Emergency Medicine Journal最新文献

{"title":"Risk of complications using a sedation protocol for aeromedical retrieval of acutely unwell mental health patients: a retrospective cohort study in Outback Australia.","authors":"Jack Lewis, Angus Perks, Peter Brendt, Emma Webster, Georgina M Luscombe","doi":"10.1136/emermed-2024-214719","DOIUrl":"https://doi.org/10.1136/emermed-2024-214719","url":null,"abstract":"<p><strong>Background: </strong>Aeromedical transfer of acutely unwell mental health (AMH) patients presents potential risks to patient, staff and aircraft. Pharmacological options to reduce risk can impair consciousness, risking airway compromise and management challenges in-flight. Pre-emptive intubation carries associated patient risks and requires a receiving intensive care unit bed. This study aimed to assess the risk of complications using a protocolised approach to sedation of AMH patients undergoing retrieval in New South Wales, Australia.</p><p><strong>Methods: </strong>This retrospective cohort study included all aeromedical transfers of AMH patients performed by the Royal Flying Doctor Service South Eastern Section (RFDSSE) between 1 January 2011 and 31 December 2022. AMH patients whose treatment during transfer aligned with the RFDSSE Mental Health (MH) transfer protocol ('On Protocol', OnP) were compared against the 'Off Protocol' (OffP) group. Patient characteristics (MH risk assessment score), transfer characteristics (duration), medications administered and complications (any, severe) experienced were compared using univariate analyses.</p><p><strong>Results: </strong>Treatment aligned with MH transfer protocol (ie, OnP) in 45.9% (n=39) of 85 cases. Complications were more common in the OffP group (54.3% vs 25.6%, a difference of 28.7% (95% CI 7.8% to 46.2%)). Similarly severe complications occurred more frequently in the OffP group (37.0% vs 5.1%, a difference of 31.8% (95% CI 14.7% to 46.7%)). Intubated patients (n=9, all OffP) had the highest rate of severe complications at 66.7%, followed by patients who received midazolam (n=33, all OffP), with a severe complication rate of 30.3%.</p><p><strong>Conclusion: </strong>A protocolised approach to sedation of AMH patients undergoing aeromedical retrieval, including the use of ketamine sedation, was associated with fewer complications overall, fewer severe complications and no episodes of treatment failure or need for intubation. Our findings suggest that the use of midazolam and/or intubation in this cohort is associated with a higher risk of complications, and ketamine presents a safer alternative.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648850","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":"Recognising high-pressure injection injuries to the hand: a practice review with guidance for emergency physicians.","authors":"Ronald M Cornely, Erin N Abbott, Barite Gutama, Benjamin Savitz, Ricardo Torres-Guzman, James L Rogers, Al C Valmadrid, William C Lineaweaver","doi":"10.1136/emermed-2024-214689","DOIUrl":"https://doi.org/10.1136/emermed-2024-214689","url":null,"abstract":"<p><p>High-pressure pneumatic guns, commonly used in industrial settings for tasks such as painting and cleaning, pose a significant risk of hand injuries since they can generate pressures up to 12 000 pounds per square inch. Despite their rarity, these injuries can have severe consequences, including permanent functional impairment and an elevated risk of amputation. Often underestimated in the community setting, high-pressure injection injuries (HPII) frequently evade early recognition, leading to detrimental outcomes. Using two illustrative cases, this practice review outlines the challenges in recognising and managing these injuries, highlighting the need for increased awareness among emergency healthcare practitioners. Early recognition is challenging and crucial, as it facilitates timely referral to hand specialists for comprehensive management, improving patient outcomes. Standardising diagnostic guidelines is also considered a potentially impactful topic of future work. By addressing these priorities, we can enhance patient care and mitigate the burden of these injuries on individuals and communities.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526860","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":"Management of haemophilia and heritable bleeding disorders in the ED.","authors":"Elizabeth Helen Horn, Kate Forsyth, Richard Gooding, Richard Gorman, Deepan Gosrani, David Hopper, Jason Mainwaring, Charles Llewellyn Percy, Will Thomas, Simon Smith","doi":"10.1136/emermed-2024-214669","DOIUrl":"https://doi.org/10.1136/emermed-2024-214669","url":null,"abstract":"<p><p>This practice review addresses the management of haemophilia and heritable bleeding disorders in the ED. These disorders are uncommonly encountered by the emergency physician, but prompt and appropriate management is critical to ensure good outcomes. This practice review describes the principles of emergency care for people with bleeding disorders, with an emphasis on a pragmatic clinical approach, and provides examples of challenging emergencies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511697","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":"Investigating the impact of self-rostering on EM trainee wellbeing and recovery: a national survey.","authors":"Alexander Robertson","doi":"10.1136/emermed-2024-214642","DOIUrl":"10.1136/emermed-2024-214642","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"433-434"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779528","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":"Identifying and profiling prearrival characteristics of avoidable emergency department visits transported by paramedics: a cohort study using linked prehospital and hospital data.","authors":"Ryan Peter Strum, Andrew Costa, Brent McLeod, Shawn E Mondoux","doi":"10.1136/emermed-2024-214792","DOIUrl":"10.1136/emermed-2024-214792","url":null,"abstract":"<p><strong>Background: </strong>Increasing demand and crowding in emergency departments (EDs) remain persistent challenges for healthcare systems worldwide. A portion of these visits is avoidable, indicating they could have been effectively managed in non-ED care settings. There has been increased attention on paramedics redirecting avoidable visits to community-based care before ED transport. However, limited evidence exists to identify which patients might be suitable for non-ED care models, particularly based on prehospital clinical presentations. This study aimed to examine the patient characteristics associated with avoidable and potentially avoidable ED visits prior to ED transport.</p><p><strong>Methods: </strong>We conducted a cohort study using linked data from Hamilton Paramedic Services and a Canadian academic hospital between January 2022 and January 2024. ED visit records were classified using the Emergency Department Avoidability Classification into three classes: avoidable, potentially avoidable and not avoidable, and matched with their paramedic care reports. We used Firth's binary logistic regression to identify primary concerns associated with avoidable or potentially avoidable ED visits, reported as ORs with 95% CIs controlling for multiple comparisons using a false discovery rate of 0.10.</p><p><strong>Results: </strong>Among the 23 891 ED visits analysed, 4.9% were classified as avoidable, 16.8% as potentially avoidable and 21.7% as either avoidable or potentially avoidable. Patients were primarily young-to-middle aged, presenting with a low medical acuity, taking fewer prescribed medications regularly and having stable vital signs within normal ranges. Primary concerns associated with these ED transports included social problems (OR 16.7, 4.5-95.5), anxiety (OR 15.0, 4.0-75.1), cough or congestion (OR 12.5, 3.2-65.4), lacerations (OR 11.0, 3.3-62.0) and minor problems (OR 7.8, 2.2-39.3).</p><p><strong>Conclusion: </strong>Our findings highlight key patient characteristics and primary concerns that could inform paramedics to identify patients suitable for non-ED care models. Incorporating evidence-based criteria into paramedic decision-making could support the safe and effective implementation of alternative care models, which could potentially reduce ED visitation and promote optimal healthcare resource distribution.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"442-450"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978806","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":"Trends in paramedic-to-general practitioner referrals following the COVID-19 pandemic and the introduction of a virtual emergency department: an interrupted time series analysis.","authors":"Belinda Jane Delardes, Ziad Nehme, Kelly-Ann Bowles, Samantha Chakraborty, Emily Mahony, Karen Smith, Jason Talevski, Loren Sher, Emily Nehme","doi":"10.1136/emermed-2024-214561","DOIUrl":"10.1136/emermed-2024-214561","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the impact of the COVID-19 pandemic and subsequent introduction of the Victorian Virtual Emergency Department (VVED) consultation service for paramedics on paramedic-to-general practitioner (GP) referral patterns, case time burden and ambulance reattendance rates.</p><p><strong>Methods: </strong>We conducted interrupted time series regression assessing paramedic-to-GP referrals with the following two interruptions: (1) the COVID-19 pandemic in March 2020 and (2) VVED integration in July 2022. We included ambulance patients between 2018 and 2023 across Victoria, Australia.</p><p><strong>Results: </strong>A total 3 205 562 patients across 65 months were included; 38.7% presented in the 26 months prior to the beginning of the COVID-19 pandemic (n=1 239 975), 43.8% between March 2020 and June 2022 (n=1 403 139) and 17.6% in the 11 months after VVED implementation (n=562 448). There was no step change in paramedic-to-GP referrals associated with the COVID-19 pandemic, although a 3% relative monthly trend increase in referrals to GP occurred (incident rate ratio (IRR) 1.03, 95% CI 1.02 to 1.04). Subsequent VVED integration was associated with a -16% relative step change in referrals to GPs (IRR 0.84, 95% CI 0.74 to 0.96); however, no trend change was observed. Median case time burden increased throughout the study by 0.52 min per month (median difference 0.52 min, 95% CI 0.51 to 0.52). At the study period conclusion, EMS attendances resulting in GP referrals had a 40 min median case cycle duration, compared with 120 min for ED conveyances. Ambulance 7-day reattendance rates were similar between those referred to VVED (8.8%) vs GPs (8.7%).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was associated with increased paramedic-to-GP referrals in lieu of ambulance conveyances. The VVED was associated with an initial decrease in paramedic-to-GP referrals; however, the trend of increasing GP referrals continued. paramedic-to-GP referrals consumed a third of the time burden associated with ambulance conveyance to ED.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"460-466"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763352","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":"Haemoperitoneum in a young woman.","authors":"Miona Jevtovic, Miljana Bubanja, Dragan Vasin","doi":"10.1136/emermed-2024-214338","DOIUrl":"10.1136/emermed-2024-214338","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 7","pages":"419-428"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332647","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":"Impact of the COVID-19 pandemic on public trust of emergency medical service providers.","authors":"Sarah R MacEwan, Christine B Cooke, Christopher B Gage, Jonathan R Powell, Leanna Perez Eiterman, Laura J Rush, Ashish R Panchal, Ann Scheck McAlearney","doi":"10.1136/emermed-2023-213871","DOIUrl":"10.1136/emermed-2023-213871","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"431-432"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959320","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":"Intriguing pacing spike.","authors":"Luis Cerdán, Carlos Ruben Lopez-Perales","doi":"10.1136/emermed-2024-214759","DOIUrl":"10.1136/emermed-2024-214759","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 7","pages":"430-484"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332648","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":"Commentary on: Multicentre cross-sectional study to assess nursing workload in Belgian emergency departments.","authors":"Jonathan Drennan","doi":"10.1136/emermed-2025-214887","DOIUrl":"10.1136/emermed-2025-214887","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"429-430"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978510","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}