Emergency Medicine Journal最新文献

{"title":"Initial treatment of presumed pacemaker or implantable cardioverter defibrillator malfunctions: algorithm and rationale.","authors":"Matthias Mueller, Christoph Weiser, Michael Pfeffer, Thomas Mitteregger","doi":"10.1136/emermed-2026-215963","DOIUrl":"https://doi.org/10.1136/emermed-2026-215963","url":null,"abstract":"<p><p>The increasing prevalence of permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs) has led to a rising number of device malfunctions, which can have painful or even life-threatening consequences. As device technology advances, emergency personnel frequently face uncertainty in the initial management of these complex patients, given limited access to device reprogramming or interrogation outside specialised cardiology settings. This paper presents practical algorithm-based approaches for the immediate treatment of presumed PPM and ICD malfunctions in the prehospital and emergency department setting to support timely effective emergency care until expert consultation is available.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879349","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":"Is intranasal adrenaline effective for the treatment of anaphylaxis?","authors":"Tom Jaconelli, Steven Crane","doi":"10.1136/emermed-2026-216454","DOIUrl":"https://doi.org/10.1136/emermed-2026-216454","url":null,"abstract":"<p><p>A short cut review of the literature was carried out to examine whether there is evidence for the use of intranasal epinephrine in comparison to intramuscular epinephrine to achieve rapid symptom control in patients presenting with anaphylaxis. 113 papers were found of which 8 were directly relevant to the clinical outcome. Seven studies were case series, six of which were published only as conference abstracts and one was an open-label phase III study. 22 studies were also identified, which assessed the pharmacodynamic and pharmacokinetic properties; these were not analysed. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The clinical bottom line is that, to date, there is insufficient evidence to determine whether intranasal epinephrine is as effective as intramuscular epinephrine in anaphylaxis. Intramuscular epinephrine remains the standard of care.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849970","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 management of crush injury and crush syndrome: a Faculty of Pre-Hospital Care consensus statement.","authors":"Felix Wood, Philip Cowburn, Jason Smith, Lauren Weekes, Timothy Godfrey, Sam Wilkins, Elizabeth Freeman, Leo Wood, Jake Gluyas-Harris, Peter Gimson, Oliver Brown, Benjamin Earle-Wright, Hannah Clancy, Rhiannon Wilkinson, Owen Williams","doi":"10.1136/emermed-2025-215431","DOIUrl":"https://doi.org/10.1136/emermed-2025-215431","url":null,"abstract":"<p><p>Guidance is required for UK prehospital care providers managing patients with suspected crush injury to minimise preventable morbidity and mortality. This consensus statement gives relevant and practicable recommendations following a structured evidence review and a consensus process. Differences between this and previous guidance reflect, in part, the context for which these recommendations are intended. The role of aggressive fluid administration and concerns regarding hyperkalaemia are de-emphasised. This consensus statement may also be relevant for providers working in other developed healthcare systems.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839623","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":"Emergency thoracotomy: how to do it in 2026.","authors":"Adam Chesters, Michael Hughes, Erica Ley, Matthew O'Meara, Gareth Davies, Anil Hormis","doi":"10.1136/emermed-2026-216110","DOIUrl":"https://doi.org/10.1136/emermed-2026-216110","url":null,"abstract":"<p><p>The prehospital and emergency department practice of emergency thoracotomy has evolved since Wise <i>et al</i> published their influential 2005 'how-to' guide. Contemporary practice incorporates refined indications, clearer survival windows, improved understanding of traumatic pathophysiology and enhanced operational, human factors and safety considerations. This updated practical guide provides a modern stepwise approach to emergency thoracotomy in pre-hospital and emergency department settings. It integrates current international guideline recommendations with two decades of operational experience, offering detailed procedural steps, troubleshooting strategies and pragmatic considerations for clinicians who may rarely perform the procedure. This guide aims to support safe, timely and effective decision-making in one of the most time-critical interventions in trauma care.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812221","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":"Injury patterns among critically injured civilians presenting to Nasser Medical Complex in Gaza: a site-linked case series.","authors":"Tipu V Khan, Kathleen Gallagher, Michael Falk, Tom Adamkiewicz, Majdi Jamal Abu Shammala, Feroze Sidhwa","doi":"10.1136/emermed-2026-216146","DOIUrl":"https://doi.org/10.1136/emermed-2026-216146","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812186","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":"Image challenge: acute foot pain in a teenager.","authors":"Fabio Domenico Caroprese, Helen Sharkey","doi":"10.1136/emermed-2026-216337","DOIUrl":"https://doi.org/10.1136/emermed-2026-216337","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812189","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":"What factors influence ambulance conveyance decisions when dealing with acutely unwell children? A systematic literature review.","authors":"Simon Thomas Robinson, Will Broughton, Julia Williams","doi":"10.1136/emermed-2026-216046","DOIUrl":"https://doi.org/10.1136/emermed-2026-216046","url":null,"abstract":"<p><strong>Introduction: </strong>Paramedics on an ambulance encounter acutely unwell children and are in a position to reduce demand on emergency departments through appropriate triage and non-conveyance decisions. How these decisions are made and what factors influence them are not completely understood. This review aimed to explore factors influencing decisions regarding child conveyance or non-conveyance.</p><p><strong>Methods: </strong>A systematic review was conducted between November 2021 and October 2025 across five databases: PubMed, Medline, CINAHL (via EBSCOhost), Scopus and the Cochrane Registry of Controlled Trials. Studies published within the last decade were eligible for inclusion. Two authors independently screened titles and abstracts, and disagreements regarding article eligibility were arbitrated by the third author. Data were extracted using Covidence and quality appraised using Critical Appraisal Skills Programme checklists. Findings were synthesised using a narrative synthesis framework.</p><p><strong>Results: </strong>Ten studies were included. Three overarching themes were identified: (1) the health system in which both ambulance service and families reside, including geographical location, resource availability, time of day and family preference as influencing factors; (2) child presentation, such that vital signs including respiratory distress, acuity and disease progression, as well as trauma, influenced decisions and (3) safety and risk, with factors affecting decisions including clinician education and experience, protocol adherence, access to shared support and clinical assessment and documentation.</p><p><strong>Conclusions: </strong>Conveyance decisions are complex, shaped by child clinical presentation, perceived risk and paramedic judgement situated within the health system context (such as medical supervision). Current evidence neither justifies mandatory conveyance nor confirms that non-conveyance is clinically safe, despite both decisions occurring in practice. Future research should prioritise family perspectives, paramedic education and develop evidence-based non-conveyance protocols that support safe decision-making in the prehospital setting.</p><p><strong>Prospero registration number: </strong>CRD420260310935.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812213","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":"Refreshing the paediatric emergency medicine research priorities across the UK and Ireland.","authors":"Charlotte Sloane, Thomas Waterfield, Jordan Evans, Michael Barrett, Mark D Lyttle, Niall Mullen","doi":"10.1136/emermed-2025-215836","DOIUrl":"10.1136/emermed-2025-215836","url":null,"abstract":"<p><strong>Background: </strong>The original research priorities for paediatric emergency medicine (PEM) in the UK and Ireland were published in 2015. This list, generated through a modified Delphi process involving healthcare professionals only, has driven the research agenda for over ten years. With many now successfully addressed and a significantly altered healthcare landscape, there was a pressing need to refresh PEM research priorities with the input of patients and carers.</p><p><strong>Methods: </strong>James Lind Alliance (JLA) methodology was employed. The scope included unscheduled emergency care provided to children and young people irrespective of setting. An independent JLA facilitator chaired monthly steering group meetings with equal input from parents and healthcare professionals. Two online surveys were employed to generate a list of evidence uncertainties and then to prioritise research questions from key stakeholder groups (patients, carers and healthcare professionals). An online workshop subsequently used an adapted nominal group technique to reach a consensus on the top list of research priorities.</p><p><strong>Results: </strong>655 questions were submitted in Survey 1 by 338 respondents (35% patients and carers and 65% healthcare professionals). After merging questions by topic and removing out-of-scope questions, 70 summary questions proceeded to evidence reviews; three were found to have been sufficiently answered. Further merging of summary questions resulted in 46 indicative research questions for Survey 2, which received 542 complete responses (26.6% patients and carers, 73.4% healthcare professionals). The 18 highest-ranking questions were brought to the consensus workshop, in which 12 patients/carers and 15 healthcare professionals reached consensus on the 10 highest priority research questions.</p><p><strong>Conclusion: </strong>This refreshed PEM prioritisation study has identified the top 10 research priorities reflecting the views of patients, carers and a range of health professionals across the UK and Ireland. These priorities will be used to drive the PEM research agenda for the next decade.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"552-557"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative study of reflective practice groups for emergency medicine resident doctors.","authors":"Daniel Darbyshire, Geoff Haynes, Rhiannon Conway, Harriet Kennedy, Jade Baker, Alex Johnston, Richard Parris","doi":"10.1136/emermed-2025-215510","DOIUrl":"10.1136/emermed-2025-215510","url":null,"abstract":"<p><strong>Aim: </strong>Resident doctors in their 3rd year of emergency medicine training in the UK face multiple challenges, leading to very high levels of burnout and exodus from the training programme. The North West School of Emergency Medicine trialled reflective practice (Balint) groups to try and help this. This involves regular small group meetings focusing on case-based reflections on the emotional aspects of practice. We aimed to explore the impact of Balint groups on emergency medicine resident doctors.</p><p><strong>Methods: </strong>Qualitative study involving semistructured interviews with resident doctors in their 3rd year of training (ST3) in the UK. Participants included those who had undertaken Balint group sessions, ST3s who did not participate, and Balint group facilitators. Interviews were recorded, transcribed and analysed using reflexive thematic analysis.</p><p><strong>Findings: </strong>12 participants were included between September 2023 and May 2024. They reported Balint groups to be a hugely positive part of their training. Participants developed a psychological toolkit and a supportive community to help manage the emotional and stress-related aspects of emergency medicine. This led to improved job satisfaction, which participants believed would enhance retention. Participants felt their ability to manage the emotional needs and challenges of their patients had improved. The groups were feasible to run but required planning and communication to facilitate release from clinical work.</p><p><strong>Conclusion: </strong>Balint groups for ST3 emergency medicine resident doctors are feasible. Clinicians report benefits for themselves and perceived benefits for their patients. This supports continuing and developing the programme locally and piloting similar programmes in other professional groups and localities.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"564-571"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431492","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":"Ultrasound-guided pericapsular nerve group block versus intravenous morphine for pain management in older adults with hip fractures: a randomised controlled trial in the emergency department.","authors":"Jiraporn Sri-On, Yupadee Fusakul, Krit Phisaiphun, Pacharee Piyachan, Kitchai Luksameearunothai, Pornsiri Kanokkanjana, Gianluca Cappelleri","doi":"10.1136/emermed-2025-215388","DOIUrl":"10.1136/emermed-2025-215388","url":null,"abstract":"<p><strong>Background: </strong>Hip fracture pain is severe and is commonly managed with intravenous opioids that cause adverse effects in older adults. Although the use of regional anaesthesia is increasing, high-quality evidence remains limited, with insufficient randomised controlled trial (RCT) evaluating the effectiveness of the pericapsular nerve group (PENG) block in the emergency department (ED). This study aimed to compare the analgesic efficacy of ultrasound-guided PENG block with intravenous morphine for acute hip fracture pain in older adults presenting to the ED.</p><p><strong>Methods: </strong>This open label, 1:1 parallel RCT using software-generated randomisation compared PENG block versus intravenous morphine (0.1 mg/kg) in patients aged ≥65 years who presented to the ED with femoral head, intertrochanteric, subtrochanteric and neck fractures with acute moderate-to-severe pain, defined as ≥5 on an 11-point Verbal Numeric Rating Scale (VNRS). <i>The primary outcome was improvement in the VNRS score at 30 min. The secondary outcomes included the need for rescue therapy (intravenous fentanyl 0.5 µg/kg) and the incidence of adverse events.</i> RESULTS: A total of 34 patients were included in the final analysis, with 17 patients in each group. At 30 min, the median reduction in pain score was greater in the PENG block group than in the intravenous morphine group (-6 (IQR-6 to -5) vs -3 (IQR -5 to -2); p=0.001). Generalised estimating equation analysis accounting for repeated measures demonstrated that the PENG block was associated with a significantly more pronounced reduction in pain over time than intravenous morphine (adjusted β = -1.55; 95% CI -2.63 to -0.47; p=0.005). Rescue analgesia was required in 5.9% of patients receiving intravenous morphine, whereas no patients in the PENG block group required rescue therapy.</p><p><strong>Conclusion: </strong>PENG block is a highly effective and safe alternative to intravenous morphine for managing acute hip fracture pain, particularly in older adults.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"530-536"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484472","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}