Emergency Medicine Journal最新文献

{"title":"Tranexamic acid for neck of femur fractures in the emergency department.","authors":"Callum Williams, Zahra Butt","doi":"10.1136/emermed-2024-214709","DOIUrl":"10.1136/emermed-2024-214709","url":null,"abstract":"<p><p>A short systematic review of the literature was undertaken to assess whether tranexamic acid (TXA) administration in the ED for neck of femur fractures was associated with improved outcomes for patients undergoing surgery. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. Four relevant papers were identified by our search strategy. The author, date, country, study population, study type, outcomes, key results and study weaknesses were tabulated. Our results suggest early TXA administration in the ED for extracapsular neck of femur fractures appears to be safe and may reduce the need for perioperative blood transfusions.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"281-283"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002261","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":"Journal update monthly top five.","authors":"Sarah Wilson, Mohomed Ashraf, Karen Chivers, Mohamed Fouz Mohamed Saleeth, Rose Kunnath, Nicolas Vecchione, Gabrielle Prager","doi":"10.1136/emermed-2025-214993","DOIUrl":"https://doi.org/10.1136/emermed-2025-214993","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 4","pages":"277-278"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709453","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":"They called it.","authors":"Jenn Reed","doi":"10.1136/emermed-2024-214749","DOIUrl":"10.1136/emermed-2024-214749","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"275-276"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064535","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":"Outcomes from out-of-hospital cardiac arrest in nursing and care homes: a cohort study.","authors":"Ed Battin, Terry Brown, Keith Couper","doi":"10.1136/emermed-2024-214362","DOIUrl":"10.1136/emermed-2024-214362","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) primarily affects older adults. Individuals in nursing homes are often elderly with significant comorbidities. Nursing homes are staffed by healthcare workers, able to respond immediately to cardiac arrest, including provision of bystander cardiopulmonary resuscitation (CPR). We aimed to describe the characteristics, treatments and outcome of individuals sustaining an OHCA in nursing and care home settings in England.</p><p><strong>Methods: </strong>Patients ≥18 years between 2015 and 2021 with a recorded location of either a nursing or care home from the 'Out-of-hospital Cardiac Arrest Outcomes' registry for England were included. We present descriptive statistics and compare groups, where appropriate, using a χ² test.</p><p><strong>Results: </strong>We included 4779 patients, of which 2474 (52.5%) were female and 3910 (81.8%) were aged ≥70. Cardiac arrest was witnessed by a bystander in 51.1% (n=2390) of cases. Overall, 80.2% (n=3698) of patients received bystander CPR and where an automated external defibrillator (AED) was available, 77.7% (n=331) were treated with an AED. Return of spontaneous circulation (ROSC) at any time was reported in 1614 (36.7%) and ROSC sustained to hospital handover in 1061 (22.3%) patients. Survival to hospital discharge or 30 days was observed in 97 (2.1%) patients. As age increased, there was a decrease in survival and ROSC sustained to hospital handover.</p><p><strong>Conclusion: </strong>Survival after OHCA in a nursing home setting was low, despite high rates of key interventions, such as bystander CPR. There may be an opportunity to optimise the availability of AEDs within nursing homes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"243-248"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122455","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":"Gnawing shoulder pain.","authors":"Manuel Cina, Rahel S König, Julia Marti","doi":"10.1136/emermed-2024-214518","DOIUrl":"https://doi.org/10.1136/emermed-2024-214518","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 4","pages":"240-274"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709452","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":"Well-being interventions alone won't heal.","authors":"Zaid Al-Najjar","doi":"10.1136/emermed-2024-214755","DOIUrl":"10.1136/emermed-2024-214755","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"287-288"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373842","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":"Diagnostic accuracy of prehospital ultrasound in detecting lung injury in patients with trauma: a systematic review and meta-analysis.","authors":"James Paul Benjamin Sen, Jonathan Emerson, John Franklin","doi":"10.1136/emermed-2023-213647","DOIUrl":"10.1136/emermed-2023-213647","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound is now readily available in the prehospital setting and its use has been highlighted as one of the top research priorities in prehospital care. Clinical examination remains the standard care for diagnosing lung injury in the prehospital setting, yet this can be challenging and has poor diagnostic accuracy. This review evaluates the accuracy of prehospital ultrasound for the diagnoses of pneumothorax, haemothorax and pulmonary contusions in patients with trauma.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted. MEDLINE/PubMed, CINAHL, Embase and the Cochrane Library were searched. Only papers reporting on the diagnostic accuracy of lung ultrasound for traumatic pneumothorax, haemothorax or pulmonary contusions; in a prehospital or helicopter emergency medical service setting; and with CT or operative findings as a reference standard, were included. Non-English studies or articles that reported on animal studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of the included studies.</p><p><strong>Results: </strong>Six observational studies, four with low risk of bias and two with some concerns, reporting on 1908 thoracic ultrasound examinations in patients with trauma, were included. For pneumothorax, meta-analysis yielded pooled sensitivity of 29% (95% CI 22% to 37%, I²=0%) and pooled specificity of 98% (95% CI 97% to 99%, I²=0%). Insufficient data were reported for a reliable meta-analysis on the presence of haemothorax. Only one study reported on the presence of pulmonary contusions and therefore no analysis was conducted.</p><p><strong>Conclusion: </strong>Prehospital ultrasound is highly specific but has a lower sensitivity for the presence of pneumothorax when compared with hospital studies. Further research is required, alongside education and training of prehospital providers, to further explore the factors that account for the differences observed in this review.</p><p><strong>Prospero registration number: </strong>CRD42023365034.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"256-263"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921022","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 cardiac arrest dispatch of physician-paramedic critical care prehospital teams: a survey-based evaluation.","authors":"Sarah Morton, Chris Eagle, Scott Wallman, Gaynor Wareham, Rob Major, Christopher Edmunds, Sarah McLachlan","doi":"10.1136/emermed-2024-214178","DOIUrl":"10.1136/emermed-2024-214178","url":null,"abstract":"<p><strong>Background: </strong>Appropriate dispatch of critical care teams to out-of-hospital cardiac arrest (OHCA) has been identified as a research priority emergency care in the UK. The study aimed to understand the criteria informing the decision to dispatch a critical care physician-paramedic prehospital team to OHCA in one UK region.</p><p><strong>Methods: </strong>An invitation to participate in an anonymised online survey was sent by email to clinicians and non-clinicians working on the critical care (physician-paramedic) dispatch desk for the East of England Ambulance Service NHS Trust between June and July 2023. Demographic data relating to the experience of the dispatchers were collected alongside evaluating the effect of 15 predetermined criteria on OHCA dispatch (based on a pilot survey) on their decision to dispatch a physician-paramedic team. Responses to closed-end questions were calculated as percentages. A compulsory free text question on dispatching the physician-paramedic team was included. Free text data were interpreted by one author and the interpretation reviewed by all authors.</p><p><strong>Results: </strong>20 respondents (19 critical care paramedics and one non-clinical dispatcher) participated, yielding a 79% response rate for clinical and 17% for non-clinical dispatchers. 'Witnessed cardiac arrest' and return of spontaneous circulation achieved on scene were criteria used by 100% of respondents in informing dispatch of a physician-paramedic team to OHCA. 10 of the 15 preidentified criteria were considered important in their decision-making by at least 75% of respondents. 'Age' was considered as more than just a number, instead incorporating both the nuances of a paediatric cardiac arrest and the importance of physiological reserve and frailty.</p><p><strong>Conclusion: </strong>The only 100% agreement in dispatch criteria was 'witnessed arrest'. Otherwise, variation existed and additional information, like identification of frailty, was gathered to support nuanced decision-making. Wider research across the UK would help identify factors and commonalities in OHCA physician-paramedic dispatch to target improved survival rates.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"249-255"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364085","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":"Association of advanced age and aetiology of cardiac arrest with outcomes in patients with out-of-hospital cardiac arrest receiving extracorporeal cardiopulmonary resuscitation: a secondary analysis of multicentre registry study in Japan.","authors":"Yuzuru Mochida, Tomoya Okazaki, Mitsuaki Kojima, Tomohisa Shoko, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda","doi":"10.1136/emermed-2023-213510","DOIUrl":"https://doi.org/10.1136/emermed-2023-213510","url":null,"abstract":"<p><strong>Background: </strong>Data on extracorporeal cardiopulmonary resuscitation (ECPR) in older patients, particularly those aged ≥75 years, remain limited and inconsistent. In this study, we investigated the association between advanced age and outcomes in patients receiving ECPR and determined differences in outcomes by aetiology of out-of-hospital cardiac arrest (OHCA) to identify older patients who may benefit from ECPR.</p><p><strong>Methods: </strong>This secondary analysis of a retrospective multicentre cohort study in Japan included adult patients with OHCA who received ECPR between 2013 and 2018. The study outcomes were unfavourable neurological outcomes at discharge, in-hospital mortality and ECPR-related complications. The study cohort was categorised by age groups, and the association between age group and outcomes was investigated. We also compared patient characteristics between favourable and unfavourable outcome groups and performed subgroup analysis to gain insights regarding the group of older patients who could benefit from ECPR.</p><p><strong>Results: </strong>Of the 1904 included patients, 1106 were aged <65 years, 547 were 65-74 years, and 251 were ≥75 years. Patients aged 65-74 years and those aged <65 years had comparable rates of unfavourable neurological outcomes and in-hospital mortality. However, patients aged ≥75 years had significantly higher rates of unfavourable neurological outcomes and in-hospital mortality than those aged <65 years. Subgroup analysis of crude mortality rates revealed relatively high survival rates for patients with pulmonary embolism (54.5%) or hypothermia (25%) compared to those with other causes of arrest in the ≥75 years group.</p><p><strong>Conclusions: </strong>Patients with OHCA aged ≥75 years and receiving ECPR are at higher risk of unfavourable neurological outcomes and in-hospital mortality than those aged <65 years. However, neurological outcomes and in-hospital mortality in patients aged ≥75 years vary with the causes of OHCA. ECPR outcomes in super-geriatric patients with OHCA may be comparable to those in younger patients for specific aetiologies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673578","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":"In emergency settings, does the use of testicular pulse oximetry aid diagnosis of testicular torsions?","authors":"Lauren Grace Edwards, Joshua William Feldman, Craig Ferguson","doi":"10.1136/emermed-2025-214936","DOIUrl":"https://doi.org/10.1136/emermed-2025-214936","url":null,"abstract":"<p><p>Pulse oximetry is a non-invasive and inexpensive method of detecting oxygenation, which could help to reduce unnecessary scrotal exploration and expedite diagnosis if shown to be accurate in patients with suspected testicular torsion. A short systematic review was conducted to address the following three-part question: in emergency settings, can the use of testicular pulse oximetry aid the diagnosis of testicular torsion?The Medline, Embase and Cochrane databases were searched using the Ovid interface on 29 January 2025. The search included papers from 1946 on Medline, from 1974 on Embase and from 1998 on Cochrane. The search strategy yielded one study that directly answered the three-part question. Study information, participant group, relevant outcomes and study weaknesses were extracted.The only study identified was a case series including 16 participants. Results showed that oxygen saturation and pulse rate were undetectable in all torted testes but detectable in all unaffected testes. However, due to the small sample size, the results of this study cannot be reliably extrapolated to a wider population. This review excluded research articles where near-infrared spectroscopy was used rather than pulse oximetry to characterise testicular blood flow, though that technology may also show future promise.The clinical bottom line is that there is currently insufficient evidence for the use of pulse oximetry in this context. However, the evidence identified suggests that the technique shows promise, particularly for use in resource-poor environments.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623986","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}