Science Based Medicine
OCTOBER 23, 2024
A recent meta-analysis of eye movement desensitization and reprocessing (EMDR) therapy concludes that the evidence “confirms” EMDR is effective in treating depression. It is a great example of the limitations of meta-analysis, and how easy it is to create essentially a false narrative using poor quality research. EMDR was “developed” by Dr.
Emergency Medicine Journal
OCTOBER 23, 2024
Patients who present to the ED usually have their BP measured as part of their routine triage assessment. BP measurements suggesting hypertension (≥140 systolic or ≥90 diastolic 1 ) are a frequent incidental finding, unrelated to the patient’s presenting complaint, but require follow-up. 2 Hypertension is associated with an increased risk of cardiovascular events, so its detection in ED may be an opportunity to initiate further investigations and management. 3 Guidance produced
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ALiEM
OCTOBER 23, 2024
Ultrasound-guided procedures are difficult enough just identifying the anatomy. Performing a nerve block with the ultrasound in one hand and the needle in the other hand adds extra challenges. The simplest 1-person approach involves attaching a syringe with local anesthetic directly to the end of the procedural needle. A 2-person approach involves attach the syringe to a custom tubing-needle setup such as below.
Emergency Medicine Journal
OCTOBER 23, 2024
This month’s update is by The Alfred Emergency and Trauma Centre in Victoria, Australia. 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.
PulmCCM
OCTOBER 23, 2024
Endovascular thrombectomy became standard care for ischemic strokes resulting from large vessel occlusion (LVO) in the anterior cerebral circulation after randomized trials published in the mid-2010s showed improved outcomes with the intervention. Patients with large strokes (as assessed on imaging) were excluded from those trials establishing thrombectomy's benefits, owing to hypothetical risks (such as bleeding or edema) after reperfusion of large areas of dead or damaged brain tissue.
Emergency Medicine Journal
OCTOBER 23, 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.
Emergency Medicine Journal
OCTOBER 23, 2024
A shortcut review of the literature was carried out to examine whether the measurement of neuron-specific enolase (NSE) can be used as a marker to exclude spinal cord, cauda equina or other significant spinal nerve root compression. 132 papers were found of which 4 included data on patients relevant to the clinical question, these are discussed in the paper.
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Emergency Medicine Journal
OCTOBER 23, 2024
The administration of dilute solutions of noradrenaline via peripheral venous catheters (PVCs) has gained increasing acceptance in recent years. Large studies have provided reassuring safety data, 1 and guidelines recognise this therapy as a short-term measure for blood pressure support, 2 particularly in septic shock. 3 Despite this the UK critical care community has been slow to accept peripheral noradrenaline; fear of extravasation injury persists in some quarters, and at a recent Investigato
Emergency Medicine Journal
OCTOBER 23, 2024
Lower limb immobilisation increases venous thromboembolism (VTE) risk. However, as the risk is low (0.6–2%), it is preferable to use a risk assessment tool to determine who should receive prophylaxis. 1 Various VTE risk assessments for lower limb immobilisation exist. 2 King’s College Hospital (KCH) Trust employs a simple four-item risk assessment tool (the K4 score) ( figure 1 ), which was derived from local expert opinion and implemented in 2016.
Emergency Medicine Journal
OCTOBER 23, 2024
Background D-dimer is the only biomarker currently recommended in guidelines for the diagnosis of acute aortic syndrome (AAS). We undertook a systematic review to determine whether any alternative biomarkers could be useful in AAS diagnosis. Methods We searched electronic databases (including MEDLINE, EMBASE and the Cochrane Library) from inception to February 2024.
Emergency Medicine Journal
OCTOBER 23, 2024
In England, the rate of emergency department (ED) attendance in the first year of life is greater than at any other age, amounting to 122 visits per 100 000 population. 1 Children aged 0–16 accounted for 23% of ED attendances (more than 5.4 million children) in 2022/2023, with children aged 0–4 accounting for 11%. Paediatric emergency medicine (PEM) was first recognised in the UK in 2001 with all doctors required to have a parent specialty—emergency medicine (EM) or paediatrics
Emergency Medicine Journal
OCTOBER 23, 2024
Background Although one objective of NHS 111 is to ease the strain on urgent and emergency care services, studies suggest the telephone triage service may be contributing to increased demand. Moreover, while parents and caregivers generally find NHS 111 satisfactory, concerns exist about its integration with the healthcare system and the appropriateness of advice.
Emergency Medicine Journal
OCTOBER 23, 2024
Objectives Paediatric trauma elbow radiographs are difficult to interpret and there is a potential for harm if misdiagnosed. The primary goal of this study was to assess the ability of healthcare professionals internationally to interpret paediatric trauma elbow radiographs from the radiograph alone by formulating the correct diagnosis. Methods This prospective international study was conducted online via the Free Open Access Medical Education platform, Don’t Forget the Bubbles (DFTB, ISSN
Emergency Medicine Journal
OCTOBER 23, 2024
Clinical introduction An 84-year-old woman came to the ED with raised skin lesions located on her trunk for several weeks ( figure 1 ). The lesions varied in size from 5 mm to 4 cm and were accompanied by severe pruritus. Medical history confirmed non-small cell lung cancer (stage IIIB) and chronic renal impairment (glomerular filtration rate 33 mL/min/1.73 m 2 ).
Emergency Medicine Journal
OCTOBER 23, 2024
In this issue of the EMJ , Dann et al 1 report an online prospective study in which clinicians were asked to identify injuries in a series of 10 paediatric elbow radiographs. 1 The participants were mostly doctors working within emergency medicine and 73% had over 6 years’ experience. However, on average, clinicians interpreted just over half of the radiographs correctly and only 3% of participants achieved a perfect score.
Emergency Medicine Journal
OCTOBER 23, 2024
Clinical introduction A man aged 41 years presented to the ED with left cheek swelling and bruising following a physical altercation. Physical examination revealed tenderness and crepitus localised to the left infraorbital region. Ocular movements were normal, with no visual disturbances reported. Pupils were equal and responsive to light. Plain facial radiography was conducted ( figure 1 ).
Emergency Medicine Journal
OCTOBER 23, 2024
It will not be news to readers that the emergency department (ED) population is ageing. Nor will it be surprising to know that, for the most part, we have done relatively little to accommodate the changing demographic profile of our patients. A systematic review of older patients’ experiences published in the EMJ in 2019 found that older patients felt vulnerable in the ED, and they wanted holistic care, support with decision-making, prompt waiting times and clear communication. 1 A little
Emergency Medicine Journal
OCTOBER 23, 2024
We begin this month’s issue of the Emergency Medicine Journal with a focus on Patient Experience. We all know that currently it is hard to offer an excellent patient experience when our departments across the world are bursting at the seams. Often, those that suffer greatest in terms of crowding are our older, frailer patients. Who better to ask then, than this vulnerable patient group on how we go about fixing things?
Emergency Medicine Journal
OCTOBER 23, 2024
Older people living with frailty are frequent users of emergency care and have multiple and complex problems. Typical evidence-based guidelines and protocols provide guidance for the management of single and simple acute issues. Meanwhile, person-centred care orientates interventions around the perspectives of the individual. Using a case vignette, we illustrate the potential pitfalls of applying exclusively either evidence-based or person-centred care in isolation, as this may trigger inappropr
Emergency Medicine Journal
OCTOBER 23, 2024
Background The aims of this study were to assess whether delayed admission from the ED influenced mortality risk, length of acute hospital stay, risk of developing delirium and return to domicile for patients presenting with a hip fracture. Methods A single centre service evaluation was undertaken including patients aged over 50 years who were admitted to a Scottish hospital through the ED with a hip fracture during a 42-month period (from January 2019 to June 2022).
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