing the number of patients seen by clinicians and increasing the chances of introducing medical error.

Documentation/Coding 40

Documentation/Coding Emergency Department 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Previous work carried out by the authors revealed that current triage tools for older trauma patients identified those with serious injuries, but specificity ranged from 11% - 31%, potentially resulting in significant levels of over-triage. The ideal triage tool should have an over-triage rate of under 35% with an under-triage rate of 5%.

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Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Cauda Equina Syndrome (CES) is a neurosurgical emergency that requires urgent assessment and intervention. GIRFT recommendations suggest MRI scanning should be available 24/7 but our ED had limited access in hours and only 2 slots at weekends. AIM: To increase the availability and earlier access to MRI for patients with suspected cauda equina syndrome.

Radiology 40

Radiology Radiology Documentation/Coding Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Major trauma is a leading cause of death and disability worldwide, and many healthcare systems seek to improve outcomes following severe injury with provision of pre-hospital critical care (PHCC). Research has focussed on the efficacy of PHCC, but less is known about how the structure of these services may influence their response to major trauma.

Ambulance Services 40

Ambulance Services Hospitals Research Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Trauma is a leading cause of death for those under 44. Patients with blood group O (bgO) have been reported to have higher mortality. The existing hypothesis (that lower levels of circulating von Willebrand factor/factor VIII in patients with bgO increases mortality through a bleeding tendency) has not been tested. Our study uniquely investigates the association between all ABO Rh groups and 30-day all-cause mortality in a large adult trauma patient cohort.

Outcomes 40

Outcomes Research 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives In recent years there has been a large increase in demand for emergency care across the country, particularly during winter. This study utilised 12 months’ of routinely collected data from Emergency Departments (EDs) and acute Admitted Patient Care Episodes (APCs) to understand trends in demand for emergency care. Specifically, we examined factors associated with seasonal variation in overall demand and avoidable usage of emergency care.

Emergency Department 40

Emergency Department Hospitals Outcomes Research 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Reflection is fundamental to the development of clinicians. It can be challenging and time consuming to access the information required to reflect upon their clinical practice by reviewing the outcomes of their individual patients, referred to as patient follow-up. Patient outcomes are commonly documented in electronic health records (EHR).

EMS 40

EMS Documentation/Coding Outcomes Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis requiring urgent treatment. Method and Design We undertook a retrospective diagnostic cohort study involving adult medical cases transported to hospital by emergency ambulance in 2019.

Sepsis 40

Sepsis Ambulance Services Operations Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Collective competence of a healthcare team is key to patient safety and quality in healthcare. This presentation reports part of a UK-Japan interdisciplinary research project on emergency care team interactions, focusing on gaze behaviour. The study investigates how healthcare professionals achieve joint attention for joint action.

Patient Safety 40

Patient Safety Research Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. Managing pain in these patients is notoriously challenging but essential to prevent complications, facilitate physiotherapy, and improve outcomes.

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives The increasing demand for mental healthcare in young people has resulted in limited availability, leading to increased emergency department (ED) visits and subsequent admissions. Individuals with mental illness frequently rely on ED services, overwhelming the demand to address mental and physical care needs. To address this, the ‘Best for You’ integrated care programme was developed in collaboration with NHS Trusts in Northwest London. ‘Best for You’ a

Emergency Department 40

Emergency Department Research 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives After reading the FORCE publication our hospital set out to adopt the suggestions of the study and manage torus or ‘buckle’ fractures with the offer of a bandage instead of a wrist splint. The full FORCE study report includes detailed health economic results but it struck us that this change could also contribute to a carbon net zero NHS.

Fractures 40

Fractures Emergency Department Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Safety net advice and provision of written resources are core to delivering safe care in paediatric emergency medicine. In 2020 a new QI project commenced at Sheffield Children’s NHS Foundation Trust (65,000 PEM attendances/year) aiming to digitalise all paper information leaflets into an electronic format. Aims: Enhanced access to reliable information Paper saving Ease of updating information Method and Design Review of all paper leaflets Upload of new digital resource

Emergency Department 40

Emergency Department Head Injuries Documentation/Coding 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Early identification of patients at higher risk of death and hospital admission is an important problem in emergency departments. Most triage scales were developed before current electronic healthcare records were developed. The implementation of a national Emergency Care Data Set allows for standardised recording of presenting complaints and use of electronic patient records (EPR) offers the potential for automated triage.

Documentation/Coding 40

Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives The prevalence of multimorbidity, the presence of two or more long-term conditions (LTCs) is increasing, and it is associated with poor health outcomes. Multimorbidity is likely to impact on care delivery in emergency department(ED) settings due to time-critical decision-making in the context of patient complexity. This study describes the impact of multimorbidity in patients attending ED on 30-day mortality and other patient-centred outcomes in an ED setting.

Emergency Department 40

Emergency Department Outcomes Hospitals 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives This qualitative study aims to establish the existence and impact of patient-to-staff incivility on staff wellbeing and patient care in the Emergency Department (ED). Background Research has indicated that incivility between staff in clinical environments negatively impacts their wellbeing, clinical performance and the care patients receive (Riskin et al., 2015).

Emergency Department 40

Emergency Department Patient Safety Research 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Emergency Departments (EDs) offer a valuable opportunity to support people to change their behaviour to improve health. Smoking remains the leading cause of morbidity and mortality. E-cigarettes are effective for supporting smoking cessation, yet there have been no randomised controlled trials of smoking cessation interventions in the ED using e-cigarettes.

Emergency Department 40

Emergency Department Outcomes 40