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

Emergency Department 98

Emergency Department 98

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.

Research 97

Research 97

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.

Ultrasounds 56

Ultrasounds Emergency Department 56

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.

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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.

Stroke 52

Stroke Outcomes 52

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.

Research 52

Research 52

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.

Outcomes 52

Outcomes 52

Emergency Medicine Journal

OCTOBER 23, 2024

The use of dock leaves to ease the discomfort of nettle stings is a well-known folk remedy in the British Isles, yet has never been tested in a clinical trial. A group of Emergency Department doctors designed and conducted the Nettle-induced Urticaria Treatment Study (NUTS) as a research training and team-building exercise to address this gap in the Emergency Medicine evidence base.

Research 52

Research Emergency Department Wellness 52

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

Sepsis 52

Sepsis Administration Shock Hospitals 52

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.

Urgent Care 52

Urgent Care Hospitals 52

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.

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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 Department 52

Emergency Department EMS 52

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 Department 52

Emergency Department Outcomes 52

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

EMS 52

EMS Outcomes 52

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 ).

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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.

Fractures 52

Fractures 52

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 ).

Fractures 52

Fractures 52

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 Department 52

Emergency Department 52

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?

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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).

Fractures 98

Fractures Hospitals Emergency Department 98