Emergency Medicine Journal最新文献

{"title":"Absorbable sutures appear clinically effective and may be more cost-effective than non-absorbable sutures for definitive closure of adult facial lacerations.","authors":"Mairead Kelly, Daniel Edward Horner","doi":"10.1136/emermed-2026-216075","DOIUrl":"10.1136/emermed-2026-216075","url":null,"abstract":"<p><p>A short cut review of the literature was carried out to examine the evidence supporting the use of absorbable suture for definitive closure of facial lacerations. Two 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. The current evidence suggests that use of absorbable sutures for definitive wound closure in facial lacerations delivers comparable cosmetic outcomes, with no difference in reported complications. Use of absorbable sutures may be more cost effective, through avoidance of further downstream healthcare resource use.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"586-587"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766083","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":"Basis of the first Palestinian trauma registry: a multicentre retrospective chart review from the West Bank.","authors":"Peter Bael, Zakaria Abu Ghattas, Adam Albedd, Sandra Istefan, Malik Itmaiza, Bayan Alqtishat, Nizar Qumsieh, Tawfeeq Al-Shobaki, Hussein Hallak","doi":"10.1136/emermed-2025-215778","DOIUrl":"10.1136/emermed-2025-215778","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"589-592"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987002","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":"Common femoral artery access in emergency medicine.","authors":"Brian Burns, Natalie Kruit, Mark Dennis, Zack Shinar, Paul Rees, Shen Wong, Brian Plunkett, Cliff Reid, Simon Carley, Demetris Yannopoulos","doi":"10.1136/emermed-2025-215295","DOIUrl":"10.1136/emermed-2025-215295","url":null,"abstract":"<p><p>Advanced vascular access skills are an essential component of all critical care specialty curricula. However, common femoral artery (CFA) cannulation and sheath insertion has thus far not been emphasised within emergency medicine training. The advent of life-saving endovascular resuscitation techniques in both medical and traumatic disease, along with the inherent advantages of central arterial pressure monitoring in the severely haemodynamically compromised patient, mandates the prioritisation and deliberate practice of this procedure.CFA access facilitates central invasive arterial pressure monitoring as well as Seldinger-guided sheath insertion through which a number of resuscitation devices may be inserted further into the arterial system and left heart-termed 'endovascular resuscitation'. Arterial line placement is considered core to emergency medicine training by Australasian College for Emergency Medicine (ACEM) and Royal College of Emergency Medicine (RCEM), but this is not specific to the skill of CFA access. Extracorporeal Membrane Oxygenation (ECMO) CPR is likely to become increasingly common in refractory cardiac arrest. ECMO is listed as a scope of practice skill for emergency medicine by ACEM. ECPR is now an American Heart Association (AHA) Class 2 recommendation for cardiac arrest. The ELSO registry reports indicate a steady increase in ECPR globally in the last 5 years. ECMO technology development and increasingly procedural and indication refinements will also likely mean this intervention will become simpler to perform and manage. There is an increasing focus on perfecting this skill prior to embarking on training programmes for endovascular resuscitation or ECPR in both the prehospital and in-hospital emergency medicine environment. We describe the key technical steps in performance of this procedure, discuss acquisition and maintenance of competency, and describe pitfalls. CFA access in emergency medicine has an increasing relevance to practice. It is imperative that this procedural skill is given diligence in training, process, governance and relevance to emergency medicine practice.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"572-576"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400190","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":"Frugal and reverse innovations in emergency medicine: a concepts piece.","authors":"Behram Asfand-E-Yar, Anisa Jabeen Nasir Jafar, Matthew Harris, Ellen J Weber, Yasser Ahmad Bhatti","doi":"10.1136/emermed-2024-214235","DOIUrl":"10.1136/emermed-2024-214235","url":null,"abstract":"<p><p>We suggest that low-cost innovations, termed as frugal, when diffused from low-income and middle-income countries to high-income countries, offer an opportunity to diversify sources of ideas and solutions in emergency medicine. We outline examples from a preliminary search of the literature, consider the barriers faced by such innovations and suggest what needs to be done to improve their chances of being considered for use in emergency medicine.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"584-585"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143124","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":"When normal anatomy fails: imaging clues after blunt trauma.","authors":"Jenifer Buskes, Dahne Beukes","doi":"10.1136/emermed-2025-215654","DOIUrl":"https://doi.org/10.1136/emermed-2025-215654","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 9","pages":"592-596"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789681","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":"Research priorities for paediatric procedural sedation in emergency medicine.","authors":"Daniel S Tsze, Rebecca K Burger, Eileen J Klein, Todd P Chang, Keli D Coleman, Alexander J Rogers, Carmen D Sulton, Corrie E Chumpitazi, Emine M Tunc, Amy L Drendel","doi":"10.1136/emermed-2025-215575","DOIUrl":"10.1136/emermed-2025-215575","url":null,"abstract":"<p><strong>Background: </strong>Procedural sedation is routinely provided for children in the emergency care setting. However, there are still significant gaps in knowledge regarding the optimal provision of sedation for children who are undergoing painful and/or distressing procedures. We aimed to develop a prioritised research agenda that identifies key questions for paediatric procedural sedation in the emergency care setting that will guide future research and optimise care for children.</p><p><strong>Methods: </strong>We used a modified Delphi approach to achieve consensus among a multidisciplinary and geographically diverse expert advisory group. An initial list of 42 research questions was identified, with successive rounds of questionnaires conducted until there was a convergence of opinion or a point of diminishing returns was reached. The list was iteratively refined each round by advisory group members who ranked research questions and were given the opportunity to provide suggestions for potential additional questions and provide feedback regarding questions considered.</p><p><strong>Results: </strong>54 advisory group members participated in the modified Delphi approach. Over the course of two rounds, we identified 10 research questions as the highest priority for future investigation. These questions included topics addressing short- and long-term outcomes related to inadequate assessment and provision of sedation, patient-centered and family-centered outcomes, validity and reliability of clinically important outcome measures, most effective sedative regimens for children undergoing painful procedures, most effective sedative regimens for children undergoing non-painful procedures, most effective sedatives for minimal sedation/anxiolysis, effectiveness of novel sedation approaches, eliminating health disparities, clinician education and competency and the use of simulation to improve sedation outcomes.</p><p><strong>Conclusions: </strong>The 10 research questions identified as highest priority can inform future work by researchers, funders, policymakers and other key decision makers who aim to meaningfully advance the provision of procedural sedation for children cared for in the emergency care setting.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"558-563"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988909","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 delay initiation of bystander CPR in out-of-hospital cardiac arrest? Results from an analysis of 200 recorded ambulance calls.","authors":"Barbara Farquharson, Marie Johnston, Catherine Best, Gareth R Clegg","doi":"10.1136/emermed-2024-214733","DOIUrl":"10.1136/emermed-2024-214733","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary resuscitation (CPR) is often not initiated promptly enough in out-of-hospital cardiac arrest, even when call-handlers provide instructions. Identifying the critical, potentially modifiable, barriers to CPR is essential. Our aim was to identify factors associated with delays (1) positioning patient flat and (2) initiating CPR in recordings of cardiac arrest calls and to explore potentially modifiable behavioural factors.</p><p><strong>Methods: </strong>Retrospective analysis of 200 call recordings to the Scottish Ambulance Service January 2019-December 2020 during which dispatcher-assisted CPR instructions were provided. Potential barriers were coded inductively. Log rank tests were used to explore differences in 'time to position patient flat' and 'time to initiate CPR' depending on the presence/absence of potential barriers identified.</p><p><strong>Results: </strong>A random sample of 200 calls were selected from 11 275 potentially eligible calls. Patients in those calls were mostly male (61%), most aged 40-80s; callers were mostly female spouses. Time to position patient flat: median 40 s (IQR: 15.5-82.0), time to initiate CPR: median 50 s (IQR: 36-92). Between 1 and 11 potential barriers were identified in calls (median=4, IQR:2-6).The most common barriers identified were communication (48%), emotion (45.5%) and physical challenges (38.5%). Various physical challenges, concern patient too heavy, concern that it was too late/futile, concern about physical ability, concern about doing harm and caller being 'upset' were significantly associated with delays to positioning the patient flat. Callers 'not knowing how' to do CPR; expressing concerns about doing harm, expressing anger and various physical challenges including concerns about ability were associated with delays in initiating CPR. Many significant barriers are potentially amenable to behavioural techniques.</p><p><strong>Conclusion: </strong>Barriers to 'positioning the patient flat' and 'initiating CPR' are not the same. Concerns vary, and so identifying and addressing the specific concerns for individual callers at each stage might facilitate earlier CPR. Many of the issues delaying CPR are potentially modifiable with behavioural techniques.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"545-551"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009338","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":"Association between the time to norepinephrine initiation and mortality in patients with sepsis.","authors":"Rathakorn Thongkong, Thotsaporn Morasert, Pongdhep Theerawit","doi":"10.1136/emermed-2025-215623","DOIUrl":"10.1136/emermed-2025-215623","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing for initiating norepinephrine in sepsis remains unclear. This study aimed to assess the link between the timing of norepinephrine initiation (NE time) and the 28-day all-cause mortality in sepsis.</p><p><strong>Methods: </strong>We conducted a prospective multicentre study. We recorded NE time, the 28-day all-cause mortality rate, the time to achieve a mean arterial pressure (MAP) >65 mm Hg, net fluid balance and lactate clearance. These parameters were compared between survivors and non-survivors. Cox regression analysis was used to determine their association with mortality.</p><p><strong>Results: </strong>A total of 138 patients were included in the study. Non-survivors had a longer median NE time (98.5 min (IQR 60.0-131) vs 49.5 min (IQR 25.5-75.0), p<0.001) and a longer duration to reach the target MAP (80 min (IQR 30.0-217.5) vs 60 min (IQR 25.0-117.5), p=0.013) compared with survivors. In the multivariable Cox regression analysis, NE time remained a predictor of 28-day all-cause mortality (adjusted HR=1.335, 95% CI 1.034 to 1.722, p=0.026). NE time exceeding 1 hour (adjusted HR=2.60, 95% CI 1.40 to 4.84, p=0.003) and 2 hours (adjusted HR=2.96, 95% CI 1.49 to 5.87, p=0.002) associated with increasing the risk of 28-day mortality.</p><p><strong>Conclusion: </strong>NE time was associated with the 28-day all-cause mortality in sepsis patients. Commencing NE therapy within the first 60 min following the onset of hypotension was associated with a reduced risk of 28-day all-cause mortality.</p><p><strong>Trial registration number: </strong>TCTR20221103005.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"537-544"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210493","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":"Preoxygenation in prehospital critical care: a survey of HEMS practices in eight European countries.","authors":"Simon Rauch, Urs Pietsch, Giulia Roveri","doi":"10.1136/emermed-2025-215335","DOIUrl":"10.1136/emermed-2025-215335","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"588-589"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988883","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":"Panic at 34 000 feet.","authors":"Tejas S Athni","doi":"10.1136/emermed-2025-215888","DOIUrl":"10.1136/emermed-2025-215888","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"595-596"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303624","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}