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This page shows you the 20 most read items in the past 30 days within this specialty in the MedWorm directory.

Fungal Meningitis OverviewFungal Meningitis Overview
The recent fungal meningitis outbreak provides a unique opportunity to review some of the signs, symptoms, and recommended treatment related to this condition. American Academy of Emergency Medicine (Source: Medscape Emergency Medicine Headlines)
Source: Medscape Emergency Medicine Headlines - June 10, 2013 Category: Emergency Medicine Tags: Emergency Medicine Article Source Type: news

A structured approach to neurologic prognostication in clinical cardiac arrest trials
Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the reliability of several methods for neurological prognostication. Algorithms for prediction of outcome, that were developed before the introduction of mild hypothermia after cardiac arrest, may have affected the results of studies with hypothermia-treated patients. In previous trials on neuroprotection after cardiac arrest, including...
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - June 10, 2013 Category: Emergency Medicine Authors: Tobias CronbergJanneke HornMichael KuiperHans FribergNiklas Nielsen Source Type: research

Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis
Conclusion Ultrasound guidance increases the likelihood of successful peripheral cannulation in difficult access patients. We recommend its use in patients who have difficult venous access, and have failed venous cannulation by standard methods. Further randomised controlled trials (RCTs) with larger sample sizes would be of benefit to investigate if Ultrasound has any additional advantages in terms of reducing the procedure time and the number of skin punctures required for successful venous cannulation. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Egan, G., Healy, D., O'Neill, H., Clarke-Moloney, M., Grace, P. A., Walsh, S. R. Tags: Radiology, Clinical diagnostic tests, Radiology (diagnostics) Review Source Type: research

A child with severe stridor
A 4-year-old boy presented to the emergency department with 1 week's fever and sore throat, associated with progression of respiratory distress since 3 days. He had significant stridor, nasal flaring and marked suprasternal recessions. Parents denied history of foreign body ingestion. Dyspnoea and stridor exacerbated on lying supine and was partially relieved by sit-up position. Physical examination revealed enlarged and exudative tonsils and bilateral cervical lymphadenopathy with tenderness. Neck x-ray, followed by CT, were performed (figures 1 and 2). Subsequent laboratory exams revealed positive heterophile a...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Chen, T.-H., Tseng, Y.-H., Yang, S.-N. Tags: TB and other respiratory infections, Ear, nose and throat/otolaryngology, Ethics, Trauma Images in emergency medicine Source Type: research

What causes adverse events in prehospital care? A human-factors approach
Conclusions The deteriorating patient was identified as the leading single contributor to prehospital adverse events, and two perfect storm patient harm scenarios were found to contribute materially to adverse outcomes. This approach to identifying both single factors contributing to an incident and factors which could be grouped together in a pattern, appears useful in delineating risk in the acute prehospital setting, and warrants further exploration in this and other areas of patient safety. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Price, R., Bendall, J. C., Patterson, J. A., Middleton, P. M. Tags: Patients Prehospital care Source Type: research

The Francis fall out: Turbulent times
Since the February release of the Francis Report into the goings on at Mid Staffordshire,1 there has been a steady stream of speeches, statements, and statistics as the fall out from Francis continues unabated. The quality of the media coverage has varied from the (almost hysterical) mewlings of some outlets to the more considered and balanced ones of others. Some of the best reporting has been delivered by BBC Radio 4 and non-mainstream publications such as Private Eye, the latter a long term campaigner on safety, risk, cover ups and whistle blowers in Health. The reporting falls in one of two categories; the first attrib...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Hughes, G. Tags: Editorial Source Type: research

Highlights from this issue
ERIC the third For some reason this sounds like a Viking warrior to me, and whilst ERIC-3 is actually a new drug found in Swindon it is also deadly. Stephen Haig and colleagues describe the experience of the Great Western Hospital in the assessment and management of patients who had taken this novel recreational drug. This seems to be a common theme in Emergency Medicine, coming soon after our experiences with Mephedrone use in recent years. ERIC-3 seems pretty dangerous stuff with two deaths and 5 ITU admissions. I suspect that this will not be the last novel drug we see presenting to the ED so a worthwhile read in prepar...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Carley, S. Tags: Primary survey Source Type: research

Short answer question case series: unique chest x-ray following blunt trauma
Case vignette A 31-year-old African–American male with no significant past medical history presents to the emergency department via emergency medical services with chest pain and shortness of breath following a direct, broadside motor vehicle collision at high speed. Initial vital signs included a pulse of 130 beats/min, blood pressure 125/95 mm Hg, respiratory rate of 35 times/minute with a pulse oximetry of 92% on room air. On physical exam, he has decreased breath sounds on the left, pain to palpation of left ribcage, minor abrasions of left wrist and elbow. His Glasgow Coma Scale is 15. Key questions Be...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Slater, B., Dalawari, P., Jang, T. Tags: Fractures, Coma and raised intracranial pressure, Pain (neurology), Hypertension, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma SAQs Source Type: research

Functional outcomes and quality of life of young adults who survive out-of-hospital cardiac arrest
Conclusions The majority of survivors have good functional and quality of life outcomes. Telephone follow-up is feasible in the young adult survivors of cardiac arrest; loss to follow-up is common. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Deasy, C., Bray, J., Smith, K., Harriss, L., Bernard, S., Cameron, P., on behalf of the VACAR Steering Committee Tags: Editor's choice, Drugs: cardiovascular system, Stroke Original article Source Type: research

Correction
Julious SA, Jain R, Mason S. Environmental triggers of hospital admissions for school-age children with asthma in two British cities. This paper was published in print with the incorrect doi. The print citation is Emerg Med J 2012;29:10 844–845. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Tags: Correction Source Type: research

BET 1: Metoclopramide or prochlorperazine for headache in acute migraine?
A short-cut review was carried out to determine whether metoclopramide or prochlorperazine was better at relieving headache in patients attending the emergency department with acute migraine. Eighty-one papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are shown in table 1. It is concluded that in adult patients presenting to the emergency department with acute migraine, prochlorperazine 10 mg is bet...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Tags: EMJ Best evidence topic reports, Headache (including migraine), Pain (neurology) Source Type: research

A report of an outbreak of toxicity from a novel drug of abuse: ERIC-3
Conclusions In this outbreak, Eric-3 gave symptoms similar to other stimulants. It may have been a novel substance 3-/4-flouroephedrine. It underlines the need for prospective data collection and information sharing. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Haig, S. D., Kelly, C., Morden, C. Tags: Drugs misuse (including addiction) Original article Source Type: research

Highlights from the literature
Unwanted shocks Implantable cardioverter-defibrillators (ICDs) have been shown to reduce the number of deaths from ventricular fibrillation and ventricular tachycardia. However, inappropriate discharges from implantable cardioverter-defibrillators (ICDs) are associated with a number of adverse physical and psychological symptoms. Two recent studies (MADIT-RIT and ADVANCE III) have suggested that increasing the threshold for delivering shocks, based on traditional triggers such as ventricular rate and duration of arrhythmias, reduces the number of inappropriate shocks. The evidence suggests that this is associated with a re...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Bailey, J., Wyatt, J. Tags: Sophia Source Type: research

Patterns of abdominal injury in 37 387 disaster patients from the Wenchuan earthquake
Conclusions Abdominal injuries are relatively uncommon in earthquake disasters and often present with associated injuries. A timely and complete diagnosis of both abdominal as well as associated injuries is of primary importance in the treatment of patients with abdominal injuries. Knowledge of different types of abdominal injury, and their relative proportions, prevalence of associated injuries, risk factors and final clinical outcomes observed in this study may be of valuable reference in dealing with major earthquake events in the future. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Xu, Y., Huang, J., Zhou, J., Zeng, Y. Tags: Trauma Original article Source Type: research

How reliable and safe is full-body low-dose radiography (LODOX Statscan) in detecting foreign bodies ingested by adults?
Conclusions LODOX Statscan is superior to digital chest radiography in the diagnostic work-up of ingested foreign bodies because it makes it possible to enlarge the field of view to the entire body, has higher sensitivity and specificity, and reduces the radiation dose by 65%. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Mantokoudis, G., Hegner, S., Dubach, P., Bonel, H. M., Senn, P., Caversaccio, M. D., Exadaktylos, A. K. Tags: Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma Original article Source Type: research

Serial high-sensitivity troponin measurements for the rapid exclusion of acute myocardial infarction in low-risk patients
In this study, we explore a strategy for rapidly excluding AMI in symptomatic patients using serial high-sensitivity troponin measurements. Main findings: (1) all patients presenting more than 3 h after symptom onset with a negative result had a second negative result; (2) AMI was excluded in all patients with two results falling below the lower limit of detection of a standard troponin assay by 8 h post-symptom onset. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Dawson, C., Benger, J. R., Bayly, G. Tags: Cardiomyopathy, Drugs: cardiovascular system, Acute coronary syndromes Short report Source Type: research

Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study
Conclusions Triage vital signs have no correlation to lactate or BD levels in penetrating trauma patients. Odds of operative intervention are greater in patients with abnormally high serum lactate levels, but not in those with abnormal triage vital signs or BD. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Caputo, N., Fraser, R., Paliga, A., Kanter, M., Hosford, K., Madlinger, R. Tags: Hypertension Original article Source Type: research

Management of severe sepsis and septic shock in the Emergency Department: a follow-up survey
Emergency Departments (ED) have a pivotal role in managing patients with severe sepsis and septic shock.1 In our survey in 2006, 20.5% EDs in England were able to commence the pathway to Early Goal-Directed Therapy (EGDT).2 We repeated the survey in 2011 to evaluate any change in 5 years. One hundred and eighty-five EDs were surveyed using a form similar to that in 2006. The data from 2006 was reanalysed. EDs satisfying four criteria were assumed to be able to initiate the pathway to EGDT. The criteria were: (1) had a strategy to identify these patients; (2) measured lactate; (3) had a written protocol which included ...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Boon, T., Coyle, C., Sivayoham, N. Tags: PostScript Source Type: research

Acute gastric dilatation in a young woman
Case A 28-year-old woman presented with no history of psychiatric disorder or major systemic disease. She had abdominal distension with vomiting after a large meal in an ‘all you can eat’ restaurant. The abdomen plain film and CT demonstrated severe distension of stomach in entire abdominal pelvic cavity (figure 1). Conservative treatment with nasal gastric tube drainage was initiated, and 8 h later, her condition improved after 3 litres of food materials were drained. The following upper gastrointestinal series showed the stomach was in a smaller size than 2 days ago. The push enteroscopy showed neither narrow...
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Lai, J.-H., Wang, H.-Y., Chen, M.-J., Chen, S.-H., Lam, H.-B., Chang, C.-W. Tags: Small intestine, Pain (neurology), Eating disorders, Ethics, Resuscitation Images in emergency medicine Source Type: research

Aspirin administration by emergency medical dispatchers using a protocol-driven aspirin diagnostic and instruction tool
Conclusions EMDs, using a standardised protocol, can enable early aspirin therapy to treat potential ACS/AMI prior to responders' arrival. Further research is required to assess reasons for not using the protocol, and the significance of the various associations discovered. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Barron, T., Clawson, J., Scott, G., Patterson, B., Shiner, R., Robinson, D., Wrigley, F., Gummett, J., Olola, C. H. O. Tags: Drugs: cardiovascular system, Pain (neurology), Acute coronary syndromes Prehospital care Source Type: research