Emergency medicine journal : EMJ最新文献

{"title":"Sensitivity of modern multislice CT for subarachnoid haemorrhage at incremental timepoints after headache onset: a 10-year analysis.","authors":"Annabel Vincent,&nbsp;Scott Pearson,&nbsp;John W Pickering,&nbsp;James Weaver,&nbsp;Leanne Toney,&nbsp;Laura Hamill,&nbsp;Michael Hurrell,&nbsp;Martin Than","doi":"10.1136/emermed-2020-211068","DOIUrl":"https://doi.org/10.1136/emermed-2020-211068","url":null,"abstract":"<p><strong>Background: </strong>CT performed within 6 hours of headache onset is highly sensitive for the detection of subarachnoid haemorrhage (SAH). Beyond this time frame, if the CT is negative for blood, a lumbar puncture is often performed. Technology improvements in image noise reduction, resolution and motion artefact have enhanced the performance of multislice CT (MSCT) and may have further improved sensitivity. We aimed to describe how the sensitivity to SAH of modern MSCT changes with time from headache onset.</p><p><strong>Methods: </strong>This was a retrospective analysis of electronic data collected as part of routine care among all patients presenting to Christchurch Hospital diagnosed with a SAH between 1 January 2008 and 31 December 2017. Patients were imaged with MSCT. The primary outcome was the proportion of patients with spontaneous aneurysmal SAH (identified via coding and confirmed by clinical and radiological records) that had a positive MSCT. The secondary outcome was the proportion of patients with any type of spontaneous SAH that had a positive MSCT.</p><p><strong>Results: </strong>There were 347 patients with an SAH of whom 260 were aneurysmal SAH. MSCT identified 253 (97.3%) of all aneurysmal SAH and 332 (95.7%) of all SAH. The sensitivity of MSCT was 99.6% (95% CI 97.6 to 100) for aneurysmal SAH and 99.0% (95% CI 97.1 to 99.8) for all SAH at 48 hours after headache onset. At 24 hours after headache onset, the sensitivity for aneurysmal SAH was 100% (95% CI 98.3 to 100).</p><p><strong>Conclusion: </strong>These data suggest that it may be possible to extend the timeframe from headache onset within which modern MSCT can be used to rule out aneurysmal SAH.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"810-817"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39655162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questions persist on the emergency department management of hypothermic young infants.","authors":"Sriram Ramgopal,&nbsp;Paul L Aronson,&nbsp;Mark I Neuman,&nbsp;Christopher M Pruitt","doi":"10.1136/emermed-2021-211753","DOIUrl":"https://doi.org/10.1136/emermed-2021-211753","url":null,"abstract":"To cite: Ramgopal S, Aronson PL, Neuman MI, et al. Emerg Med J Epub ahead of print: [please include Day Month Year]. doi:10.1136/ emermed-2021-211753 Handling editor Gene YongKwang Ong Pediatrics, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA Emergency Medicine, Children’s Hospital Boston, Boston, Massachusetts, USA Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"878-879"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39762399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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":"Robert Hirst,&nbsp;Hannah Courtney,&nbsp;Irene Grossi,&nbsp;Catherine Hill,&nbsp;Alexander T Maidwell-Smith,&nbsp;Edward Stuart","doi":"10.1136/emermed-2022-212865","DOIUrl":"https://doi.org/10.1136/emermed-2022-212865","url":null,"abstract":"This month’s update is from the Research in Emergency Care, Avon Collaborative Hub (REACH) team based in Bristol, UK. We used a multimodal search strategy, drawing on free openaccess medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as follows: ► Worth a peek—interesting, but not yet ready for prime time. ► Head turner—new concepts. ► Game changer—this paper could/ should change practice.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"871-872"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40564377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care testing with high-sensitivity cardiac troponin assays: the challenges and opportunities.","authors":"Louise Cullen,&nbsp;Paul O Collinson,&nbsp;Evangelos Giannitsis","doi":"10.1136/emermed-2021-211907","DOIUrl":"https://doi.org/10.1136/emermed-2021-211907","url":null,"abstract":"<p><p>Methods to improve the safety, accuracy and efficiency of assessment of patients with suspected acute coronary symptoms have occupied decades of study and have supported significant changes in clinical practice. Much of the progress is reliant on results of laboratory-based high-sensitivity cardiac troponin assays that can detect low concentrations with high precision. Until recently, point-of-care (POC) platforms were unable to perform with similar analytical precision as laboratory-based assays, and recommendations for their use in accelerated assessment strategies for patients with suspected acute coronary syndrome has been limited. As POC assays can provide troponin results within 20 min, and can be used proximate to patient care, improvements in the efficiency of assessment of patients with suspected acute coronary syndrome is possible, particularly with new high-sensitivity assays.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"861-866"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/0b/emermed-2021-211907.PMC9613856.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39688091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why so hypoxic?","authors":"Carl Byrne,&nbsp;Michael Slattery,&nbsp;Susan Uí Bhroin","doi":"10.1136/emermed-2022-212741","DOIUrl":"https://doi.org/10.1136/emermed-2022-212741","url":null,"abstract":"RefeRences 1 Mahler SA, Register TC, Riley RF, et al. Monocyte chemoattractant protein1 as a predictor of coronary atherosclerosis in patients receiving coronary angiography. Crit Pathw Cardiol 2018;17:105–10. 2 Deo R, Khera A, McGuire DK, et al. Association among plasma levels of monocyte chemoattractant protein1, traditional cardiovascular risk factors, and subclinical atherosclerosis. J Am Coll Cardiol 2004;44:1812–8. 3 Nelken NA, Coughlin SR, Gordon D, et al. Monocyte chemoattractant protein1 in human atheromatous plaques. J Clin Invest 1991;88:1121–7. 4 Hoogeveen RC, Morrison A, Boerwinkle E, et al. Plasma MCP1 level and risk for peripheral arterial disease and incident coronary heart disease: atherosclerosis risk in Communities study. Atherosclerosis 2005;183:301–7. 5 Schecter AD, Rollins BJ, Zhang YJ, et al. Tissue factor is induced by monocyte chemoattractant protein1 in human aortic smooth muscle and THP1 cells. J Biol Chem 1997;272:28568–73. 6 Gosling J, Slaymaker S, Gu L, et al. Mcp1 deficiency reduces susceptibility to atherosclerosis in mice that overexpress human apolipoprotein B. J Clin Invest 1999;103:773–8. 7 GonzalezQuesada C, Frangogiannis NG. Monocyte chemoattractant protein1/ccl2 as a biomarker in acute coronary syndromes. Curr Atheroscler Rep 2009;11:131–8. 8 Mitchell AM, Garvey JL, Kline JA. Multimarker panel to rule out acute coronary syndromes in lowrisk patients. Acad Emerg Med 2006;13:803–6. 9 de Lemos JA, Morrow DA, Sabatine MS, et al. Association between plasma levels of monocyte chemoattractant protein1 and longterm clinical outcomes in patients with acute coronary syndromes. Circulation 2003;107:690–5. 10 de Lemos JA, Morrow DA, Blazing MA, et al. Serial measurement of monocyte chemoattractant protein1 after acute coronary syndromes: results from the A to Z trial. J Am Coll Cardiol 2007;50:2117–24. 11 Greenslade JH, Carlton EW, Van Hise C, et al. Diagnostic accuracy of a new highsensitivity troponin I assay and five accelerated diagnostic pathways for ruling out acute myocardial infarction and acute coronary syndrome. Ann Emerg Med 2018;71:439–51. 12 Mahler SA, Riley RF, Hiestand BC, et al. The heart pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes 2015;8:195–203. 13 Body R, Morris N, Reynard C, et al. Comparison of four decision AIDS for the early diagnosis of acute coronary syndromes in the emergency department. Emerg Med J 2020;37:8–13. 14 Mahler SA, Miller CD, Hollander JE, et al. Identifying patients for early discharge: performance of decision rules among patients with acute chest pain. Int J Cardiol 2013;168:795–802. 15 Than M, Flaws D, Sanders S, et al. Development and validation of the emergency department assessment of chest pain score and 2 H accelerated diagnostic protocol. Emerg Med Australas 2014;26:34–44. 16 Stopyra J, Snavely AC, Hiestand B, et al. Comparison of accelerated diagnostic pathways for acute chest ","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"858-877"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40564379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics.","authors":"Laura Goodwin,&nbsp;Sarah Voss,&nbsp;Graham McClelland,&nbsp;Emily Beach,&nbsp;Adam Bedson,&nbsp;Sarah Black,&nbsp;Toity Deave,&nbsp;Nick Miller,&nbsp;Hazel Taylor,&nbsp;Jonathan Benger","doi":"10.1136/emermed-2021-211970","DOIUrl":"https://doi.org/10.1136/emermed-2021-211970","url":null,"abstract":"<p><strong>Background: </strong>Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics.</p><p><strong>Methods: </strong>A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA.</p><p><strong>Results: </strong>There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5°C. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement.</p><p><strong>Conclusions: </strong>This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"826-832"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40592989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A handy point-of-care ultrasound.","authors":"Susan Uí Bhroin,&nbsp;Ahmad Jamal,&nbsp;Nicolas Lim","doi":"10.1136/emermed-2022-212318","DOIUrl":"https://doi.org/10.1136/emermed-2022-212318","url":null,"abstract":"11 McClelland G, Burrow E, McAdam H. Babies born in the prehospital setting attended by ambulance clinicians in the North East of England. Br Paramed J 2019;4:43–8. 12 World Health Organization. Thermal protection of the newborn: a practical guide. Geneva: World Health Organization, 1997. 13 Flanagan B, Lord B, Barnes M. Is unplanned outofhospital birth managed by paramedics ’infrequent’, ’normal’ and ’uncomplicated’? BMC Pregnancy Childbirth 2017;17:436. 14 Bryman A. Social research methods. Oxford: Oxford University Press, 2016. 15 South Western Ambulance Service NHS Foundation Trust. Welcome to South Western ambulance service NHS Foundation Trust (SWASFT). Available: https://www.swast.nhs. uk/welcome/about-us/welcome-to-south-western-ambulance-service-nhs-foundationtrust-swasft [Accessed 27 May 2020]. 16 Patton MQ. Qualitative research & evaluation methods: Integrating theory and practice. California: Sage Publications, 2014. 17 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 18 PROMPT. Pre Hospital prompt, 2021. Available: https://www.promptmaternity.org/ pre-hospital-prompt [Accessed 28 Jul 2021]. 19 Moscovitz HC, Magriples U, Keissling M, et al. Care and outcome of outofhospital deliveries. Acad Emerg Med 2000;7:757–61. 20 Dobbie AE, Cooke MW. A descriptive review and discussion of litigation claims against ambulance services. Emerg Med J 2008;25:455–8. 21 Persson AC, Engström Åsa, Burström O, et al. Specialist ambulance nurses’ experiences of births before arrival. Int Emerg Nurs 2019;43:45–9. 22 Yetman RJ, Coody DK, West MS, et al. Comparison of temperature measurements by an aural infrared thermometer with measurements by traditional rectal and axillary techniques. J Pediatr 1993;122:769–73. 23 National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management. NICE guideline [NG143], 2019. Available: https://www.nice.org. uk/guidance/ng143 [Accessed 21 Oct 2020]. 24 Vu EN, Schlamp RS, Wand RT, et al. Prehospital use of tranexamic acid for hemorrhagic shock in primary and secondary air medical evacuation. Air Med J 2013;32:289–92. 25 Evans BA, Brown A, Bulger J, et al. Paramedics’ experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury: results of focus groups. BMJ Open 2019;9:e026073. 26 Dyson K, Bray JE, Smith K, et al. Paramedic exposure to outofhospital cardiac arrest resuscitation is associated with patient survival. Circ Cardiovasc Qual Outcomes 2016;9:154–60. 27 Lee HC, Ho QT, Rhine WD. A quality improvement project to improve admission temperatures in very low birth weight infants. J Perinatol 2008;28:754–8. 28 Choi HS, Lee SM, Eun H, et al. The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery. Korean J Pediatr 2018;61:239–44. 29 Harer MW, Vergales B, Cady T, et al. Implementation of a multidisciplinary guidel","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"832-846"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40564816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency physicians' experience of stress during resuscitation and strategies for mitigating the effects of stress on performance.","authors":"Christopher James Groombridge,&nbsp;Amit Maini,&nbsp;Darshini Ayton,&nbsp;Sze-Ee Soh,&nbsp;Nicola Walsham,&nbsp;Yesul Kim,&nbsp;De Villiers Smit,&nbsp;Mark Fitzgerald","doi":"10.1136/emermed-2021-211280","DOIUrl":"https://doi.org/10.1136/emermed-2021-211280","url":null,"abstract":"<p><strong>Objective: </strong>This study explored the perspectives and behaviours of emergency physicians (EPs), regularly involved in resuscitation, to identify the sources and effects of any stress experienced during a resuscitation as well as the strategies employed to deal with these stressors.</p><p><strong>Methods: </strong>This was a two-centre sequential exploratory mixed-methods study of EPs consisting of a focus group, exploring the human factors related to resuscitation, and an anonymous survey. Between April and June 2020, the online survey was distributed to all EPs working at Australia's largest two major trauma centres, both in Melbourne, and investigated sources of stress during resuscitation, impact of stress on performance, mitigation strategies used, impact of the COVID-19 pandemic on stress and stress management training received. Associations with gender and years of clinical practice were also examined.</p><p><strong>Results: </strong>7 EPs took part in the focus group and 82 responses to the online survey were received (81% response rate). The most common sources of stress reported were resuscitation of an 'unwell young paediatric patient' (81%, 95% CI 70.6 to 87.6) or 'unwell pregnant patient' (71%, 95% CI 60.1 to 79.5) and 'conflict with a team member' (71%, 95% CI 60.1 to 79.5). The most frequently reported strategies to mitigate stress were 'verbalising a plan to the team' (84%, 95% CI 74.7 to 90.5), 'implementing a standardised/structured approach' (73%, 95% CI 62.7 to 81.6) and 'asking for help' (57%, 95% CI 46.5 to 67.5). 79% (95% CI 69.3 to 86.6) of EPs reported that they would like additional training on stress management. Junior EPs more frequently reported the use of 'mental rehearsal' to mitigate stress during a resuscitation (62% vs 22%; p<0.01) while female EPs reported 'asking for help' as a mitigator of stress more frequently than male EPs (79% vs 47%; p=0.01).</p><p><strong>Conclusions: </strong>Stress is commonly experienced by EPs during resuscitation and can impact decision-making and procedural performance. This study identifies the most common sources of stress during a resuscitation as well as the strategies that EPs use to mitigate the effects of stress on their performance. These findings may contribute to the development of tailored stress management training for critical care clinicians.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"839-846"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39725522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the thermal properties and surface temperature of prehospital antihypothermia devices: an in vitro study.","authors":"Erez Dvir,&nbsp;Danny Epstein,&nbsp;Baruch Berzon,&nbsp;Aeyal Raz,&nbsp;Amit Lehavi","doi":"10.1136/emermed-2020-211057","DOIUrl":"https://doi.org/10.1136/emermed-2020-211057","url":null,"abstract":"<p><strong>Background: </strong>Preventing and treating hypothermia in prehospital settings is crucial. Several products have been developed to prevent heat loss and actively warm patients in prehospital settings. We compared the efficacy and the surface temperature of different antihypothermia products, using a fluid-based model at two ambient temperatures.</p><p><strong>Methods: </strong>We tested five active (Blizzard Heat with active pads, Ready-Heat, Ready-Heat-II, Hypothermia Prevention and Management Kit (HPMK), Bair Hugger) and five passive (Blizzard Heat, Heat Reflective Shell, sleeping bag, 'space blanket', wool blanket) antihypothermia products. A torso model consisting of four 8 L bags of fluid preheated to 36°C±0.5°C (97±0.5°F) was used to compare the devices' performances at 20°C (68°F) and 8°C (46°F). Inner and surface temperatures were recorded for up to 480 min.</p><p><strong>Results: </strong>We found significant differences in heat loss in fluid bags among the tested devices at both temperatures (p<0.001). At 20°C, only HPMK and Ready-Heat-II increased the inner temperature for 480 min while Blizzard Heat with active pads prevented heat loss. Ready-Heat prevented heat loss for 90 min. All the other devices did not prevent heat loss beyond 30 min. At 8°C, none of the products heated the model. Bair Hugger, HPMK, Ready-Heat II and sleeping bag prevented heat loss for 30 min. At 60, 90 and 120 min HPMK, Ready-Heat II and Bair Hugger were the most effective. Over 480 min, Bair Hugger was most effective, with a heat loss of 2.3°C±0.4°C. The surface temperature exceeded 44°C (111°F) for all the exothermic warming devices when used for a prolonged period of time.</p><p><strong>Conclusion: </strong>At 20°C, HPMK and Ready-Heat-II increased fluid temperature in the model, while the other devices decreased heat loss. At 8°C, none of the tested devices increased the temperature. However, active heating devices prevented heat loss slightly better than passive methods. A protective insulation layer should be used with all active heating blankets.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"833-838"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39594189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study.","authors":"Tom Roberts,&nbsp;Daniel E Horner,&nbsp;Kevin Chu,&nbsp;Martin Than,&nbsp;Anne-Maree Kelly,&nbsp;Sharon Klim,&nbsp;Frances Kinnear,&nbsp;Gerben Keijzers,&nbsp;Mehmet Akif Karamercan,&nbsp;Tissa Wijeratne,&nbsp;Sinan Kamona,&nbsp;Win Sen Kuan,&nbsp;Colin A Graham,&nbsp;Richard Body,&nbsp;Said Laribi","doi":"10.1136/emermed-2021-211370","DOIUrl":"https://doi.org/10.1136/emermed-2021-211370","url":null,"abstract":"<p><strong>Background: </strong>Most headache presentations to emergency departments (ED) have benign causes; however, approximately 10% will have serious pathology. International guidelines recommend that patients describing the onset of headache as 'thunderclap' undergo neuroimaging and further investigation. The association of this feature with serious headache cause is unclear. The objective of this study was to determine if patients presenting with thunderclap headache are significantly more likely to have serious underlying pathology than patients with more gradual onset and to determine compliance with guidelines for investigation.</p><p><strong>Methods: </strong>This was a planned secondary analysis of an international, multicentre, observational study of adult ED patients presenting with a main complaint of headache. Data regarding demographics, investigation strategies and final ED diagnoses were collected. Thunderclap headache was defined as severe headache of immediate or almost immediate onset and peak intensity. Proportion of patients with serious pathology in thunderclap and non-thunderclap groups were compared by χ² test.</p><p><strong>Results: </strong>644 of 4536 patients presented with thunderclap headache (14.2%). CT brain imaging and lumbar puncture were performed in 62.7% and 10.6% of cases, respectively. Among patients with thunderclap headache, serious pathology was identified in 10.9% (95%CI 8.7% to 13.5%) of cases-significantly higher than the proportion found in patients with a different headache onset (6.6% (95% CI 5.9% to 7.4%), p<0.001.). The incidence of subarachnoid haemorrhage (SAH) was 3.6% (95% CI 2.4% to 5.3%) in those with thunderclap headache vs 0.3% (95% CI 0.2% to 0.5%) in those without (p<0.001). All cases of SAH were diagnosed on CT imaging. Non-serious intracranial pathology was diagnosed in 87.7% of patients with thunderclap headache.</p><p><strong>Conclusions: </strong>Thunderclap headache presenting to the ED appears be associated with higher risk for serious intracranial pathology, including SAH, although most patients with this type of headache had a benign cause. Neuroimaging rates did not align with international guidelines, suggesting potential need for further work on standardisation.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"803-809"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39612902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}