Emergency Medicine Journal最新文献

{"title":"Community emergency medicine: a service review of patients that sustain head injuries in the community-can early intervention by a senior clinical decision maker provide care closer to home?","authors":"Amelia Davies, Mathew Bloch, Laura Owen","doi":"10.1136/emermed-2024-214692","DOIUrl":"10.1136/emermed-2024-214692","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"317-318"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tea trolley training: a novel approach to prehospital teaching.","authors":"Ian Sheldrake, Matthew Kerton","doi":"10.1136/emermed-2025-215826","DOIUrl":"10.1136/emermed-2025-215826","url":null,"abstract":"<p><p>The 'tea trolley training' model is well described and established in hospital medical education, but, to the authors' knowledge, has not previously been used for training in the prehospital environment. We sought to adapt this workplace-based teaching approach to improve intraosseous (IO) knowledge, confidence and morale among ambulance clinicians, without adversely affecting operational performance.A mobile 'tea trolley' containing IO equipment, task trainers and refreshments was taken to two emergency department ambulance bays on separate days. Short teaching sessions were delivered opportunistically to prehospital clinicians by a critical care team. An anonymised QR-code survey captured role, self-reported impact on knowledge, confidence, morale and inter-professional working.62 clinicians responded (including paramedics, emergency care assistants and technicians). Most reported improved IO skills and knowledge (94%, n=58), with the remainder neutral. All respondents felt the format worked well and would attend future sessions. Almost all (98%, 61/62) reported improved morale, and all felt that regular tea trolley training would enhance collaborative working between the ambulance service and local air ambulance. No adverse impact on turnaround times was reported.Adapting tea trolley training to the prehospital setting is feasible, well received and perceived to improve IO competence, morale and collaborative working, without compromising operational resilience.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"312-313"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute hyperkalaemia in emergency care: evidence-based approaches.","authors":"Niclas Geldermann, Julia Dzimiera, Henning Fischer, Michael Christ","doi":"10.1136/emermed-2025-215469","DOIUrl":"10.1136/emermed-2025-215469","url":null,"abstract":"<p><p>Acute hyperkalaemia is a potentially life-threatening electrolyte disturbance frequently encountered in emergency departments. Timely recognition and appropriate treatment are critical to prevent serious complications such as cardiac arrhythmias and death. This narrative review summarises current evidence-based and guideline-based recommendations for the emergency management of hyperkalaemia, with a focus on practical challenges and frequently encountered clinical uncertainties. A selective literature search was conducted using PubMed, EMBASE and major international guidelines, emphasising clinical studies performed in emergency departments or acute care settings.Key treatment principles include therapy with intravenous calcium salts, primarily indicated in patients with ECG changes or serum potassium levels ≥6.5 mmol/L. Insulin-glucose therapy remains a cornerstone of transcellular potassium shifting but carries a considerable risk of subsequent hypoglycaemia, particularly in non-diabetic patients with low baseline glucose levels. Inhaled beta-agonists such as salbutamol provide an effective and synergistic potassium-lowering effect and are recommended in combination with insulin. The use of sodium bicarbonate remains uncertain and its indication appears limited to patients with severe comorbid conditions and metabolic acidosis. Diuretics may support potassium elimination in patients with volume overload, although prospective evidence in ED populations is lacking. Sodium polystyrene sulfonate is no longer recommended due to questionable efficacy and risk of gastrointestinal adverse events. Newer potassium binders, including sodium zirconium cyclosilicate and patiromer, show promise in recent studies but require further validation in acute care settings. Haemodialysis remains the definitive option in refractory cases or patients with end-stage renal disease.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"305-311"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to physician-based Helicopter Emergency Medical Services in the UK: a service analysis in 2024.","authors":"Sophie Macdonald, Gareth Grier, Danë Goodsman, Sarah Morton","doi":"10.1136/emermed-2024-214386","DOIUrl":"10.1136/emermed-2024-214386","url":null,"abstract":"<p><strong>Background: </strong>Physician-based prehospital teams provide advanced critical care services in the UK (eg, prehospital anaesthesia). The last review of such teams in 2009, which included England, Wales and Northern Ireland, reported only one physician-based prehospital team available 24/7. Helicopter Emergency Medical Services (HEMS) across the UK offer paid physician-based teams, while other organisations may provide physician-based teams on a voluntary ad hoc basis. The primary aim of this study was to determine if access to a physician-based HEMS team has changed in the past 12 years.</p><p><strong>Methods: </strong>An online survey was distributed to all UK HEMS organisations in January 2024. The primary outcome measure was the number of physician-based teams operated by HEMS in 2024 and the operational hours of such teams. Secondary outcomes included interventions offered by HEMS teams and any additional medical teams offered (eg, paramedic only).</p><p><strong>Results: </strong>All 21 HEMS responded. The number of potentially available physician-based HEMS teams has increased from 11 in England, Wales and Northern Ireland in 2009 to 28 in 2024, with two services in Scotland (total=30). HEMS providing consistent 24/7 physician-based prehospital teams increased from one (5.9%) in 2009 to 11 (52.4%) in 2024. The East of England has the highest 24/7 availability, with Northern Ireland, South West England and Northern England the least. Within physician-based teams, variation remains in advanced interventions available-for example, 19 services (90.4%) offer blood transfusion while only one (4.7%) offers resuscitative balloon occlusion of the aorta. Only one service is completely government funded; the others are funded by charity alone or a combination of charity and government sources.</p><p><strong>Conclusion: </strong>Both geographical and temporal variations in access to a physician-based HEMS remain across the UK, although there has been improvement since 2009. However, within this provision, variation exists in terms of interventions provided such as the provision of blood products.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"272-278"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior shoulder bony mass.","authors":"Tun Hing Lui, Charles Churk Hang Li, Chun Lok Chow","doi":"10.1136/emermed-2025-215162","DOIUrl":"https://doi.org/10.1136/emermed-2025-215162","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 5","pages":"290-316"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early prophylactic antibiotics following endotracheal intubation for traumatic brain injury may reduce respiratory complications.","authors":"Luke Dearden, Melissa Drake, Daniel Horner","doi":"10.1136/emermed-2025-215149","DOIUrl":"10.1136/emermed-2025-215149","url":null,"abstract":"<p><p>A rapid literature review was carried out to examine the evidence supporting early prophylactic antibiotics use following endotracheal intubation in patients traumatic brain injury (TBI), to reduce the risk of subsequent ventilator-associated pneumonia. Four papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. Current evidence suggests that early administration of prophylactic antibiotics to patients with severe TBI requiring endotracheal intubation reduces the risk of subsequent pneumonia.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"314-316"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of burnout and workplace stressors among emergency department healthcare workers in Uganda.","authors":"Jonathan Kajjimu, Diane Rakotomalala, Matthew Allan Heimann, Sarah Oworinawe, Matilda Nanyanzi, Faith Komagum, Conrad Makai, Joseph Kwagala, Mary Ellen Lyon, Daniel Ridelman, Andrew Tagg, Prisca Mary Kizito, Shweta Gidwani","doi":"10.1136/emermed-2025-215225","DOIUrl":"10.1136/emermed-2025-215225","url":null,"abstract":"<p><strong>Background: </strong>Burnout is a widely recognised occupational phenomenon, with emergency department (ED) healthcare workers globally facing a heightened risk. Despite this, data on the burden of burnout among ED healthcare workers, especially in low-resource settings, are limited. Our study sought to establish the prevalence and factors associated with burnout and workplace stressors among ED healthcare workers in Uganda.</p><p><strong>Methods: </strong>An online-based survey was conducted among ED professionals across four private and public hospitals. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey tool. Data were analysed using univariable and multivariable logistic regression analyses.</p><p><strong>Results: </strong>Data from 82 participants were analysed (response rate of 88%), with approximately equal numbers of males and females, just over half providing care to both adult and paediatric patients and 61% working in public facilities. Overall, 9.7% of participants met the criteria for burnout. In total, 48.7% (n=40) reported high emotional exhaustion, 21.9% (n=18) reported high depersonalisation and 35.4% (n=29) reported low personal accomplishment. At least 80% of participants identified key ED stressors including work-related fatigue, patients' financial problems, work overload, equipment shortages and challenges in balancing professional and personal responsibilities. After adjusting for covariates such as overload of health professional literature needed to be read, patients' financial problems, educational issues, lack of sufficient clinical skills and ED violence, burnout was positively associated with poor communication with colleagues in the ED (adjusted OR (AOR) 9.90; 95% CI 1.60 to 61.17; p=0.014) and with caring for the old and terminally ill patients (AOR 7.54; 95% CI 1.38 to 41.29; p=0.020). These associations were consistent with the high depersonalisation domain of burnout.</p><p><strong>Conclusion: </strong>Burnout, particularly in the emotional exhaustion domain, is notably prevalent among ED healthcare workers in Uganda. There is a pressing need for context-specific interventions aimed at improving early recognition of burnout and addressing persistent ED stressors. Such measures are essential to enhance ED healthcare workers' well-being, and ultimately improve in-hospital emergency care in Uganda.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"291-297"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: a scoping review.","authors":"Ricky Odedra, Phoebe Averill, Ruud Gerard Nijman, Veronika Wiemker, Bhairavi Hariharan, Erik Mayer","doi":"10.1136/emermed-2025-215617","DOIUrl":"https://doi.org/10.1136/emermed-2025-215617","url":null,"abstract":"<p><strong>Background: </strong>Communication in a family's primary language can support safe care. Vital steps within the care delivery process are contingent on successful communication, including reporting symptoms, clinical decision-making, informed consent, discharge communication and follow-up coordination. The importance of effective information exchange is particularly pronounced in paediatric emergency care, and complex interactions may arise as parents or carers advocate on behalf of children. This scoping review aimed to identify and map existing research indicating where along the care journey communication-related risks for safety lie during paediatric emergency care and what strategies exist to mitigate them.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science and Cochrane Library for studies which examined the influence of language barriers on patient safety in paediatric emergency care as well as studies that evaluated interventions. Bibliographic database searches were executed on 18 December 2024; retrieved records were independently screened by two authors at title and abstract level followed by full text level. Data on study objectives, population characteristics, study design and their key findings were extracted.</p><p><strong>Results: </strong>1578 articles were identified, of which 33 were included and mapped according to (i) studies reporting safety risks linked to language barriers in paediatric emergency care (n=24) and (ii) existing interventions designed to mitigate these risks (n=9). Studies highlighted that language barriers can influence safety at multiple stages of the emergency care pathway, with discharge most frequently reported as a point of risk for paediatric patient safety. Interventions focused primarily on usage, uptake and documentation of professional interpreter services.</p><p><strong>Conclusion: </strong>Addressing misunderstandings around follow-up and home-care advice during medical safety netting are priority areas for intervention. Future research should involve carer and clinical perspectives in exploring whether technology-enabled tools, including artificial intelligence, can safely mitigate language barriers in these situations.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular resuscitation: an expert practice review.","authors":"Thomas David Adams, Jon Barratt, James E Manning, Paul Rees, Ben Singer, Ed Benjamin Graham Barnard","doi":"10.1136/emermed-2025-215376","DOIUrl":"https://doi.org/10.1136/emermed-2025-215376","url":null,"abstract":"<p><p>Endovascular resuscitation (EVR) describes a collection of novel therapies that aim to bridge patients in shock states or cardiac arrest to definitive treatment, through a combination of haemorrhage control and mechanical circulatory support. The last half-decade has seen landmark trials report on several techniques and adoption is growing despite controversies around risk, efficacy and implementation. As leaders in resuscitation, it is essential that emergency physicians understand the principles and practice of endovascular techniques to advocate for the critically unwell patients that may benefit from EVR and be engaged in future implementation.This practice review aims to provide emergency physicians with an overview of EVR, based around case scenarios of out-of-hospital cardiac arrest and non-compressible haemorrhage. We review the rationale for EVR in these conditions and describe the critical initial step of vascular access. We then describe the physiology, technique, efficacy and safety of three escalating interventions: resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion and extracorporeal cardiopulmonary resuscitation.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systemic concern with arterial blood gas analysers in patients with increased temperatures that has the potential to adversely impact on patient care: an observational study.","authors":"Colin J Crooks, Joe West, Joanne R Morling, Mark Simmonds, Irene Juurlink, Steve Briggs, Simon Cruickshank, Susan Hammond-Pears, Tasso Gazis, Dominick Shaw, Timothy R Card, Andrew W Fogarty","doi":"10.1136/emermed-2025-215822","DOIUrl":"https://doi.org/10.1136/emermed-2025-215822","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}