MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Emergency Medicine Journal' source. Wed, 08 Feb 2012 14:35:37 +0100 http://www.medworm.com/index.php?rid=5582778&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F170%3Frss%3D1 Prehospital intraosseous access Intraosseous (IO) needles are commonly used to obtain vascular access in children rapidly. Recent studies have shown that IO needles can also be used as a rapid method for obtaining vascular access in adults. A randomised controlled trial attempted to establish whether there was a difference in the frequency of first attempt success between humeral IO, tibial IO and peripheral intravenous access in adult patients experiencing non-traumatic out-of-hospital cardiac arrest. The study found that tibial IO needles had the highest first attempt success and the most rapid time to vascular access. Perhaps IO access should be adopted more widely in the adult population (Annals of Emerg Med 2011;58:509–16). Pigtails for chest trauma There is an increasing trend ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582778 Wed, 11 Jan 2012 05:00:00 +0100 5582778 http://www.medworm.com/index.php?rid=5582777&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F169%3Frss%3D1 Case vignette A 40-year-old woman with history of hypertension and migraines presents with a complaint of headache. Two days prior to presentation she began to experience a left-sided, throbbing headache that radiated to the right and was accompanied by blurring of left eye vision and nausea. The blurred vision and headache were exacerbated by bright light, consistent with prior migraine attacks. She took her usual dose of naproxen with resolution of her nausea but still had a mild headache and blurred left eye vision. Two hours prior to presentation she walked outside and experienced worsening of her headache upon exposure to the sunlight, but without concomitant change in her vision or nausea. Aleve did not improve her symptoms, so she decided to present to the emergency department. Her ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582777 Wed, 11 Jan 2012 05:00:00 +0100 5582777 http://www.medworm.com/index.php?rid=5582776&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F168%3Frss%3D1 I must comment on the article by Milligan et al regarding massive transfusion in trauma.1 The authors state that ‘standardizing blood transfusion in major trauma to include automatic delivery of appropriate blood products at particular points in resuscitation may be of benefit’. They base this on their survey of 32 emergency medicine doctors to whom they asked questions apparently relating to the definition of massive transfusion (MT), ‘target’ laboratory values and blood product components. The definition of MT is a retrospective one and therefore not of value to the emergency physician faced with a bleeding patient. The ‘target’ laboratory values may be of academic interest but are not the primary relevant point we should be interested in—the aut... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582776 Wed, 11 Jan 2012 05:00:00 +0100 5582776 http://www.medworm.com/index.php?rid=5582775&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F166%3Frss%3D1 A short cut review was carried out to establish whether pregabalin can reduce acute herpetic pain and reduce post herpetic neuralgia. 48 papers were found using the reported searches, of which one 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 this best paper are tabulated. It is concluded that pregabalin does not seem to decrease the intensity of pain related to acute herpes zoster. Moreover, it does not decrease the incidence of post herpetic neuralgia. More research is. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582775 Wed, 11 Jan 2012 05:00:00 +0100 5582775 http://www.medworm.com/index.php?rid=5582774&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F164%3Frss%3D1 A short cut review was carried out to establish whether capnography should be routinely used during procedural sedation in Emergency Departments. 206 papers were found using the reported searches, of which nine 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 these best papers are tabulated. It is that capnography may provide early warning of ventilatory changes that could result in hypoxia. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582774 Wed, 11 Jan 2012 05:00:00 +0100 5582774 http://www.medworm.com/index.php?rid=5582773&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F163-a%3Frss%3D1 A short cut review was carried out to establish whether the seat belt sign was a significant predictor of intra-abdominal injury in children involved in motor vehicle collisions. 51 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 these best papers are tabulated. It is concluded that seatbelt sign appears to be associated with an increased risk of intra-abdominal injuries, especially gastrointestinal and pancreatic injuries. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582773 Wed, 11 Jan 2012 05:00:00 +0100 5582773 http://www.medworm.com/index.php?rid=5582772&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F163%3Frss%3D1 Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582772 Wed, 11 Jan 2012 05:00:00 +0100 5582772 http://www.medworm.com/index.php?rid=5582771&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F160%3Frss%3D1 This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' su... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582771 Wed, 11 Jan 2012 05:00:00 +0100 5582771 http://www.medworm.com/index.php?rid=5582770&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F156%3Frss%3D1 Conclusion No differences in outcome were found between patients with isolated severe TBI who were directly transported and those transferred to this hospital's emergency room. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582770 Wed, 11 Jan 2012 05:00:00 +0100 5582770 http://www.medworm.com/index.php?rid=5582769&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F152%3Frss%3D1 Conclusions Shift work can affect health and well-being on a variety of levels, both physiologically and psychologically, affecting aspects of work and personal life. Further research is warranted to prevent the issues of patient safety, work-related fatigue and the cumulative effects of shift work. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582769 Wed, 11 Jan 2012 05:00:00 +0100 5582769 http://www.medworm.com/index.php?rid=5582768&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F147%3Frss%3D1 Conclusions Only moderate agreement is highlighted between the initial severity assessed by the dispatching physician and the final severity assessed by the physician later examining the patient. This demonstrates the need to develop a tool for assessing severity of acute allergic reactions for dispatching physicians in Medical Emergency Dispatch Centres. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582768 Wed, 11 Jan 2012 05:00:00 +0100 5582768 http://www.medworm.com/index.php?rid=5582767&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F141%3Frss%3D1 Conclusions The majority would call for an ambulance appropriately when a real emergency occurred, and most inappropriate classification occurs when an ambulance is not required. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582767 Wed, 11 Jan 2012 05:00:00 +0100 5582767 http://www.medworm.com/index.php?rid=5582766&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F136%3Frss%3D1 Conclusions The majority of services are currently complying with the recommendations in the Association of prior to Anaesthetists of Great Britain and Ireland safety guideline. There are still areas of concern, particularly with regard to ongoing training and the high numbers of services that do not use a trained assistant for the process of prehospital anaesthesia. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582766 Wed, 11 Jan 2012 05:00:00 +0100 5582766 http://www.medworm.com/index.php?rid=5582765&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F133%3Frss%3D1 Conclusions The institution of video event recorder technology along with formal review and feedback resulted in a change in driving behaviour. Given that call volumes increased and driving events decreased, these measures may serve as surrogates for improvements in safety and maintenance costs. Economic analysis is necessary for conclusions on fiscal impact. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582765 Wed, 11 Jan 2012 05:00:00 +0100 5582765 http://www.medworm.com/index.php?rid=5582764&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F129%3Frss%3D1 Conclusions In this series of treated OHCA, only a small fraction of patients experienced CVC after ROSC. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582764 Wed, 11 Jan 2012 05:00:00 +0100 5582764 http://www.medworm.com/index.php?rid=5582763&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F124%3Frss%3D1 Conclusion Medical telephone counselling is a demanding task requiring competent specialists with dedicated training in communication supported by suitable computer technology. Provided these conditions are in place, computer-assisted telephone triage can be considered to be a safe method of assessing the potential clinical risks of patients' medical conditions. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582763 Wed, 11 Jan 2012 05:00:00 +0100 5582763 http://www.medworm.com/index.php?rid=5582762&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F123%3Frss%3D1 Question 1 Which of the following are true regarding suicidal intent and suicide? A previous suicide attempt is the best predictor of a future suicide attempt. 10–15% of those attempting suicide succeed, but 60–70% of successful suicides have no prior history of attempts. Patients who attempt suicide have low CSF serotonin levels. Borderline personality disorder is the Axis II diagnosis most closely associated with suicide. Question 2 Which of the following are true regarding assessment of potentially suicidal patients? A ‘SAD PERSONS’ score of <6 has a negative predictive value (NPV) of >95%. No single psychological test can accurately predict suicidal attempts. Scoring systems might help in determining the need for hospitalisation. Suicide is often provoked ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582762 Wed, 11 Jan 2012 05:00:00 +0100 5582762 http://www.medworm.com/index.php?rid=5582761&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F118%3Frss%3D1 Conclusion MBT is a rare event with high mortality in UK trauma. Haemostatic resuscitation is not currently practiced in the UK and the authors were unable to show that FFP and platelet use were significant predictors of survival in MBT. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582761 Wed, 11 Jan 2012 05:00:00 +0100 5582761 http://www.medworm.com/index.php?rid=5582760&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F117%3Frss%3D1 A 31-year-old man presented to the emergency department at 04:50 complaining of left-sided abdominal and flank pain that started from the previous afternoon. The pain had initially settled but he woke up with a recurrence of the pain. The pain settled with the administration of rectal diclofenac and an intravenous pyelogram was normal. The patient was stable and blood tests were unremarkable. He was admitted by the surgeon, reviewed by senior surgeons in the morning and discharged. After 2 days, he returned with persistent abdominal pain. Abdominal examination was unremarkable. Emergency department ultrasound showed significant intra-abdominal free fluid and a lesion in the spleen (figure 1A,B). A CT scan confirmed the presence of free fluid in the abdomen, intrasplenic laceration tog... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582760 Wed, 11 Jan 2012 05:00:00 +0100 5582760 http://www.medworm.com/index.php?rid=5582759&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F113%3Frss%3D1 Conclusions PCT value at the time of admission is an independent predictor of mortality, but maybe not a good indicator of concomitant infection in exertional heatstroke. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582759 Wed, 11 Jan 2012 05:00:00 +0100 5582759 http://www.medworm.com/index.php?rid=5582758&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F108%3Frss%3D1 Conclusion Even though slowing the rate of infusion of metoclopramide does not affect the rate of improvement in nausea, it may be an effective strategy for reducing the incidence of akathisia and sedation in patients with nausea. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582758 Wed, 11 Jan 2012 05:00:00 +0100 5582758 http://www.medworm.com/index.php?rid=5582757&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F104%3Frss%3D1 Conclusion Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582757 Wed, 11 Jan 2012 05:00:00 +0100 5582757 http://www.medworm.com/index.php?rid=5582756&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F103%3Frss%3D1 An 84-year-old man attended our emergency department with a 5-month history of poor oral intake since the death of his wife. He complained of lethargy, dyspnoea, epistaxis and myalgic pains. He was severely thin with purpuric skin lesions over his knuckles, elbows and shins (figures 1 and 2).1 Scurvy was suggested and confirmed by dermatology. The patient was started on ascorbic acid (400 mg/24 h) and initially improved, but died later of a nosocomial infection. Scurvy is a state of vitamin C (ascorbic acid) deficiency. Ascorbic acid is used in the synthesis of collagen, neurotransmitters and helps in dietary iron absorption. Deficiency results in poor wound healing, defective capillary walls and anaemia. The UK incidence of clinical scurvy is unknown, but the prevalence of vitam... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582756 Wed, 11 Jan 2012 05:00:00 +0100 5582756 http://www.medworm.com/index.php?rid=5582755&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F100%3Frss%3D1 Conclusions In this cohort patients undergoing hypothermia treatment after non-shockable cardiac arrest do not benefit significantly concerning neurological outcome. Hypothermia treatment needs to be evaluated in a large multicentre trial of cardiac arrest patients found initially to be in non-shockable rhythms to clarify whether cooling may also be beneficial for other rhythms than VF. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582755 Wed, 11 Jan 2012 05:00:00 +0100 5582755 http://www.medworm.com/index.php?rid=5582754&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F95%3Frss%3D1 Conclusion The application of ERC guidelines of 2005 markedly reduced the first HOI and mean duration of HOI at the cost of delayed secure airway management and ECG analysis in this MCT model. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582754 Wed, 11 Jan 2012 05:00:00 +0100 5582754 http://www.medworm.com/index.php?rid=5582753&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F91%3Frss%3D1 In recent years there has been a commendable focus on patient-centred medicine, with increasing attention being paid to the timely assessment and management of acute pain. 78% of patients who attend the emergency department report pain, the severity of which is often used to determine clinical priority at triage. Clinical guidelines are increasingly including the timely provision of appropriate analgesia as a clinical standard. Pain scoring has been widely adopted, causing pain to be considered as the ‘fifth vital sign’ by some. Interestingly, there remains little evidence to support the benefit of this approach for patients. The aim of this review is to explore some of the assumptions that made in defining and addressing ‘pain’, and to explore whether it is truly &... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582753 Wed, 11 Jan 2012 05:00:00 +0100 5582753 http://www.medworm.com/index.php?rid=5582752&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F90%3Frss%3D1 International readers may need reminding that in April 2011 a new set of clinical quality (A&E) indicators was introduced in the NHS in England to replace the previous 4 h waiting time standard, the new indicators providing a platform with which to measure the quality of care delivered in A&E departments in England. The indicators were developed by the national clinical director for urgent and emergency care, working with the College of Emergency Medicine, the Royal College of Nursing and informed patient representatives. At the beginning of October last year the government released data for May 2011, related to A&E attendances for that month and drawing on just over 1.4 million detailed records of attendances at major A&E departments, single specialty A&E departme... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582752 Wed, 11 Jan 2012 05:00:00 +0100 5582752 http://www.medworm.com/index.php?rid=5582751&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F2%2F89%3Frss%3D1 This month we range from Politics to philosophy, from basic science to standards of care. There is a spread of material on the resuscitation of cardiac arrest and lots of pre-hospital care; triage at ‘front’ and ‘rear’, trauma transfer times, airway care in the field and even how to improve ambulance safety. The meaning of words In this month's editorial, Hughes (see page 90) shows how easy it is to become confused with the political language of the performance culture in UK Emergency Medicine and translates some into simple terms that can be understood! On a much simpler and certainly more fundamental level, Body and Foex (see page 91) consider the philosophical difference between pain and suffering. Do we see and try to manage the disease/injury or care for the pa... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5582751 Wed, 11 Jan 2012 05:00:00 +0100 5582751 http://www.medworm.com/index.php?rid=5525427&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F88%3Frss%3D1 Can we trust guidelines? How can we trust clinical guidelines when so many of the members of the panels that produce them have financial conflicts of interest? That is the question that naturally follows from a study published in the BMJ. The study evaluated panel members of clinical practice guidelines released by national organisations in the USA and Canada between 2000 and 2010 that covered screening or treatment of hyperlipidaemia or diabetes for financial conflicts of interest. A staggering 52% of panel members had a conflict of interest, including some of the chairs and some that were undeclared. The accompanying editorial is written in an understandably scathing fashion about the current system (BMJ 2011;343:d5621 and d5728). Closure of skin wounds A review focusing on the closure o... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525427 Tue, 20 Dec 2011 05:00:00 +0100 5525427 http://www.medworm.com/index.php?rid=5525426&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F86-b%3Frss%3D1 A 76-year-old man with no medical history presented with progressive lower back pain and right thigh swelling which he had had for 5 days. Fever, limp and anorexia were also noted. Lower back pain was brought on by extension of the right hip and physical examination showed right thigh swelling, erythema and skin crepitus. Blood examination disclosed generalised inflammation with a high C-reactive protein level. CT showed dilatation of right psoas muscle with fluid accumulation and gas formation (figure 1A), which extended to the right iliac muscle and the intermuscular bundles in the right thigh (figure 1B). An iliopsoas abscess complicated with necrotising fasciitis was considered. He was then admitted to the intensive care unit, where he received surgical intervention and antibiotic... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525426 Tue, 20 Dec 2011 05:00:00 +0100 5525426 http://www.medworm.com/index.php?rid=5525425&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F86-a%3Frss%3D1 A 73-year-old woman presented with symptoms of vomiting and dehydration. An emergency room anteroposterior chest radiograph demonstrated right subdiaphragmatic air, raising immediate suspicions of pneumoperitonium. Subsequent clinical assessment demonstrated a soft and non-tender abdomen and arterial blood gas had a slight alkalotic state as opposed to an acidotic state as would be expected in a perforation. After seeking senior advice, it was concluded that this was a case of pseudo-pneumoperitonium, otherwise known as Chilaiditi's sign. On closer inspection of the patient's radiograph (figure 1), distended loops of the bowel are visible below the right dome with one segment clearly transposed between the diaphragm, the liver and the air within the lumen, giving the impression of pseudo-p... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525425 Tue, 20 Dec 2011 05:00:00 +0100 5525425 http://www.medworm.com/index.php?rid=5525424&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F85%3Frss%3D1 Endotracheal tube migration is a hazard with potentially catastrophic consequences for all intubated patients, but particularly those in the prehospital environment. Recognition of the migrated tube is often late with reliance on physiological change seen on monitoring, as there is no obvious visual clue prior to the deterioration of the patient. We have overcome this problem in a simple way by applying a small amount of tape to the tube, just above the tube tie, making any movement in either direction instantly recognisable (Figure 1). There can never be any substitute for properly securing the tube by any of the many means available and firmly holding the tube, at all times if possible, but at least whenever the patient is being transferred on or off a vehicle or stretcher. However, this... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525424 Tue, 20 Dec 2011 05:00:00 +0100 5525424 http://www.medworm.com/index.php?rid=5525423&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F84%3Frss%3D1 Case vignette A 40-year-old woman presents at 08:40 with her fifth episode of lip and tongue swelling. She is immediately given intravenous diphenhydramine, methylprednisolone and famotidine. Her oxygen saturation is 100% with stable vital signs. At 10:30, she develops neck swelling, dyspnoea and dysphagia, but speaks with full sentences. An anaesthesiologist is called for early intubation, an otolaryngologist is called for possible tracheostomy, and the patient is given subcutaneous epinephrine and nebulised albuterol. However, her respiratory rate increases to 30 breaths/min as pulse oximetry drops to 89%. Additional epinephrine is administered, but she continues to decompensate. The anaesthesiologist is unable to intubate the patient. The otolaryngologist is unable to locate the tr... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525423 Tue, 20 Dec 2011 05:00:00 +0100 5525423 http://www.medworm.com/index.php?rid=5525422&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F83%3Frss%3D1 Training provided for emergency medicine trainees in the Acute Care Common Stem (ACCS) programme throughout the UK is variable. Concerns have been raised that without appropriate training and support, junior trainees in emergency medicine may ultimately lack some of the skills and experience required to become effective higher specialty trainees.1 In July 2010, the College of Emergency Medicine published a new curriculum for postgraduate training.2 Embedded in the heart of the new curriculum are 25 common competences.3 Proficiency in each area is identified as vital in order to prepare individuals to be appropriately trained and experienced to deliver care as consultants in modern emergency departments. Trainees must demonstrate competence to at least ‘Level 2’ in each area by ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525422 Tue, 20 Dec 2011 05:00:00 +0100 5525422 http://www.medworm.com/index.php?rid=5525421&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F82-c%3Frss%3D1 Luscombe et al1 have developed a more accurate age-based paediatric weight estimation tool than that was previously commonly used in the UK, and their formula has also been incorporated into the 5th edition of the Advanced Paediatric Life Support (APLS) manual, for 6–12-year-olds.2 It is important for readers to realise that in their article, the inaccurate ‘APLS formula’ refers to the previous, and not the most recent, edition of APLS. However, it is unfortunate that their study makes no mention of the precision of either formula. Although the new formula has minimal bias (ie, the mean difference between estimated and actual weight is very small), nevertheless all age-based weight formulae have very poor precision, which can be indicated by the standard deviation of the ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525421 Tue, 20 Dec 2011 05:00:00 +0100 5525421 http://www.medworm.com/index.php?rid=5525420&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F82-b%3Frss%3D1 The letters by Kaye and Ferguson highlight some issues in the controversy on this subject.1 However, it is important to look at the totality of the evidence in more detail. The most recently published independent review on this subject concluded that ‘there is no consistent or proven benefit to thrombolytics.’2 This review also highlights the problems with the pooled analyses, which have been incorrectly labelled as a ‘meta-analysis’ in the letters. Pooled analyses are selected subgroups and not randomised trials and at best are hypothesis generating. Readers should check this review for themselves. Ferguson mentions the baseline imbalance in stroke severity in the National Institute of Neurological Disorders and Stroke (NINDS) trial.1 A recent reanalysis of the NIN... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525420 Tue, 20 Dec 2011 05:00:00 +0100 5525420 http://www.medworm.com/index.php?rid=5525419&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F82-a%3Frss%3D1 In this report, similar to the findings of Yilmaz et al,2 the authors have shown that MPV was an early and independent predictor of acute coronary syndrome in patients with chest pain who presented to the emergency department. In this report,2 the authors have demonstrated that in patients with acute coronary syndrome MPV was an independent predictor of having a non-ST elevation myocardial infarction. In fact, platelets are quite heterogeneous blood elements, diverging in terms of size, density and reactivity.3 Platelet size has been shown to be related to platelet reactivity4 and, along with this finding, there is evidence that MPV is an important biological variable, and immature platelets have... (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525419 Tue, 20 Dec 2011 05:00:00 +0100 5525419 http://www.medworm.com/index.php?rid=5525418&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F80%3Frss%3D1 Report by: Ioannis Paneris Search checked by: Michael Callaghan Institution: Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Clinical scenario A 30-year-old male gym enthusiast presents with a 3-week history of sudden onset of back pain, after lifting heavy weight, His pain radiates from the lumbar spine to the right posterior thigh lateral calf and foot and has associated mild paraesthesia. He has had treatment with Ultrasound (US) before for a different condition and he is asking if US could be useful in this case. Three-part question IN (Adults with acute sciatica) IS (therapeutic ultrasound beneficial) AT (decreasing pain and improving function)? Search strategy National library for health web interface. {(lumbar OR (low ADJ back)) AND (sciatica OR radicul*... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525418 Tue, 20 Dec 2011 05:00:00 +0100 5525418 http://www.medworm.com/index.php?rid=5525417&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F78%3Frss%3D1 Report by: John J MacDonald Search checked by: Richard Body Institution: Stockport NHS Foundation Trust, Stockport, UK Clinical scenario A 73-year-old male with known chronic obstructive pulmonary disease (COPD) presents to the emergency department with dyspnoea. He is diagnosed with an acute exacerbation of COPD. Despite optimal medical management he fails to improve, his arterial blood gases demonstrate type II respiratory failure with worsening respiratory acidosis. He is offered a trial of non-invasive ventilation but refuses as. A decision is taken that invasive ventilation is not in the best interests of the patient. You wonder if the respiratory stimulant doxapram may improve the patient's respiratory failure. Three-part question In (patients with an acute exacerbation of COPD who a... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525417 Tue, 20 Dec 2011 05:00:00 +0100 5525417 http://www.medworm.com/index.php?rid=5525416&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F77-b%3Frss%3D1 Report by: Bryony Patrick Search checked by: Richard Body Institution: University of Manchester, Manchester, UK Clinical scenario A 30-year-old man presents to the emergency department (ED) after twisting his knee. You suspect a soft tissue injury and are aware that the Ottawa knee rule could be used to help determine whether radiography is necessary. A colleague suggests that you should use the Pittsburgh rule instead. You wonder which rule has greater sensitivity (thus missing fewer fractures) and greater specificity (thus reducing the need for unnecessary radiography). Three-part question In (adult patients presenting to the emergency department with traumatic knee pain) does the (Ottawa knee rule or the Pittsburgh knee rule) have (greater sensitivity and specificity for knee fractures)... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525416 Tue, 20 Dec 2011 05:00:00 +0100 5525416 http://www.medworm.com/index.php?rid=5525415&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F77-a%3Frss%3D1 Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525415 Tue, 20 Dec 2011 05:00:00 +0100 5525415 http://www.medworm.com/index.php?rid=5525414&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F74%3Frss%3D1 The authors report a case of a previously healthy 40-year-old man who was admitted to the emergency department due to severe hypoxaemia after emesis. He vomited after a cup of coffee with the milk at his office. On admission, he showed cyanosis and oxygen saturation measured by pulse oximetry was extremely low (86%) in spite of the administration of 10 litres of oxygen. The authors suspected pneumonia, but oxygen saturation was disproportionately low to pneumonia severity. Oxygen saturation measured by pulse oximetry was significantly different from oxygen saturation calculated from arterial blood gas analysis, suggesting the existence of haemoglobin abnormality. The level of methaemoglobin was 9.3% (reference range, 1–2%). The patient was treated by antibiotics for pneumonia, and hi... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525414 Tue, 20 Dec 2011 05:00:00 +0100 5525414 http://www.medworm.com/index.php?rid=5525413&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F72%3Frss%3D1 Description A 29-year-old woman presented to our emergency department with syncope, acute chest pain and circulatory collapse. She had a tachycardia of 135 bpm, blood pressure of 77/55 mm Hg and a profound metabolic acidosis (pH 7.07, lactate 10, base excess-20). A 12-lead ECG (figure 1) showed sinus tachycardia with right axis deviation, large p waves and poor R wave progression across the chest leads, suggestive of acute right heart strain. A D-dimer was elevated at 15984 μg/l (reference range 0–200 μg/l); a plain anteroposterior chest radiograph was unremarkable. Bedside transthoracic echocardiography showed a dilated, poorly functioning right ventricle with visible thrombus prolapsing across the tricuspid valve as demonstrated in figure 2 and video 1. These findings confirm... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525413 Tue, 20 Dec 2011 05:00:00 +0100 5525413 http://www.medworm.com/index.php?rid=5525412&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F70%3Frss%3D1 An acute poisoning with nitrobenzene presenting as methaemoglobinemia is an uncommon medical emergency. A young girl with nitrobenzene induced methaemoglobinaemia died despite use of mechanical ventilator, administration of oral methylene blue and parenteral ascorbic acid. Here author highlights the rare occurrence of such cases, methaemoglobin induced severe oxidative stress, unexplained splenomegaly and leucocytosis and the ineffectivity of oral methylene blue and other supportive measures in evading death due to nitrobenzene poisoning. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525412 Tue, 20 Dec 2011 05:00:00 +0100 5525412 http://www.medworm.com/index.php?rid=5525411&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F67%3Frss%3D1 A 21-year-old woman presented with a 4-week history of sudden onset vomiting, nausea and anorexia. Questioning revealed that she had a 7-year history of heavy cannabis use (smoking). She did not describe abdominal pain, change in bowel habit, antibiotic use, foreign travel or contact with gastroenteritis. Biochemistry results demonstrated mild metabolic derangement with a low potassium and a low bicarbonate, and urine toxicology was positive for cannabinoids. Other investigations, including a full blood count, renal function tests, liver function tests, a coagulation sample, an ECG, urinary β-hCG and a CT head scan, were all normal. A diagnosis of cannabinoid hyperemesis was made and her symptoms resolved after treatment with intravenous fluids, antiemetics and abstinence from cannabi... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525411 Tue, 20 Dec 2011 05:00:00 +0100 5525411 http://www.medworm.com/index.php?rid=5525410&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F65%3Frss%3D1 Conclusion Despite the lack of strong evidence, the majority of UK EDs are using EWS in some form. MEWS is the most commonly used but departments vary on their use of EWS for senior ED and/or critical care review. Over 90% of respondents in this survey support EWS in the ED. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525410 Tue, 20 Dec 2011 05:00:00 +0100 5525410 http://www.medworm.com/index.php?rid=5525409&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F60%3Frss%3D1 Conclusions The presence of strong weather effects among different target groups indicates possibility for the development of a short-term forecast system of daily ambulance demand using weather variables. The availability of such a forecast system would render more effective deployment of the ambulance services to meet the unexpected increase in service demands. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525409 Tue, 20 Dec 2011 05:00:00 +0100 5525409 http://www.medworm.com/index.php?rid=5525408&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F56%3Frss%3D1 Conclusions Using the criteria that all casualties requiring a technical rescue or >400 m evacuation route to an appropriate helicopter-landing site, 34% of casualties could have been rescued using a hoist or long-line with an expected reduction in the pre-hospital time. Helicopters working in UK mountain rescue should be equipped to international standards. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525408 Tue, 20 Dec 2011 05:00:00 +0100 5525408 http://www.medworm.com/index.php?rid=5525407&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F54%3Frss%3D1 The use of a suction laryngoscope that enables simultaneous suction and laryngoscopy was evaluated. 34 emergency medical technicians intubated the trachea of a manikin with simulated upper airway haemorrhage using the suction laryngoscope and the Macintosh laryngoscope, in random order. When using the suction laryngoscope, the number of oesophageal intubations was lower (3/34 vs 11/34; p=0.021) and the time taken to intubation was shorter (mean (SD) 50 (15) vs 58 (27) s; p=0.041). In cases of airway haemorrhage, the use of the suction laryngoscope might be beneficial. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525407 Tue, 20 Dec 2011 05:00:00 +0100 5525407 http://www.medworm.com/index.php?rid=5525406&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F47%3Frss%3D1 Conclusions ECPs have a differential impact compared with usual care providers dependent on the operational service settings. Maximal impact occurs when they operate in mobile settings when care is taken to the patient. In these settings ECPs have a broader range of skills than the usual care providers (eg, paramedic), and are targeted to specific clinical groups who can benefit from alternative pathways of care (such as older people who have fallen). Trial Registration No ISRCTN22085282 (Controlled trials.com). (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525406 Tue, 20 Dec 2011 05:00:00 +0100 5525406 http://www.medworm.com/index.php?rid=5525405&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F43%3Frss%3D1 Conclusions This study provides further support for the notion that ICH is highly unlikely to mimic a benign dizziness presentation. Coupled with the limitations of CT to show acute ischaemia in the posterior fossa, these results suggest that screening for ICH may not be necessary in benign appearing dizziness presentations although more research is needed. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525405 Tue, 20 Dec 2011 05:00:00 +0100 5525405 http://www.medworm.com/index.php?rid=5525404&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F40%3Frss%3D1 Conclusions The CMNW score categorised more patients as higher risk, who suffered death at 30 days than the TIMI score. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525404 Tue, 20 Dec 2011 05:00:00 +0100 5525404 http://www.medworm.com/index.php?rid=5525403&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F37%3Frss%3D1 Conclusion Intravenous paracetamol appears to provide a level of analgesia comparable to intravenous morphine in isolated limb trauma. Further larger studies are required. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525403 Tue, 20 Dec 2011 05:00:00 +0100 5525403 http://www.medworm.com/index.php?rid=5525402&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F32%3Frss%3D1 Conclusions These preliminary data in manikins could indicate the applicability of the methods to the prehospital setting. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525402 Tue, 20 Dec 2011 05:00:00 +0100 5525402 http://www.medworm.com/index.php?rid=5525401&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F28%3Frss%3D1 Conclusion Convenience, location, institutional preference and access to other physicians are common factors that influence patients' decisions to seek care in ED. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525401 Tue, 20 Dec 2011 05:00:00 +0100 5525401 http://www.medworm.com/index.php?rid=5525400&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F27%3Frss%3D1 A 42-year-old man presented to the emergency department with a 6-week history of knee pain that had increased in severity following a fall. On examination, the patient was tender over the proximal aspect of the left tibia. A knee radiograph showed a lesion within the proximal tibia of mixed sclerotic and lucent density (figure 1A). CT showed a large abscess cavity within the proximal tibia (figure 1B), which was confirmed on MRI to consist of a central fluid component with surrounding necrotic tissue and marrow oedema consistent with a Brodie's abscess caused by subacute osteomyelitis (figure 1C). Flucloxacillin-sensitive Staphylococcus aureus was isolated following surgical drainage of the abscess and a prolonged course of antibiotics was commenced. The patient remains well at follow-up. ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525400 Tue, 20 Dec 2011 05:00:00 +0100 5525400 http://www.medworm.com/index.php?rid=5525399&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F24%3Frss%3D1 Conclusion Nurses improve in defibrillation decision-making skills and confidence after appropriate brief, focused in-house training. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525399 Tue, 20 Dec 2011 05:00:00 +0100 5525399 http://www.medworm.com/index.php?rid=5525398&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F19%3Frss%3D1 Conclusions Bedside chest ultrasound is a reliable tool for the diagnosis of pneumonia in the ED, probably being superior to CXR in this setting. It is likely that its wider use will allow a faster diagnosis, conducive to a more appropriate and timely therapy. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525398 Tue, 20 Dec 2011 05:00:00 +0100 5525398 http://www.medworm.com/index.php?rid=5525397&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F15%3Frss%3D1 Conclusions A significant proportion of doctors and paramedics were unable to diagnose PMI. Hence, the majority of PMIs may be being missed. Routine use of posterior-leads in the standard assessment of patients with chest pain may identify up to an additional 7% of STEMIs, allowing prompt reperfusion therapy, which would reduce morbidity and mortality. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525397 Tue, 20 Dec 2011 05:00:00 +0100 5525397 http://www.medworm.com/index.php?rid=5525396&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F14%3Frss%3D1 A school-age child was admitted for a sudden onset of dyspnoea. Ten hours before, the child had been evaluated for cough and an acute pain in the middle anterior part of his neck. Physical examination was reported to be unremarkable. In the following hours, the mother complained of the recurrence of the cough. At admission, physical examination revealed crepitus on the neck. Oxygen saturation was 92%. A chest x-ray showed subcutaneous emphysema and pneumomediastinum without pneumothorax. A CT scan revealed air collection in the mediastinum and in the spinal canal (figures 1 and 2). Subcutaneous emphysema worsened reaching the face, and the child was intubated for important desaturation and respiratory distress. The child improved in 2 days and the emphysema resolved completely in 5&nb... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525396 Tue, 20 Dec 2011 05:00:00 +0100 5525396 http://www.medworm.com/index.php?rid=5525395&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F10%3Frss%3D1 Conclusions Deaths and serious injuries caused by firearms remain rare in the civilian population of England and Wales, although an upward trend can be described. Victims of assault and homicide are predominantly young men living in urban areas and the population involved is getting younger. However, of all deaths, self-inflicted wounds are nearly twice as common as assaults, affecting predominantly older men living in more rural areas. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525395 Tue, 20 Dec 2011 05:00:00 +0100 5525395 http://www.medworm.com/index.php?rid=5525394&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F9%3Frss%3D1 Linear red to purple marks (figure 1) were seen on the back of 16-year-old boy brought to the emergency department around midnight with chest pains and palpitations. According to the patient, these marks had been there for a few years and he denied any history of physical injury, but it raised suspicion of bruises (non-accidental injury) to emergency department staff. The patient was later reviewed by a paediatrician who diagnosed these as striae. He was a thin boy and had had quite rapid growth over the last few years. These striae are also seen in non-obese individuals due to a sudden growth spurt and can cause panic to inexperienced personnel because of the possibility of non-accidental injury. Striae can be associated with obesity, Cushing syndrome, Marfan syndrome, other collagen diso... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525394 Tue, 20 Dec 2011 05:00:00 +0100 5525394 http://www.medworm.com/index.php?rid=5525393&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F6%3Frss%3D1 Emergency medicine in The Netherlands is faced with an increasing interest by politicians and stakeholders in health care. This is due to crowding, increasing costs, criticism of the quality of emergency care, restructuring of out-of-hours services in primary care and the introduction of a training programme for emergency physicians in 2000. A comprehensive search was conducted of published research, policy reports and updated Dutch websites on acute care. Publications were included in this review if these referred to emergency care, including emergency departments (ED), general practitioner (GP) cooperatives and emergency medical services in The Netherlands and were written in English or Dutch. The literature search identified 14 eligible papers. The manual search identified 11 additional... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525393 Tue, 20 Dec 2011 05:00:00 +0100 5525393 http://www.medworm.com/index.php?rid=5525392&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F3%3Frss%3D1 It is estimated that approximately 60 000 out-of-hospital cardiac arrests (OHCA) occur in the UK each year.1 2 Resuscitation is attempted by emergency medical services (EMS) in <50% of cases, with non-resuscitation decisions being undertaken according to national guidance.3 The Ambulance Service Association first noted variability in outcomes from cardiac arrest between 2004 and 2006 with return of spontaneous circulation rates ranging from 10% to 25%.1 Recent data from the Scottish and London Ambulance Service confirm similar variability in survival to discharge rates of 1%4 and 8% respectively.5 As part of the focus on improving quality of care, the Department of Health for England introduced survival from cardiac arrest as part of the Ambulance Service National Quality Indicator set ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525392 Tue, 20 Dec 2011 05:00:00 +0100 5525392 http://www.medworm.com/index.php?rid=5525391&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F2%3Frss%3D1 We all know that good, quality, skilled communication improves patient care, reduces adverse incidents and complaints, and improves hospital efficiency; the lack of it has the opposite effect. This journal has commented on the subject in the past, most recently in an editorial in June 2010. Readers may thus be interested in a recent publication from the University of Melbourne and the University of Technology in Sydney.1 The Australian Learning and Teaching Council set up a Communication for Health in Emergency Contexts (CHEC) project, the stated aim of which is to improve teaching and learning of communication in Australian health education by developing resources that specifically focus on communication in emergency departments (EDs). The project seeks to demonstrate the communicative co... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525391 Tue, 20 Dec 2011 05:00:00 +0100 5525391 http://www.medworm.com/index.php?rid=5525390&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F29%2F1%2F1%3Frss%3D1 Firearms figures—is life getting more dangerous? This retrospective study has data on firearm injuries from the Traumatic Audit and Research Network (which includes in-hospital deaths and severely injured patients) matched with data from the Office for National Surveys which provides information on prehospital and hospital deaths from 1990 to 2007/8 (see page 10). While US data have shown an increase in deaths over time, there has so far been a lack of information to inform the veracity of UK media speculation of increasing morbidity and mortality. This paper suggests that there are significant regional differences relating to age and that there are gender-related risks of death. These outcomes vary depending on whether or not the firearm injuries are self-inflicted or the result of ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5525390 Tue, 20 Dec 2011 05:00:00 +0100 5525390 http://www.medworm.com/index.php?rid=5422622&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1086%3Frss%3D1 Epinephrine: best evidence to date? Sophia recommends a read of this Australian randomised double-blind placebo-controlled trial, and the accompanying editorial by Drs Soar and Nolan. The study authors conclude that patients who received epinephrine had a statistically improved likelihood of a return of spontaneous circulation (greater than 30 s), but no improvement in survival to hospital discharge (their primary outcome). Their discussion highlights some of the difficulties in conducting a randomised controlled trial, with adverse press reports, concerns from politicians and only one of five ambulance services being willing to participate. The study was left with too few patients, and was therefore underpowered to detect any statistically significant difference in survival to hospit... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422622 Fri, 18 Nov 2011 05:00:00 +0100 5422622 http://www.medworm.com/index.php?rid=5422621&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1084-b%3Frss%3D1 A 77-year-old man with a history of end-stage renal disease collapsed suddenly during his routine haemodialysis at a local clinic. The patient experienced choking while drinking water just before collapsing. He immediately received cardiopulmonary resuscitation. Return of spontaneous circulation occurred soon, and he was transferred to our hospital. In the emergency department, chest plain radiography revealed hyperdense lesions resembling a removable partial denture with both sharp ends inside the gastric bulb (figure 1A). His care givers could not find his denture. An abdominal CT was performed instead of oesophagogastroduodenoscopy.1 CT revealed a torturous and calcified splenic artery (axial view in figure 1B and coronal view in figure 1C) and no obvious foreign body inside the stomach... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422621 Fri, 18 Nov 2011 05:00:00 +0100 5422621 http://www.medworm.com/index.php?rid=5422620&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1084-a%3Frss%3D1 A 4-day-old full-term male neonate presented with postprandial non-bilious vomiting. Delayed meconium passage had been recorded at 36 h of age. Progressive abdominal distention was noted. A supine radiograph of the abdomen showed marked distention of the stomach and proximal duodenum with double bubble sign (figure 1). Air density was not identified distal to the duodenum. Duodenal obstruction was strongly suspected. Exploratory laparotomy revealed duodenal atresia proximal to the ampulla of Vater and severe dilatation in the first part of the duodenum, which were repaired by duodenoduodenostomy. The double bubble sign is a classic radiographic manifestation of duodenal obstruction, the cause of which could be intrinsic (such as duodenal atresia, duodenal stenosis or duodenal web) or ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422620 Fri, 18 Nov 2011 05:00:00 +0100 5422620 http://www.medworm.com/index.php?rid=5422619&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1083%3Frss%3D1 A 67-year-old woman was admitted after having her first-ever epileptic seizure. Three days before, she started complaining of vertigo, gait disturbances and tension-type headache. Examination revealed obtundation, dysarthria and ataxia. Blood pressure was 300/123 mm Hg. Within 4 h, her consciousness deteriorated to deep coma. Brain MRI showed extensive vasogenic oedema with lesions in the cerebellum, brainstem, thalami, basal ganglia and cerebral cortex (figure 1A–E). Magnetic resonance angiography revealed stenosis of both renal arteries (figure 1F). Cerebrospinal fluid showed elevated protein (253 mg/dl) and lactate levels (39.3 mg/dl), and cell count was 7/μl. Because of cerebellar oedema and enlarged ventricular spaces, temporary ventricular drainage w... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422619 Fri, 18 Nov 2011 05:00:00 +0100 5422619 http://www.medworm.com/index.php?rid=5422618&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1082-b%3Frss%3D1 A 57-year-old homeless man presented to the emergency room for poor performance status. In 2006, he suffered a closed right forearm fracture, treated by open reduction and internal fixation with two plates. Two weeks later, after another fall, he presented with a displacement of the initial forearm fracture, secondary to the bending of both plates. The patient was then operated for hardware removal, double intramedullary pinning and immobilisation with an above-elbow cast. The patient did not attend his follow-up appointments, promptly removed his cast and a few weeks later proceeded to a self-removal of the pins, which, by then, had been protruding through the skin. Currently, there is complete pseudo-arthrosis of the radius and ulna, resulting in a somewhat satisfactory range of motion (... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422618 Fri, 18 Nov 2011 05:00:00 +0100 5422618 http://www.medworm.com/index.php?rid=5422617&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1082-a%3Frss%3D1 A 64-year-old man was admitted to our accident and emergency department with acute neck pain. On initial assessment he was hypotensive. Auscultation of the praecordium revealed a splashing ‘mill-wheel’ murmur and melaena was found on rectal examination. Blood tests revealed anaemia and leucocytosis: Hb 5.7 g/dl, WCC 32.94 109/l. Air within the mediastinum was seen on chest x-ray (figure 1A). Echocardiography revealed a pericardial effusion containing air bubbles, confirming pneumopericardium (figure 1B,C). The patient was resuscitated and a local surgical team was placed on stand-by. Despite this, the patient suffered a fatal cardio-respiratory arrest. A postmortem established the cause of death as pneumopericardium and gastrointestinal bleed secondary to an oesophago-peri... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422617 Fri, 18 Nov 2011 05:00:00 +0100 5422617 http://www.medworm.com/index.php?rid=5422616&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1080%3Frss%3D1 Discussion 1. In this patient, VP shunt malfunction and infection must be considered since severe morbidity or mortality can occur if either goes undetected or untreated. Symptoms of acute shunt obstruction include headache, vomiting, papilloedema, cranial nerve VI palsy, change in personality and the ‘setting sun’ sign (lack of upward gaze) in infants. Shunt malfunction may be caused by obstruction, fracture, migration or kinking of the tubing, or damage to the shunt apparatus... (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422616 Fri, 18 Nov 2011 05:00:00 +0100 5422616 http://www.medworm.com/index.php?rid=5422615&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1079-b%3Frss%3D1 We read with interest the article by Figgis et al highlighting the need for improvement in the prehospital management of chest pain. It is concerning that only 20% of patients had a 12-lead ECG and that 64% of paramedics surveyed felt that they had received insufficient training on ECG interpretation.1 Of particular concern is the inability of paramedics to identify ST elevation myocardial infarction (STEMI) implying, therefore, that a significant proportion of patients are failing to be considered for prehospital thrombolysis. Prehospital thrombolysis has been shown to significantly decrease the time from chest pain to thrombolysis (104 min vs 162 min, p=0.007) and all-cause mortality (OR 0.83, CI 0.7 to 0.98), compared with in-hospital thrombolysis in a large meta-analysis (n=6... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422615 Fri, 18 Nov 2011 05:00:00 +0100 5422615 http://www.medworm.com/index.php?rid=5422614&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1079-a%3Frss%3D1 Kandis et al showed that mean platelet volume (MPV) is increased during acute heart failure (AHF) and predicts 30-day mortality in patients attended at the emergency department (ED).1 We have ascertained their hypothesis including all patients attended at the ED (not only those hospitalised), with all types of ventricular dysfunction (not only those with systolic dysfunction), and also looked for differences in 30-day readmission rates. We reanalysed 404 consecutive AHF episodes attended during 1 month in four EDs from the Spanish AHF registry; 54.2% of them were hospitalised and 63.7% had preserved systolic function.2 The 30-day mortality and readmission rates were 10.0% and 21.6%, respectively, and both were statistically related with increased MPV. When patients on antiplatelet med... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422614 Fri, 18 Nov 2011 05:00:00 +0100 5422614 http://www.medworm.com/index.php?rid=5422613&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1077%3Frss%3D1 A short cut review was carried out to establish whether intranasal fentanyl is better than parenteral morphine for managing acute severe pain in children. 51 papers were found using the reported searches, of which 4 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 these best papers are tabulated. It is concluded that intranasal fentanyl is an effective and safe alternative to IV or IM morphine for managing acute pain in children presenting to the Emergency Department. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422613 Fri, 18 Nov 2011 05:00:00 +0100 5422613 http://www.medworm.com/index.php?rid=5422612&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1076%3Frss%3D1 A short cut review was carried out to establish whether ketamine is a viable induction agent in trauma patients with potential brain injuries. 276 papers were found using the reported searches, of which 5 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 these best papers are tabulated. It is concluded that there is no evidence to suggest harm with Ketamine use as induction agent for the patient with potential traumatic brain injury. The drug has major advantages in those patients with associated haemodynamic compromise and should potentially be regarded as the agent of choice. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422612 Fri, 18 Nov 2011 05:00:00 +0100 5422612 http://www.medworm.com/index.php?rid=5422611&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1075%3Frss%3D1 A short cut review was carried out to establish whether wrist splints require a thumb extension when immobilising suspected scaphoid fractures. 63 papers were found using the reported searches, of which 2 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 these best papers are tabulated. It is concluded that while there is no direct evidence to answer the clinical question, the research available strongly suggests that it is reasonable to continue using standard wrist splints to immobilise patients with suspected scaphoid fractures. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422611 Fri, 18 Nov 2011 05:00:00 +0100 5422611 http://www.medworm.com/index.php?rid=5422610&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1074-b%3Frss%3D1 A short cut review was carried out to establish whether prophylactic antibiotics should be given to prevent Weil's disease after a fall into standing water. 30 papers were found using the reported searches, of which 4 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 these best papers are tabulated. It is concluded that if there is immersion in an endemic area for leptospirosis, or if there is higher risk of water contamination such as standing water, known rat infestation, drainage channels then doxycycline would have to be recommended. Other scenarios are not as clear. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422610 Fri, 18 Nov 2011 05:00:00 +0100 5422610 http://www.medworm.com/index.php?rid=5422609&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1074-a%3Frss%3D1 Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422609 Fri, 18 Nov 2011 05:00:00 +0100 5422609 http://www.medworm.com/index.php?rid=5422608&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1071%3Frss%3D1 Capnocytophaga canimorsus infection is the most severe and rapidly progressive bacterial infection transmitted by dog bite and fortunately is very rare. The authors describe a 68-year-old gentleman who presented in an acute confusional state 2 days after having been bitten on the left hand by a dog. Despite immediate broad-spectrum intravenous antibiotics, he developed significant sequelae including disseminated intravascular coagulopathy, microvascular emboli leading to peripheral necrosis, widespread local tissue destruction and septic arthritis. Our case illustrates a life-threatening presentation of infection with C canimorsus, which is known as ‘the dog bite organism’. Early diagnosis and aggressive treatment is key to survival. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422608 Fri, 18 Nov 2011 05:00:00 +0100 5422608 http://www.medworm.com/index.php?rid=5422607&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1068%3Frss%3D1 A 31-year-old man purchased the legal high Energy-1 (NRG-1) over the internet; this was advertised as containing the compound naphthylpyrovalerone (NPV), which at the time was currently legally available in the UK. He ingested 1 g of this substance and developed a prolonged high associated with palpitations, sweating and insomnia. Analysis of both the powder and serum samples from the patient demonstrated that he ingested two classified recreational drugs β-keto-N-methylbenzodioxolylpropylamine (butylone) and methylenedioxypyrovalerone (MDPV) rather than the legal substance NPV. Users of legal highs need to be aware that legal highs purchased over the internet may contain illegal substances and therefore they may be liable for prosecution if found in possession of these substances. Fu... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422607 Fri, 18 Nov 2011 05:00:00 +0100 5422607 http://www.medworm.com/index.php?rid=5422606&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1066%3Frss%3D1 Conclusions BNP seems to rise from baseline to a peak between 18 h and 1 week after an acute syncopal episode in many patients. The reasons for this are not clear. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422606 Fri, 18 Nov 2011 05:00:00 +0100 5422606 http://www.medworm.com/index.php?rid=5422605&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1063%3Frss%3D1 This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422605 Fri, 18 Nov 2011 05:00:00 +0100 5422605 http://www.medworm.com/index.php?rid=5422604&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1062%3Frss%3D1 A 72-year-old woman with a history of liver cirrhosis presented with progressive leg swelling and abdominal discomfort for 1 week. Physical examination showed elevated jugular venous pressure, hepatosplenomegaly, tenderness over right upper quadrant abdomen and bilateral lower leg pitting oedema. Echocardiography showed hypokinesis of the right ventricle. CT of the abdomen displayed hepatosplenomegaly, enlargement of inferior vena cava (arrow) and a mottled pattern of contrast enhancement due to heterogeneous perfusion of the liver—nutmeg liver (figure 1), which occurs usually as a result of hepatic venous congestion. The diagnosis of cardiac dysfunction causing nutmeg liver is based on the associated cardiac examination and the exclusion of other plausible causes, including hep... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422604 Fri, 18 Nov 2011 05:00:00 +0100 5422604 http://www.medworm.com/index.php?rid=5422603&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1061%3Frss%3D1 During a multiple casualty chemical, biological, radiological and nuclear incident it is imperative that triage is accurately undertaken to use resources effectively and give the greatest chance of survival to those who need it. This reflection explores an option to assist in this matter by proposing a colorimetric breathing detection system, while remembering that this it is untested, may be a useful aid. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422603 Fri, 18 Nov 2011 05:00:00 +0100 5422603 http://www.medworm.com/index.php?rid=5422602&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1060%3Frss%3D1 An 83-year-old woman was admitted after a fall. Her CT scan showed a fracture involving the roof and medial/lateral wall of the left maxillary sinus requiring a maxofacial surgeon's input and also a left scleral anteromedially dense focus, probably a foreign body, requiring ophthalmology assessment (figure1A, arrow). At ophthalmology review, the bulbar conjunctiva was white apart from a medial discoloured lesion (figure1B). The lesion seen on the CT scan is a calcified scleral plaque and does need treatment. These asymptomatic plaques are seen in older patients or in hypercalcaemic states and are commonly located at or anterior to the sites of insertion of the horizontal extraocular muscles. Competing interestsNone. Patient consentObtained. Provenance and peer reviewNot commissioned; inter... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422602 Fri, 18 Nov 2011 05:00:00 +0100 5422602 http://www.medworm.com/index.php?rid=5422601&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1059%3Frss%3D1 Conclusion Ivory wave's popularity seems to be growing and it seems quite plausible that this drug could become ‘the next mephedrone’. Clinicians should be aware of its likely presentations, dangers, and management. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422601 Fri, 18 Nov 2011 05:00:00 +0100 5422601 http://www.medworm.com/index.php?rid=5422600&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1058%3Frss%3D1 Towards evidence based emergency medicine: PRIVATE Best BETs from the Manchester Royal Infirmary. Craig Ferguson Emerg Med J 2011;28:990. The correct title should have been published as: Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. Apologises for any inconvenience caused. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422600 Fri, 18 Nov 2011 05:00:00 +0100 5422600 http://www.medworm.com/index.php?rid=5422599&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1055%3Frss%3D1 Conclusion A profile of largely psychoactive and cardiovascular toxicity is described with drug naivety perhaps explaining the high rates of bingeing and addiction reported. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422599 Fri, 18 Nov 2011 05:00:00 +0100 5422599 http://www.medworm.com/index.php?rid=5422598&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1051%3Frss%3D1 This article describes the theoretical background, advantages, risks and applications of discrete choice experiments for measuring patient preference in emergency medicine. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422598 Fri, 18 Nov 2011 05:00:00 +0100 5422598 http://www.medworm.com/index.php?rid=5422597&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1046%3Frss%3D1 Conclusion PSI and CURB-65 are useful for identification of patients with less severe NHAP. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422597 Fri, 18 Nov 2011 05:00:00 +0100 5422597 http://www.medworm.com/index.php?rid=5422596&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1041%3Frss%3D1 Conclusions Although a prospective study with a large cohort is required, the present results suggest that high initial sAA activity is associated with increased risk of malignant VA and predicts short-term prognosis in patients with STEMI. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422596 Fri, 18 Nov 2011 05:00:00 +0100 5422596 http://www.medworm.com/index.php?rid=5422595&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1036%3Frss%3D1 Conclusions Procedural sedation and analgesia by Emergency Physicians is safe and effective; however, complications do happen. Complications are more likely at deeper levels of sedation and at night. Emergency Physicians must have the necessary skills and equipment to deal with such complications when they arise. EDs must be adequately staffed with trained clinicians 24 h a day to provide PSA. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422595 Fri, 18 Nov 2011 05:00:00 +0100 5422595 http://www.medworm.com/index.php?rid=5422594&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1032%3Frss%3D1 Conclusion This study supports the validity of the ESI as it showed that patients' vital signs are associated with the ESI triage categories. However, a revision of the ESI guidelines concerning pain assessments is necessary. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422594 Fri, 18 Nov 2011 05:00:00 +0100 5422594 http://www.medworm.com/index.php?rid=5422593&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1026%3Frss%3D1 Conclusions The TTAS was found to be a reliable triage system that accurately prioritises the treatment needed to avoid overtriage, more efficiently deploying the appropriate resources to ED patients. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422593 Fri, 18 Nov 2011 05:00:00 +0100 5422593 http://www.medworm.com/index.php?rid=5422592&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1019%3Frss%3D1 Conclusion Patients attending an emergency department due to DSH have a high risk of repeating their self-harm behaviour. We present a model for risk stratification for repeated DSH describing low-risk (18%), median-risk (28% to 32%) and high-risk (47% to 72%). Our results might help caretakers to direct optimal resources to these groups. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422592 Fri, 18 Nov 2011 05:00:00 +0100 5422592 http://www.medworm.com/index.php?rid=5422591&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1013%3Frss%3D1 Conclusion The model accurately reproduced the use of a dominant wait-reduction strategy to identify patients approaching the breach and re-prioritise them to expedite treatment and remove them from the department by the 4 h target. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422591 Fri, 18 Nov 2011 05:00:00 +0100 5422591 http://www.medworm.com/index.php?rid=5422590&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1008%3Frss%3D1 Multiple reports over the past 20 years have criticised the care delivered to major trauma patients in England. The setting up of regional trauma networks is well underway to address these deficiencies. Outcomes currently collected in major trauma are restricted to mortality rates and process measures; however, many patients are left with long-term disabilities and reduced quality of life (QoL), which are not measured at present. Trauma systems need to develop outcome measures that capture this important information to judge the quality of care and influence the development of services. This review aimed to identify the current practice of international trauma registries with regard to outcome measurement and review the literature surrounding these measures. An internet-based search o... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422590 Fri, 18 Nov 2011 05:00:00 +0100 5422590 http://www.medworm.com/index.php?rid=5422589&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1004%3Frss%3D1 Background Recent publications have indicated that there is a crisis in clinical research. The cost of an industry-led clinical trial is now estimated at some US$100–200 million, within which an average 25% of centres will recruit no patients. The median number of enrolment (entry) criteria in a drug trial is 49, with a median of 158 different trial procedures. The number of data items per patient often runs into thousands, so it is little surprise that the average time to trial completion increased 70% between 1999 and 2006.1 There seems to be a self-sustaining ‘industry’ of bureaucracy around research. This system generates huge costs and a mountain of paperwork, which in turn makes the employment of trial managers essential. These costs are passed on to the industry or... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422589 Fri, 18 Nov 2011 05:00:00 +0100 5422589 http://www.medworm.com/index.php?rid=5422588&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1003%3Frss%3D1 A patient with a history of arterial hypertension, chronic atrial fibrillation treated with amiodarone and ticlopidin, hypercholesterolaemia and acute myocardial infarction 20 years ago presented to the emergency room after having diarrhoea and vomiting for the last 10 days, complicated with progressive abdominal pain in the last 24 h. During the initial evaluation, arterial hypotension, tachycardia and subicteric escleral dye were prominent symptoms. Physical examination showed abdominal distension and diffuse painful palpation, without peritoneal irritation signs. Lab tests showed a pH of 7, serum bicarbonate of 6 mmol/l, lactic acid of 9.2 mmol/l and serum creatinine of 3.6 mg/dl. Diffuse small and large bowel dilatations were found on a plain abdominal x-r... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422588 Fri, 18 Nov 2011 05:00:00 +0100 5422588 http://www.medworm.com/index.php?rid=5422587&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1002%3Frss%3D1 The Kings' Fund will be familiar to many readers. In September, it published a briefing paper, with the above title1 that appears rather dry and of no immediate interest to readers; close scrutiny, however, reveals some interesting comments and perspectives that should be noted. The reason why the Fund feels it necessary to comment on this subject is that, while acknowledging that reconfiguration of hospital services can provide a powerful means of improving quality in an environment where money and skilled healthcare workers are scarce (and in some places reconfiguration is needed urgently), the current reconfiguration process is lengthy, wasteful and carries significant risks to the delivery of safe services. There are also risks that prospective legislative changes will make an already ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422587 Fri, 18 Nov 2011 05:00:00 +0100 5422587 http://www.medworm.com/index.php?rid=5422586&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F12%2F1001%3Frss%3D1 A path to effective emergency medicine research In this commentary an experienced investigator highlights the increasing costs, challenges and bureaucracy associated with undertaking ‘traditional’ models of research in emergency medicine-related topics (see page 1004). He argues that because emergency physicians (and this editor adds, prehospital clinicians) are generalists with respect to their clinical interests they might instead choose to become methodological specialists. New outcome measures for trauma Regional trauma networks continue to be rolled out across the UK but evaluation of their effectiveness could arguably be enhanced beyond currently available mortality data (see page 1008). In this issue Sleat et al describe a literature and database review to determine what... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5422586 Fri, 18 Nov 2011 05:00:00 +0100 5422586 http://www.medworm.com/index.php?rid=5315112&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F1000%3Frss%3D1 Elephants that kill Every year, hundreds of people are killed as a result of elephant attacks. Human conflict with elephants may result from encroaching of the animals' habitat by human civilisation. A report from West Bengal describes how 14 individuals died having been attacked by ‘wild tuskers’. The deaths resulted from trampling injuries to the head and/or chest, rather than from penetrating tusk injuries. Farm workers and labourers of low socioeconomic group living adjacent to forest areas appear to be most at risk (J Forensic Leg Med 2011;18:154–7). Out of hospital cardiac arrest Data from animal studies have provided some evidence to suggest that a few minutes of chest compressions before analysis of cardiac rhythm could be beneficial by enhancing the likelihood of... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315112 Fri, 14 Oct 2011 04:00:00 +0100 5315112 http://www.medworm.com/index.php?rid=5315111&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F999%3Frss%3D1 A patient was shot below the left scapula. Initial resuscitation involved a bag valve mask device. Bilateral chest movements with equal air entry were noted. Subsequently, with spontaneous breathing, chest expansion and air entry became minimal. The patient's voice became inaudible but the words ‘can't breathe’ could be elucidated. As the patient was increasingly distressed and tachypnoeic with the use of the shoulder girdle muscles, a pneumothorax or haemothorax was presumed. Percussion note, however, was resonant bilaterally and a chest radiograph was unremarkable except for the absence of the bullet. There was no exit wound. Further examination revealed signs of high cord injury. Cervical spine radiographs confirmed shrapnel at the level of C2 and C3, with impingement of the... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315111 Fri, 14 Oct 2011 04:00:00 +0100 5315111 http://www.medworm.com/index.php?rid=5315110&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F998%3Frss%3D1 Case vignette A 32-year-old man is brought in by ambulance with altered mental status. He has pinpoint pupils that are minimally reactive, and apnoea. He receives high-dose naloxone with improvement in his respiratory status. Upon awaking, he states that someone slipped him a ‘mickey,’ but his friends believe he ingested some ‘old pain pills’ on the night of presentation. An hour later, the patient is found to be apnoeic and difficult to arouse, despite a normal blood glucose level. Consequently, further investigation is pursued with a normal head CT, blood chemistry tests, cerebrospinal fluid analysis and urine toxicology testing. The patient is given additional naloxone and awakens again. Key questions What is a ‘mickey’ and would it show up on a urine... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315110 Fri, 14 Oct 2011 04:00:00 +0100 5315110 http://www.medworm.com/index.php?rid=5315109&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F997-b%3Frss%3D1 The Fourth National Audit Project by the Royal College of Anaesthetists revealed a significant number of major airway events in the emergency department (ED), a third of which resulted in death or severe neurological damage.1 This was due to repeated inadequacies in care including the planning and provision of airway equipment. The Royal College of Anaesthetists recommends that difficult airway equipment immediately available in EDs should be similar to that in operating theatres. We audited the availability of difficult airway equipment in Croydon University Hospital (2011) and East Surrey Hospital (2009) and found discrepancies in the EDs compared with the operating theatres. For example, one ED had only one type and size of facemask and laryngeal mask airway, and standard cannulas for n... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315109 Fri, 14 Oct 2011 04:00:00 +0100 5315109 http://www.medworm.com/index.php?rid=5315108&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F997-a%3Frss%3D1 The use of smartphones in the emergency department (ED) to capture images from patients' injuries has led to many trusts adopting strict guidance to restrict the use of patient identifiable data on devices such as these. Most EDs will keep a departmental digital camera in order to capture images such as compound fracture wounds before manipulation and plastering to assist the orthopaedic team in planning for surgery. Plastic surgery is another area where early imaging of wounds such as haemorrhaging lacerations or burns are done before covering with dressings that may be painful to remove for a re-look. The problem with digital cameras lies not only in its cost (necessitating it to be locked away, which delays access) but also that it stores images on the camera. Loss of the camera (broken... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315108 Fri, 14 Oct 2011 04:00:00 +0100 5315108 http://www.medworm.com/index.php?rid=5315107&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F994%3Frss%3D1 A short cut review was performed to assess the utility of a skeletal survey in patients with suspected non-accidental injury. Three studies including a total of 983 patients were found. The authors, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are tabulated. The clinical bottom line is that skeletal surveys are useful in children who are suspected to have non-accidental injury, particularly in those aged under 1 year. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315107 Fri, 14 Oct 2011 04:00:00 +0100 5315107 http://www.medworm.com/index.php?rid=5315106&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F993%3Frss%3D1 A short cut review was performed to assess the effect of the presence of family members on the efficiency of paediatric trauma resuscitation. Two studies with a total of 999 patients were included. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are tabulated. The clinical bottom line is that the presence of the patient's family does not adversely affect the outcome of paediatric trauma resuscitation. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315106 Fri, 14 Oct 2011 04:00:00 +0100 5315106 http://www.medworm.com/index.php?rid=5315105&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F991%3Frss%3D1 A short cut review was performed to seek the evidence for use of intravenous lipid emulsion in the treatment of overdose with β-receptor antagonists. Eight case reports and one case series with a total of 10 patients were found. The authors, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are tabulated. The clinical bottom line is that there is only anecdotal evidence of effectiveness for this treatment. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315105 Fri, 14 Oct 2011 04:00:00 +0100 5315105 http://www.medworm.com/index.php?rid=5315104&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F990-b%3Frss%3D1 A short cut review was performed to assess the utility of emergency physician echocardiography in patients with cardiac arrest. Six studies with a total of 434 patients were found. The authors, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are tabulated. The clinical bottom line is that cardiac standstill witnessed in emergency physician echocardiography is predictive of a poor outcome in cardiac arrest. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315104 Fri, 14 Oct 2011 04:00:00 +0100 5315104 http://www.medworm.com/index.php?rid=5315103&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F990-a%3Frss%3D1 Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315103 Fri, 14 Oct 2011 04:00:00 +0100 5315103 http://www.medworm.com/index.php?rid=5315102&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F986%3Frss%3D1 A 74-year-old woman received thrombolysis for pericarditis. She subsequently developed shock and cardiac arrest. The case report describes the events of how a simple immediate bedside focused echo proved to be a life saving assessment. Current availability and training issues in focused transthoracic echo are discussed. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315102 Fri, 14 Oct 2011 04:00:00 +0100 5315102 http://www.medworm.com/index.php?rid=5315101&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F985%3Frss%3D1 A 26-year-old male presented with a 2-week history of increasing left-sided otalgia and discharge. Examination revealed a left-sided neck swelling with an enlarged cervical lymph node. Otoscopy of the left ear revealed tympanic membrane retraction with posterior perforation and granulation. A deep left-sided collection within the neck inferior to the mastoid was seen on ultrasound. This was confirmed by CT; in addition, there was opacification of the middle ear and mastoid air spaces (figure 1). This represented a Bezold's abscess and was surgically drained. It was found to be positive for acid-fast bacilli on Ziel–Niehlson stain. Bezold's abscess is a rare complication of mastoiditis caused by necrosis of the mastoid tip allowing infection to migrate into the neck. The deep location... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315101 Fri, 14 Oct 2011 04:00:00 +0100 5315101 http://www.medworm.com/index.php?rid=5315100&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F983%3Frss%3D1 The authors report the case of a 4-year-old boy who presented to the emergency department with acute post-traumatic winging of right scapula following a fall onto his back. The x-ray of his right shoulder showed no fracture. An MRI Scan of cervical spine and brachial plexus did not reveal any abnormalities. He was managed conservatively with regular physiotherapy. At 2 years follow-up, there was no improvement in the winging of his right scapula. He was asymptomatic at rest but complains of pain in the right scapular and shoulder region during swimming limiting his swimming activity. Currently he was being evaluated by the orthopaedic team for corrective surgery. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315100 Fri, 14 Oct 2011 04:00:00 +0100 5315100 http://www.medworm.com/index.php?rid=5315099&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F981%3Frss%3D1 A traumatic abdominal wall hernia (TAWH) caused by a handlebar collision is very rare. It is difficult for the emergency physician to exclude the possibility of mesenteric or intestinal injuries when viewing handlebar trauma. Because TAWH may have no other clinical symptoms, early recognition and differentiation from haematoma is important. An unusual case of TAWH caused by a handlebar injury is reported, where a multi-layer muscular defect was found along with a segment of incarcerated jejunum and omentum. The latest literature is reviewed, and valuable ideas on the management of blunt abdominal trauma with TAWH are shared. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315099 Fri, 14 Oct 2011 04:00:00 +0100 5315099 http://www.medworm.com/index.php?rid=5315098&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F980%3Frss%3D1 A 39-year-old man with a history of oesophageal cancer, status post-concurrent chemoradiation therapy, underwent subtotal oesophagectomy with gastric tube reconstruction for 1 year. He was bought to our emergency department due to acute dyspnoea with chest tightness. Physical examination revealed hypotension (85/60 mm Hg), distension of jugular vein and diminished heart sounds. The cardiac enzymes were not elevated. Chest radiography showed accumulation of air in the pericardial sac in association with compression of the right ventricle (figure 1). Pneumopericardium with cardiac tamponade was diagnosed. The CT scan showed distension of the reconstructed gastric tube in the right hemithorax and a fistula with pericardial space was suspected. About 600 ml of air was drain... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315098 Fri, 14 Oct 2011 04:00:00 +0100 5315098 http://www.medworm.com/index.php?rid=5315097&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F979-c%3Frss%3D1 Conclusion Medical emergencies at sea are surprisingly diverse, with a wide variety of major and minor injuries & illnesses. This series ranges from diving emergencies, major trauma, an elderly cruise ship passenger with a ruptured AAA, and obstetric emergencies. Our data are retrospective and the MTS is not designed for prehospital use, but most maritime cases attended by RAF/RN SAR helicopters appear to be genuinely urgent. Lives would be at risk without the service, which features both winching capability & a technician or HPC-registered paramedic on board. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315097 Fri, 14 Oct 2011 04:00:00 +0100 5315097 http://www.medworm.com/index.php?rid=5315096&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F979-b%3Frss%3D1 Conclusion Our findings will inform improved systems of care for asthma and the effect on indicators will be measured using time series methods. This approach could be used more widely to improve management of specific clinical conditions where quality of care is demonstrated to be suboptimal. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315096 Fri, 14 Oct 2011 04:00:00 +0100 5315096 http://www.medworm.com/index.php?rid=5315095&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F979-a%3Frss%3D1 Conclusions and Recommendations This study has enabled the development of a prioritised vehicle equipment check-sheet with high face validity. Its prioritised nature means that vital equipment is accounted for first, ensuring their presence and functionality even if the vehicle is dispatched before a full check can be completed. The check-sheet is now being introduced throughout the Scottish Ambulance Service and would have applicability to other emergency medical services. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315095 Fri, 14 Oct 2011 04:00:00 +0100 5315095 http://www.medworm.com/index.php?rid=5315094&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F974%3Frss%3D1 Conclusions In the case of a single healthcare professional using a bag–valve–mask device, the quality of over-the-head CPR is at least equivalent to lateral, and superior to alternating CPR. Because of the potential difficulties in bag–valve–mask ventilation in the lateral position, the authors recommend over-the-head CPR. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315094 Fri, 14 Oct 2011 04:00:00 +0100 5315094 http://www.medworm.com/index.php?rid=5315093&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F970%3Frss%3D1 Conclusions Among OHCA patients who met recognised inclusion criteria, therapeutic hypothermia was implemented successfully by the ED staff. The temperature should be measured continuously from the same site in both the ED and the ICU. This will provide consistent and continuous temperature monitoring between the ED and the ICU and will enable prompt intervention to prevent temperature increases. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315093 Fri, 14 Oct 2011 04:00:00 +0100 5315093 http://www.medworm.com/index.php?rid=5315092&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F963%3Frss%3D1 Conclusions SAV should not be administered in Old World scorpion envenomation until its efficacy is established by an appropriately designed RCT. In the Arizona scorpion sting, SAV hastens the recovery process. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315092 Fri, 14 Oct 2011 04:00:00 +0100 5315092 http://www.medworm.com/index.php?rid=5315091&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F962%3Frss%3D1 A 45-year-old gentleman attended our emergency department after having been punched in the right eye the previous night. He had developed sudden right periorbital swelling after blowing his nose, as well as vertical diplopia. Examination revealed crepitus suggestive of subcutaneous emphysema around the orbital margins. Eye movements displayed lag on looking up. X-Rays of his facial bones showed the presence of intraorbital air, as indicated by a crescent-shaped area of radiolucency in the superior aspect of the right orbit (figure 1). No visible bony fractures were identified on plain radiography. The black eyebrow sign has been previously described as a sign of intraorbital emphysema.1 For this to occur the structural integrity of the orbital bones must be disrupted, and is indicative of ... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315091 Fri, 14 Oct 2011 04:00:00 +0100 5315091 http://www.medworm.com/index.php?rid=5315090&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F959%3Frss%3D1 Conclusion Predicting admission at triage is not sufficiently accurate to inform hospital in-patient bed management systems. The decision to admit can only be determined after a comprehensive clinical work up and patients cannot be accurately ‘signposted’ during the triage process. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315090 Fri, 14 Oct 2011 04:00:00 +0100 5315090 http://www.medworm.com/index.php?rid=5315089&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F955%3Frss%3D1 Conclusions The curriculum did not cover all the clinical conditions, procedures and investigations encountered by emergency medicine (EM) registrars in Cape Town. In addition, there were multiple categories in the curriculum that were not encountered in EM practice at all. The investigations section of the curriculum correlated particularly poorly with the skills needed for the burden of disease seen in ECs in Cape Town. The curriculum should be redrafted guided by a practice analysis of EM. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315089 Fri, 14 Oct 2011 04:00:00 +0100 5315089 http://www.medworm.com/index.php?rid=5315088&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F952%3Frss%3D1 Conclusions Clinicians need to be aware that half the vulnerable children in hospital are identified through one or other parent. It is hypothesised that the availability of an experienced child protection advisor on-site, combined with child protection training, makes it possible for clinicians caring for adults with problems related to violence, drug abuse or acute mental illness, to take action to address the potential vulnerability of their children. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315088 Fri, 14 Oct 2011 04:00:00 +0100 5315088 http://www.medworm.com/index.php?rid=5315087&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F948%3Frss%3D1 Conclusion The data from our study suggest that NPT lactate provides early diagnostic information about the risk of SBI in children presenting to the ED with a suspected infection. Combining NPT lactate with WBC and CRP resulted in a promising rule-in-tool for SBI in children in the ED which, with prospective validation, has the potential to aid early identification of SBI in children. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315087 Fri, 14 Oct 2011 04:00:00 +0100 5315087 http://www.medworm.com/index.php?rid=5315086&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F945%3Frss%3D1 Conclusion The ‘quality’ of the waiting time appears to be important in the decision to leave. If this aspect was taken into account, a reduction in the number of LWBS patients and improved quality of care could be achieved in emergency departments. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315086 Fri, 14 Oct 2011 04:00:00 +0100 5315086 http://www.medworm.com/index.php?rid=5315085&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F941%3Frss%3D1 Conclusions High serum levels of S100B were found early after trauma. The highest concentrations of S100B were found in patients with multi trauma. This suggests that S100B serum concentrations are significantly affected by extracerebral injuries. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315085 Fri, 14 Oct 2011 04:00:00 +0100 5315085 http://www.medworm.com/index.php?rid=5315084&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F938%3Frss%3D1 Conclusion The S-100B serum level showed a high sensitivity and negative predictive value in the screening of patients with mild head injury. The use of serum S-100B as a biomarker for CCT triage may improve patient screening and decrease the number of CCT scans performed. This would reduce unnecessary radiation exposure and free up capacity in the emergency rooms of peripheral hospitals to enable them to cope better with multiple admissions. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315084 Fri, 14 Oct 2011 04:00:00 +0100 5315084 http://www.medworm.com/index.php?rid=5315083&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F932%3Frss%3D1 Conclusions Electrical cardioversion of recent-onset AF in the SOU is safe, effective and reduces hospitalisations. Further studies are needed to identify the most cost-effective strategy for the management of AF patients in emergency settings. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315083 Fri, 14 Oct 2011 04:00:00 +0100 5315083 http://www.medworm.com/index.php?rid=5315082&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F927%3Frss%3D1 Conclusions Development of an ED-based sexual assault centre at a referral hospital in Kenya using a standardised history, physical, and treatment protocol was feasible, and high rates of prophylaxis were provided. Based on characteristics of people who have been assaulted, community prevention efforts should concentrate on decreasing the societal acceptability of rape. In conjunction with improvement of protocols at the centre under consideration, development of similar centres in sub-Saharan African ED should be encouraged. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315082 Fri, 14 Oct 2011 04:00:00 +0100 5315082 http://www.medworm.com/index.php?rid=5315081&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F924%3Frss%3D1 Conclusions This study shows a sensitivity of RIDT of 59%, in agreement with other prospective studies, which could be useful in clinical practice for diagnosis influenza A (H1N1) 2009 in children. In outbreaks of a high prevalence, such as the 2009 outbreak, this test can help to prevent an overload of public health services. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315081 Fri, 14 Oct 2011 04:00:00 +0100 5315081 http://www.medworm.com/index.php?rid=5315080&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F917%3Frss%3D1 Oxygen (O2) is widely recommended in international guidelines for treatment of acute myocardial infarction (AMI), but there is uncertainty about its safety and benefits. A systematic review and meta-analysis were performed to determine whether inhaled O2 in AMI improves pain or the risk of death. Cochrane CENTRAL Register of Controlled Trials, MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, LILACS and PASCAL were searched from start date to February 2010. Other sources included British Library ZETOC, Web of Science, ISI Proceedings, relevant conferences, expert contacts. Randomised controlled trials of inhaled O2 versus air in patients with suspected or proven AMI of < 24 h onset were included. Two authors independently reviewed studies to confirm inclusion criteria met, and undertook data... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315080 Fri, 14 Oct 2011 04:00:00 +0100 5315080 http://www.medworm.com/index.php?rid=5315079&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F915%3Frss%3D1 The WHO has recently described the management of potentially rabid mammal bites and envenomings by snakes or scorpions as ‘a global public health emergency’ (http://www.who.int/bloodproducts/animal_sera/Rabies.pdf). However, as far as Western medicine is concerned, scorpion envenomation may be considered as an orphan disease. An orphan disease, as defined by MedicineNet, is ‘A disease which has not been "adopted" by the pharmaceutical industry because it provides little financial incentive for the private sector to make and market new medications to treat or prevent it.’ An orphan disease may be:A rare disease. According to US criteria, an orphan disease is one that affects fewer than 200 000 people. (There are more than 5000 such rare disorders.) A common disease t... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315079 Fri, 14 Oct 2011 04:00:00 +0100 5315079 http://www.medworm.com/index.php?rid=5315078&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F914%3Frss%3D1 A year is a long time in politics; sometimes in health a year can seem even longer than that. In 2010, we used this editorial space to report on the introduction of time-based emergency targets in Australasia—4 h in Australia and 6 h in New Zealand.1 We offered to provide occasional updates, believing they are of interest to international readers as well as local ones. Well, there is a striking development in Australia with the government recently announcing that the 4-hour emergency target threshold will be lowered from 95% to 90%, to be reached by 2015.2 Why did the government change its mind? Simple really—it decided to consult people (I won't use the hackneyed phrase ‘key stakeholders’) and then (the crucial step) listen to them. A National Expert Pane... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315078 Fri, 14 Oct 2011 04:00:00 +0100 5315078 http://www.medworm.com/index.php?rid=5315077&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2F913%3Frss%3D1 Oxygen? Maybe not. There was a time when it was generally accepted that, apart from neonates, all critically ill or injured patients should be given as much oxygen as could be delivered to them. Gradually, concerns about the potential dangers of oxygen as a therapy have emerged. So, should oxygen be routinely administered to patients with acute myocardial infarction? This question is addressed by Burls and colleagues (see page 917) who present some interesting results after performing a systematic review and meta-analysis. An ED based sexual assault centre Sexual violence is depressingly widely prevalent in sub-Saharan Africa. Many victims present for treatment at the emergency department, yet care for victims does not appear to be typically consistent or standardised. In acknowledgement o... Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315077 Fri, 14 Oct 2011 04:00:00 +0100 5315077 http://www.medworm.com/index.php?rid=5315076&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-p%3Frss%3D1 Conclusion Urgent transfer to tertiary specialities is rarely required in severely injured mountain casualties from Snowdonia: bypassing our DGH directly to a regional trauma centre is not required. Furthermore, it would be logistically difficult. In summer, with endurance typically 1 h 45 min, the RAF helicopter would likely need to re-fuel before continuing to NW England after picking up a casualty. This audit, although limited in number, supports the concept of a regional trauma system with pre-defined protocols and pathways for patient care. We also require a more timely service from neurosurgical colleagues. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315076 Fri, 14 Oct 2011 04:00:00 +0100 5315076 http://www.medworm.com/index.php?rid=5315075&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-o%3Frss%3D1 Conclusion The case study approach will enable us to evaluate the impact of this collaborative project in constituent ambulance services as well as the initiative as a whole. It will enable us to show whether and to what extent the project has had an impact, but also how and why this has happened. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315075 Fri, 14 Oct 2011 04:00:00 +0100 5315075 http://www.medworm.com/index.php?rid=5315074&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-n%3Frss%3D1 Discussion Patients and carers have experience and knowledge relevant to developing and undertaking prehospital research. TRUST coordinates and supports service user involvement in research in this field. Service users have fed their views into meetings covering project-specific and strategic topics at all stages of the research process. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315074 Fri, 14 Oct 2011 04:00:00 +0100 5315074 http://www.medworm.com/index.php?rid=5315073&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-m%3Frss%3D1 Conclusion RAF/RN winchmen deal with a wide variety of cases, of all ages. Considering that, typically, 70% of the 70 winchmen at any time are qualified paramedics (the remainder are technician-level) advanced skills are used moderately frequently. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315073 Fri, 14 Oct 2011 04:00:00 +0100 5315073 http://www.medworm.com/index.php?rid=5315072&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-l%3Frss%3D1 Conclusions Further patient-centred research is required in the UK to increase understanding of the important factors that influence decisions about whether to use an emergency ambulance or not. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315072 Fri, 14 Oct 2011 04:00:00 +0100 5315072 http://www.medworm.com/index.php?rid=5315071&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-k%3Frss%3D1 Conclusions Listening to Disco Science while performing CPR did not increase the proportion of prehospital professionals delivering compressions correctly. Perhaps unsurprisingly, listening to Achy Breaky Heart had a negative effect. Disconcertingly, regardless of the nature or absence of musical accompaniment, the majority of participants did not compress at the recommended rate or depth. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315071 Fri, 14 Oct 2011 04:00:00 +0100 5315071 http://www.medworm.com/index.php?rid=5315070&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-j%3Frss%3D1 Conclusion Medical emergencies at sea are surprisingly diverse, with a wide variety of major and minor injuries & illnesses. This series ranges from diving emergencies, major trauma, an elderly cruise ship passenger with a ruptured AAA, and obstetric emergencies. Our data are retrospective and the MTS is not designed for prehospital use, but most maritime cases attended by RAF/RN SAR helicopters appear to be genuinely urgent. Lives would be at risk without the service, which features both winching capability & a technician or HPC-registered paramedic on board. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315070 Fri, 14 Oct 2011 04:00:00 +0100 5315070 http://www.medworm.com/index.php?rid=5315069&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-i%3Frss%3D1 Conclusion Although this project did not look at the pharmacological degradation of emergency drugs, the variation in temperature found has implications which may impact on the efficacy of pre hospital medications and for the operating efficiency of medical devices. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315069 Fri, 14 Oct 2011 04:00:00 +0100 5315069 http://www.medworm.com/index.php?rid=5315068&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-h%3Frss%3D1 Conclusion We conclude that introduction of the bypass guidelines would lead to an additional 46 patients being taken to a trauma centre in that month. This suggests that specific arrangements may need to be made to deal with the extra workload, and further investment may be required. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315068 Fri, 14 Oct 2011 04:00:00 +0100 5315068 http://www.medworm.com/index.php?rid=5315067&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-g%3Frss%3D1 Conclusion We have reported new data related to patterns of presentation of non-fatal poisoning, allowing improvements in the management of this patient group. However, current 999 clinical and management information systems do not allow routine identification of these cases, limiting ability to monitor impact of changes in care provided. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315067 Fri, 14 Oct 2011 04:00:00 +0100 5315067 http://www.medworm.com/index.php?rid=5315066&cid=s_28223_14_f&fid=28223&url=http%3A%2F%2Femj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F28%2F11%2Fe2-f%3Frss%3D1 Conclusion Despite excellent inter-observer agreement, the Sgarbossa criteria is too insensitive to be implemented in clinical practice as it cannot be relied upon to identify correctly, patients who have suffered AMI. Instead, diagnosis and management should proceed according to clinical judgement with reperfusion therapy administered following evaluation of risk verses benefit. (Source: Emergency Medicine Journal) Emergency Medicine Journal journals http://www.medworm.com/rss/comments.php?id=5315066 Fri, 14 Oct 2011 04:00:00 +0100 5315066