Emergency Medicine Journal

NOVEMBER 21, 2024

Background The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic. Methods A quasi-experimental study was performed. In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED.

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Emergency Department Teamwork Patient Safety Hospitals 93

Science Based Medicine

NOVEMBER 21, 2024

The FDA is proposing to order the removal of phenylephrine from oral cough and cold remedies. The post FDA poised to reshape the cold remedy aisle first appeared on Science-Based Medicine.

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Emergency Medicine Journal

NOVEMBER 21, 2024

This month’s update is by the Emergency Medicine team in South East 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.

Administration 52

Administration Outcomes 52

NRC Health

NOVEMBER 21, 2024

Consumers expect always-on connectivity, transparency, and personalization; so, to drive loyalty, the Wexner Medical Center has focused on delivering individualized, high-quality patient experiences while enhancing its digital front door. The post Unleashing innovative marketing insights to connect the dots for patient experience initiatives appeared first on NRC Health.

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Emergency Medicine Journal

NOVEMBER 21, 2024

Background Despite pronounced increases in homelessness and mental health problems in the USA over the past decade, further exacerbated during the pandemic, and the higher prevalence of mental health conditions among individuals experiencing homelessness, no study has examined trends in self-injury-related ED visits by individuals experiencing homelessness using up-to-date nationwide data.

Emergency Department 52

Emergency Department Outcomes Hospitals 52

PEMBlog

NOVEMBER 21, 2024

I am excited to share the recording of the AAP Section on Emergency Medicine Fall Virtual Education Session , originally held on Tuesday, November 19, 2024 focused on delivering timely and actionable feedback, along with strategies to develop and implement sustainable feedback programs. PEM educators shared their experiences and provided practical strategies to strengthen evaluation processes and initiatives in this multidisciplinary, interactive session.

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Documentation/Coding Pediatrics Emergency Department 52

Emergency Medicine Journal

NOVEMBER 21, 2024

A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In adult patients presenting to the ED with diabetes-related visual symptoms, how effective is using a portable handheld fundus camera in diagnosing diabetic retinopathy? MEDLINE, Embase and Cochrane databases were searched for relevant evidence.

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Emergency Medicine Journal

NOVEMBER 21, 2024

I read with interest the frailty practice review by Van Oppen et al in which they suggest that existing emergency department (ED) guidelines and protocols poorly represent older people living with frailty. They recommend that clinicians caring for these patients should not only appraise the available evidence in the context of an individual’s situation and values but also consider the person’s personal preferences to truly deliver person-centred care. 1 They highlight the fact that e

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Emergency Department Wellness 52

EM Ottawa

NOVEMBER 21, 2024

A common Emergency Department (ED) presentation, vaginal bleeding in pregnancy affects approximately 30% of pregnancies in the 1st trimester and 1-2% in the 2nd trimester. About half of these result in pregnancy loss. Here we will use cases to highlight an ED approach to stable vaginal bleeding in pregnancy with an emphasis on: Management of […] The post Stable Vaginal Bleeding in Pregnancy appeared first on EMOttawa Blog.

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Emergency Medicine Journal

NOVEMBER 21, 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.

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Research 52

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. Vitals were within normal limits. Here is her triage ECG: What do you think? Smith : This is classic for pulmonary embolism (PE). There are 2 key points to making this diagnosis on the ECG: 1) There is T-wave inversion which you might think is due to Wellens' waves, but the patient has active symptoms, so it is not Wellens' sydrome 2) The T-wave inversion in V1-V4 is accompanied by T-wave invers

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EKG/ECG Shock Ultrasounds Wellness 90

Emergency Medicine Journal

NOVEMBER 21, 2024

Emergency department (ED) encounters among patients experiencing non-fatal opioid-involved overdoses continue to increase. 1 Across Georgia, ~13 000 non-fatal drug-involved overdoses present to EDs, annually. Patient interventions capable of ensuring timely access to recovery services following these encounters are warranted. Peer recovery coaches (PRCs) are persons in long-term recovery from substance use disorders (SUD) who leverage their experience to serve as liaisons between patients and cl

Emergency Department 52

Emergency Department Outcomes Hospitals 52

Sensible Medicine

NOVEMBER 21, 2024

It’s my pleasure to introduce this letter and response to a recent article by Ryan about pediatric gender medicine. Mr Lipfert is a pre-medical student and Mr. Ryan is a journalist. Sensible Medicine Pediatric Gender Medicine: Dispatches From a Deceptive Medical Field It is my pleasure to introduce this article by the intrepid reporter Benjamin Ryan.

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Pediatrics Domestic Violence Research Psychiatric 98

Emergency Medicine Journal

NOVEMBER 21, 2024

Subarachnoid haemorrhage (SAH) can be a difficult diagnosis in patients who present to the emergency department (ED) with acute headache but are alert with no neurological deficit. 1 The classical teaching is that SAH cannot be excluded by non-contrast CT and so patients should proceed to lumbar puncture (LP) if the initial CT is normal. However, there has been a recent shift in practice—driven by emerging evidence 1 2 —away from routinely offering LP to exclude SAH.

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Emergency Department Research 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Suspected stroke is a common scenario for emergency medical services (EMS) which typically triggers urgent transportation to the nearest stroke-admitting hospital with prenotification according to local protocols. 1 2 This linear pathway is appropriate for the majority of presentations and facilitates access to time-critical treatments, such as intravenous thrombolysis.

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Stroke EMS Hospitals 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Olanzapine long-acting injection is a commonly used antipsychotic drug formulation in the treatment of schizophrenia. Postinjection delirium/sedation syndrome (PDSS) is a potential side effect of this intramuscular depot, for which patients are often presented at the ED. In this article, we give an overview of the current literature outlining the key aspects of managing this syndrome in a critical care setting, illustrated by a typical fictional clinical case.

Emergency Department 52

Emergency Department 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Background Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes. Methods We conducted a retrospective analysis of data from the Japanese Association for Acute Medicine-OHCA Registry for patients <18 years of age with OHCA between June 2014 and December

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Hospitals Outcomes Resuscitation CPR 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Clinical introduction A 71-year-old man presented to the ED with progressive headache and neck pain. The patient had no visual, neurological, chest or abdominal symptoms. Temperature was 38.8°C, he was fully conscious with no signs of meningeal irritation. C reactive protein was 85 mg/L. CXR and brain CT were unremarkable; cerebrospinal fluid analysis was normal.

Fractures 52

Fractures 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Background Early assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with TIA present to emergency medical services (EMS) but may not require hospitalisation. Paramedics could identify and refer patients with low-risk TIA, without conveyance to the ED.

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Emergency Medicine Journal

NOVEMBER 21, 2024

Detection of rapid loss of intravascular volume due to haemorrhage or fluids can be a time-sensitive data point in critical situations. Clinical evaluation can be difficult and prior research has shown inaccuracies leading to increased morbidity and mortality. 1 One way to measure this is through the assessment of capillary refill time (CRT), which has been shown to significantly vary between physicians. 2 However, goal-directed fluid management often uses manual CRT measurements as a guiding me

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Research 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Welcome to the December issue of EMJ , it is a good time to reflect on and celebrate the research progress in emergency medicine in 2024, which is so inspiring. It is also a good time to consider the areas of emergency medicine such as mental health where more research is much needed. We continue to see a worrying rise in mental health presentations globally so it is timely to have number of papers in this issue pertaining to mental health and psychosocial issues.

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Research Hospitals 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Vignette 1 It all began when I realised that my memory was becoming a problem, both at work and at home. Simple words that used to come effortlessly suddenly required extra effort to find. It’s like grasping for something that should be there but isn’t. Usually if I stopped trying, the word came eventually. At first, I chalked it up to the demands of a busy life, juggling work, and family commitments.

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Emergency Medicine Journal

NOVEMBER 21, 2024

Clinical introduction A 50-year-old construction worker presented to the ED with a history of fall. He had pain in the right foot and difficulty weight bearing. The patient was assessed and diagnosed to have a closed isolated injury to the right foot ( figure 1 ). The foot was neurovascularly intact. Examination only showed painful restriction of plantar flexion of the big toe.

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Dislocations Fractures 52

Emergency Medicine Journal

NOVEMBER 21, 2024

Background Acute aortic syndrome (AAS) requires urgent diagnosis with computed tomographic angiography (CTA). Diagnostic strategies need to weigh the benefits of detecting AAS against the costs of using CTA with a low yield of AAS when the prevalence of AAS is low. We aimed to estimate the cost-effectiveness of diagnostic strategies using clinical probability scoring and D-dimer to select patients with potential symptoms of AAS for CTA.

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Research Hospitals 52