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Emergency Medicine Journal: EMJ

Jennifer A Newberry, Corey B Bills, Elizabeth A Pirrotta, Michele Barry, Govindaraju Venkata Ramana Rao, Swaminatha V Mahadevan, Matthew C Strehlow
BACKGROUND: Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India. METHODS: We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015...
January 11, 2019: Emergency Medicine Journal: EMJ
Michelle Seiler, Georg Staubli, Markus A Landolt
OBJECTIVE: Nitrous oxide 70% (N2 O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with N2 O 70% with and without INF. METHODS: Patients aged 2-16 years who qualified for PAS with N2 O 70% were randomly assigned to receive either INF or placebo prior to N2 O inhalation in this randomised, double-blind study, which was performed in a tertiary children's hospital ED between September 2015 and October 2017...
January 10, 2019: Emergency Medicine Journal: EMJ
Jason Smith, James Vassallo, Mark D Lyttle
No abstract text is available yet for this article.
January 10, 2019: Emergency Medicine Journal: EMJ
Matthew R Edmunds, Anjana S Haridas, Daniel S Morris, Kasyap Jamalapuram
INTRODUCTION: Acute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C. METHODS: From February to April 2018, an online survey was sent to ED physicians of all training grades in seven UK locations...
January 10, 2019: Emergency Medicine Journal: EMJ
Edmond A Hooker, William J Faulkner, Lisa D Kelly, Robert C Whitford
OBJECTIVE: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities. STUDY DESIGN: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice...
January 10, 2019: Emergency Medicine Journal: EMJ
Aidan Baron
No abstract text is available yet for this article.
January 10, 2019: Emergency Medicine Journal: EMJ
Sabine Lemoine, Daniel Jost, Bertrand Prunet
No abstract text is available yet for this article.
January 10, 2019: Emergency Medicine Journal: EMJ
Maria Clara Magalhães-Barbosa, Jaqueline Rodrigues Robaina, Arnaldo Prata-Barbosa, Claudia de Souza Lopes
OBJECTIVE: To present a systematic review on the reliability of triage systems for paediatric emergency care. METHODS: A search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0-18 years published up to April 2018...
January 10, 2019: Emergency Medicine Journal: EMJ
Lisa M Kodadek, Susan Peterson, Ryan Y Shields, Danielle German, Anju Ranjit, Claire Snyder, Eric Schneider, Brandyn D Lau, Adil H Haider
BACKGROUND: In the USA, The Joint Commission and Institute of Medicine have called for collection of patient sexual orientation (SO) and gender identity (GI) information in healthcare. In a recent study, we reported that ED clinicians believe patients will refuse to provide this information; however, very few patients say they would refuse to provide SO/GI. As part of this study, we interviewed patients and providers regarding the importance of collecting this information. While these interviews were briefly summarised in our prior report, the qualitative data warranted a more thorough analysis and exposition to explore provider and patient views as well as risks and benefits of collecting SO/GI...
January 10, 2019: Emergency Medicine Journal: EMJ
Kharmene L Sunga, Dara Kass
Female physicians in the USA achieve associate and full professor rank at numbers disparate to their representation within emergency medicine (EM). The authors describe a novel curriculum aimed at developing women speakers as a step on the journey towards academic recognition. In this pilot programme, four female physicians at a single academic emergency department participated in a year-long Speaker Development Programme (SDP), and all presented in at least one national EM conference at SDP completion. Participants reported improved speaking skills, confidence and drive to present externally...
January 10, 2019: Emergency Medicine Journal: EMJ
John P Slevin, Cierra Harrison, Eric Da Silva, Nathan J White
OBJECTIVES: Haemorrhage control is a critical component of preventing traumatic death. Other than the battlefield, haemostatic devices, such as tourniquets or bandages, may not be available, allowing for significant avoidable blood loss. We hypothesised that compression of vascular pressure points using a position adapted from the martial art of Brazilian Jiu-Jitsu could be adapted to decrease blood flow velocity in major extremity arteries. METHODS: Knee mount compression was applied to the shoulder, groin and abdomen of healthy adult volunteer research subjects from Seattle, Washington, USA, from March through May 2018...
January 5, 2019: Emergency Medicine Journal: EMJ
Charles Reynard, Niall Morris, Phil Moss, Heather Jarman, Richard Body
OBJECTIVES: To construct a model to optimise and personalise recommendations for antiplatelet prescription for patients with suspected acute coronary syndrome (ACS). Acknowledging that emergency physicians work with diagnostic uncertainty, we sought to identify the point at which the probability of ACS is sufficiently high that the benefits of antiplatelet treatment outweigh the risks. Second, we evaluated the projected clinical impact of this approach by using a clinical prediction model (Troponin-only Manchester Acute Coronary Syndromes (T-MACS)) to calculate the probability of ACS...
January 5, 2019: Emergency Medicine Journal: EMJ
Amir Mirhaghi, Mohsen Ebrahimi
No abstract text is available yet for this article.
December 22, 2018: Emergency Medicine Journal: EMJ
Jennifer Anne Greene, Brent J Deveau, Justine S Dol, Michael B Butler
INTRODUCTION: Death due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Evidence on the safety of this practice is limited...
December 22, 2018: Emergency Medicine Journal: EMJ
Kevin Chu, Carol Windsor, Jennifer Fox, Tegwen Howell, Gerben Keijzers, Robert Eley, Frances Kinnear, Jeremy Furyk, Ogilvie Thom, Nathan J Brown, Anthony F T Brown
INTRODUCTION: Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians' decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. METHODS: We conducted an interview-based qualitative study informed by social constructionist theory. Fifteen emergency physicians from six EDs across Queensland, Australia, underwent individual face-to-face or telephone interviews...
December 20, 2018: Emergency Medicine Journal: EMJ
Timothy J Coats, Marisol Fragoso-Iñiguez, Ian Roberts
OBJECTIVE: To describe the use of tranexamic acid (TXA) in trauma care in England and Wales since the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial results were published in 2010. METHODS: A national longitudinal and cross-sectional study using data collected through the Trauma Audit and Research Network (TARN), the clinical audit of major trauma care for England and Wales. All patients in the TARN database injured in England and Wales were included apart from those with an isolated traumatic brain injury, with a primary outcome of the proportion of patients given TXA and the secondary outcome of time to treatment...
December 8, 2018: Emergency Medicine Journal: EMJ
Ignacio Navarro, Andrew Anglemyer
INTRODUCTION: Community-based programmes have been implemented to curtail ED use by individuals with chronic public intoxication. Among these programmes is the Serial Inebriate Programme (SIP), which aims to reduce use of ED and emergency medical services. We present the results of an evaluation of the SIP in Santa Cruz, California, including data on the participants' police and jail history, information not considered in prior analyses of SIPs. METHODS: In the present study, we used a retrospective cohort to evaluate the effectiveness of the SIP in Santa Cruz, California from 2013 to 2015...
December 6, 2018: Emergency Medicine Journal: EMJ
Zhongheng Zhang, Faran Bokhari, Yizhan Guo, Hemant Goyal
BACKGROUND AND OBJECTIVES: Delayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis. METHODS: Patients with sepsis admitted to the ICU from the ED from January 2010 to April 2018 were retrospectively identified from a clinical data warehouse...
December 5, 2018: Emergency Medicine Journal: EMJ
Scott William Kirkland, Amir Soleimani, Brian H Rowe, Amanda S Newton
OBJECTIVES: Diverting patients away from the emergency department (ED) has been proposed as a solution for mitigating overcrowding. This systematic review examined the impact of interventions designed to either bypass the ED or direct patients to other alternative care after ED presentation. METHODS: Seven electronic databases and the grey literature were searched. Eligible studies included randomised/controlled trials or cohort studies that assessed the effectiveness of pre-hospital or ED-based diversion interventions...
December 3, 2018: Emergency Medicine Journal: EMJ
Robert P Chilcott, Joanne Larner, Hazem Matar
The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities...
December 1, 2018: Emergency Medicine Journal: EMJ
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