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Emergency Medicine Journal: EMJ

Katherine Fitzgerald, Philip Yates, Jonathan Benger, Adrian Harris
OBJECTIVE: To explore the experience of psychological distress and well-being in emergency medicine (EM) consultants. METHODS: A qualitative, interpretative phenomenological analysis (IPA) study based on 1:1 semistructured interviews with EM consultants working full time in EDs across South West England. Eighteen EM consultants were interviewed across five EDs, the mean (SD) age of participants being 43.17 (5.8) years. The personal meanings that participants attached to their experiences were inductively analysed...
October 13, 2016: Emergency Medicine Journal: EMJ
Subhashis Basu, Hasan Qayyum, Suzanne Mason
INTRODUCTION: Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which affect ED staff have not been established. METHODS: We conducted a systematic review of literature examining the sources of organisational stress in the ED, their link to adverse health outcomes and interventions designed to address them. A narrative review of contextual factors that may contribute to occupational stress was also performed...
October 11, 2016: Emergency Medicine Journal: EMJ
Constance Boissin, Lisa Blom, Lee Wallis, Lucie Laflamme
BACKGROUND: Mobile health has promising potential in improving healthcare delivery by facilitating access to expert advice. Enabling experts to review images on their smartphone or tablet may save valuable time. This study aims at assessing whether images viewed by medical specialists on handheld devices such as smartphones and tablets are perceived to be of comparable quality as when viewed on a computer screen. METHODS: This was a prospective study comparing the perceived quality of 18 images on three different display devices (smartphone, tablet and computer) by 27 participants (4 burn surgeons and 23 emergency medicine specialists)...
October 5, 2016: Emergency Medicine Journal: EMJ
Malcolm B Doupe, Suzanne Day, Wes Palatnick, Alecs Chochinov, Dan Chateau, Carolyn Snider, Ricardo Lobato de Faria, Erin Weldon, Shelley Derksen
BACKGROUND: Scientists have called for strategies to identify ED patients with unmet needs. We identify the unique profile of ED patients who arrive by ambulance and subsequently leave without consulting a provider (ie, a paradoxical visit, PV). METHODS: Using a retrospective cohort design, administrative data from Winnipeg, Manitoba were interrogated to identify all ED patients 17+ years old as having zero, single or multiple PVs in 2012/2013. Analyses compare the sociodemographic, physical (eg, arthritis), mental (eg, substance abuse) and concurrent healthcare use profile of non-PV, single and multiple PV patients...
October 4, 2016: Emergency Medicine Journal: EMJ
Matthew Pritam Taylor, Paul Wrenn, Andrew David O'Donnell
BACKGROUND: Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings. OBJECTIVE: To improve understanding of how neurogenic shock presents in humans, allowing better identification and treatment...
October 3, 2016: Emergency Medicine Journal: EMJ
Emmanuel Caruana, Sylvie Chevret, Romain Pirracchio
BACKGROUND: The benefit of cricoid pressure during tracheal intubation is still debated and, due to its potential negative impact on laryngeal views, its routine use is questioned. The goal of this study was to estimate its impact on laryngeal view. METHODS: All patients intubated in the prehospital setting were included. Three different propensity score (PS) models were used and compared in terms of the balance achieved between those patients who received cricoid pressure and those who did not...
September 30, 2016: Emergency Medicine Journal: EMJ
Leszek Pstras
No abstract text is available yet for this article.
September 29, 2016: Emergency Medicine Journal: EMJ
Hilary Sarah Thornton, Mohammed H Elwan, Joseph A Reynolds, Timothy J Coats
No abstract text is available yet for this article.
September 29, 2016: Emergency Medicine Journal: EMJ
Kenneth A Michelson, Richard G Bachur, Jason A Levy
OBJECTIVES: The presence of critically ill patients may impact care for other ED patients. We sought to evaluate whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. METHODS: We performed a retrospective cohort study of all paediatric ED visits over 3 years. Patients were exposed if they arrived during the first hour of a critically ill patient's care...
September 28, 2016: Emergency Medicine Journal: EMJ
Alberto Jiménez-Puente, José Del Río-Mata, José Luís Arjona-Huertas, Begoña Mora-Ordóñez, Alfonso Martínez-Reina, Miguel Martínez Del Campo, Lourdes Nieto-de Haro, Antonio Lara-Blanquer
BACKGROUND: The rate of unscheduled return visits is often used as a quality-of-care indicator in EDs, although its validity is not yet fully established. Our aim was to identify the characteristics of return visits that may be attributed to problems in quality of care. METHODS: Retrospective paired review of medical charts in a random sample of return visits during the 72 hours following discharge from the ED in three hospitals of Andalusia, Spain in 2013. Charts were reviewed by senior medical physicians to determine which return visits reflected quality-of-care problems...
September 26, 2016: Emergency Medicine Journal: EMJ
Cliff Reid, Ian Ferguson, Brian Burns, Karel Habig, Mohammed Shareef
BACKGROUND: Life-like end-tidal capnography (ETCO2) waveforms have been demonstrated in recently deceased and fresh-frozen cadavers following tracheal intubation, offering potential for high fidelity airway simulation training. As the mechanism for carbon dioxide production is not fully understood, it is possible that oesophageal intubation may also generate a capnograph. Our aim was to measure ETCO2 levels following (1) oesophageal and (2) tracheal intubation in fresh-frozen cadavers, and to observe the size, shape and duration of any capnographic waveform...
September 23, 2016: Emergency Medicine Journal: EMJ
Maryam Khan, Marco L A Sivilotti, Michael J Bullard, Marcel Émond, Jane Sutherland, Andrew Worster, Corinne M Hohl, Jacques S Lee, Mary Eisenhauer, Merril Pauls, Howard Lesiuk, George A Wells, Ian G Stiell, Jeffrey J Perry
BACKGROUND: CT has excellent sensitivity for subarachnoid haemorrhage (SAH) when performed within 6 hours of headache onset, but it is unknown to what extent patients with more severe disease are likely to undergo earlier CT, potentially inflating estimates of sensitivity. Our objective was to evaluate which patient and hospital factors were associated with earlier neuroimaging in alert, neurologically intact ED patients with suspected SAH. METHODS: We analysed data from two large sequential prospective cohorts of ED patients with acute headache undergoing CT for suspected SAH...
September 22, 2016: Emergency Medicine Journal: EMJ
Wen-Chu Chiang, Yu-Sheng Huang, Shu-Hsien Hsu, Anna Marie Chang, Patrick Chow-In Ko, Hui-Chih Wang, Chih-Wei Yang, Ming-Ju Hsieh, Edward Pei-Chuan Huang, Kah-Meng Chong, Jen-Tang Sun, Shey-Ying Chen, Matthew Huei-Ming Ma
OBJECTIVE: The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance. METHODS: We analysed Utstein registry data for 2009-2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole...
September 21, 2016: Emergency Medicine Journal: EMJ
Deepankar Datta, Julia Grahamslaw, Alasdair James Gray, Catriona Graham
BACKGROUND: Blood lactate is a marker of patient illness severity. Capillary lactate (CAP-LACT) measurement can potentially improve patient screening; however, it has poor evidence of clinical utility. AIM: We aimed to investigate agreement between CAP-LACT and peripheral venous lactate (PV-LACT). METHODS: We performed a prospective observational pilot study of 99 patients requiring lactate measurement. Paired CAP-LACT and PV-LACT was recorded...
September 21, 2016: Emergency Medicine Journal: EMJ
Jestin N Carlson, Susanne Schunder-Tatzber, Christine J Neilson, Natalie Hood
BACKGROUND: While glucose tablets have been advocated for treating symptomatic hypoglycaemia in awake patients, dietary sugars may be more convenient. We performed a systematic review to compare the impact of these treatment options on the relief of symptomatic hypoglycaemia, time to resolution of symptoms, blood glucose levels, complications and hospital length of stay. METHOD: We searched PubMed, Embase and the Cochrane Library through 28 June 2016 and assessed the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach...
September 19, 2016: Emergency Medicine Journal: EMJ
Michael R Whitehouse, Catriona McDaid, Michael B Kelly, Christopher G Moran, Matthew L Costa
OBJECTIVE: To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes. DESIGN: We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies. DATA SOURCES: We searched five electronic databases with no limits and performed grey literature searches...
September 15, 2016: Emergency Medicine Journal: EMJ
Jae Yun Jung, Young Ho Kwak, Do Kyun Kim, Dongbum Suh, Ikwan Chang, Chiyul Yoon, Jung Chan Lee, Hee Chan Kim, Jae Yeon Choi, HeeJeong Ahn
BACKGROUND: We sought to validate the accuracy and assess the efficacy of a newly developed electronic weight estimation device (ie, the rolling tape) for paediatric weight estimation. METHODS: We enrolled a convenience sample of children aged <17 years presenting to our emergency department who volunteered to participate in the study. The children's heights and weights were measured, and three researchers estimated these values using the rolling tape and Broselow tape at 5 min intervals...
September 15, 2016: Emergency Medicine Journal: EMJ
Alana Hawley, Mathew Mercuri, Kerstin Hogg, Erich Hanel
BACKGROUND: The growing popularity of obstacle course runs (OCRs) has led to significant concerns regarding their safety. The influx of injuries and illnesses in rural areas where OCRs are often held can impose a large burden on emergency medical services (EMS) and local EDs. Literature concerning the safety of these events is minimal and mostly consists of media reports. We sought to characterise the injury and illness profile of OCRs and the level of medical care required. METHODS: This study analysed OCR events occurring in eight locations across Canada from May to August 2015 (total 45 285 participants)...
September 15, 2016: Emergency Medicine Journal: EMJ
Juan González Del Castillo, Francisco Javier Ayuso, Victoria Trenchs, Mikel Martinez Ortiz de Zarate, Carmen Navarro, Kinda Altali, Cristina Fernandez, David Huckins, Francisco Javier Martín-Sánchez
OBJECTIVE: Evaluate the diagnostic accuracy of the APPY1 Test alone and in combination with the Alvarado score (AS) to rule out acute appendicitis (AA) in patients presenting to EDs with abdominal pain suspicious for AA. METHODOLOGY: Observational study in a prospective consecutive cohort including all patients from 2 to 20 years with abdominal pain suggestive of AA in four EDs. The APPY1 Test was performed and AS was calculated to determine risk stratification for each patient...
September 9, 2016: Emergency Medicine Journal: EMJ
Susan P Smith, Joseph F Cosgrove, Peter J Driscoll, Andrew Smith, John Butler, Peter Goode, Carl Waldmann, Christopher J Vallis, Fiona Topham, Michael Monty Mythen
In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services...
September 9, 2016: Emergency Medicine Journal: EMJ
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