Emergency medicine journal : EMJ最新文献

{"title":"Commencing one-handed chest compressions while activating emergency medical system using a handheld mobile device in lone-rescuer basic life support: a randomised cross-over simulation study.","authors":"Sang O Park,&nbsp;Dong Hyuk Shin,&nbsp;Changhoon Kim,&nbsp;Young Hwan Lee","doi":"10.1136/emermed-2021-211774","DOIUrl":"https://doi.org/10.1136/emermed-2021-211774","url":null,"abstract":"<p><strong>Introduction: </strong>In conventional basic life support (c-BLS), a lone rescuer is recommended to start chest compressions (CCs) after activating the emergency medical system. To initiate earlier CCs in lone-rescuer BLS, we designed a modified BLS (m-BLS) sequence in which the lone rescuer commences one-handed CCs while calling for help using a handheld cellular phone with the other free hand. This study aimed to compare the quality of BLS between c-BLS and m-BLS.</p><p><strong>Methods: </strong>This was a simulation study performed with a randomised cross-over controlled trial design. A total of 108 university students were finally enrolled. After training for both c-BLS and m-BLS, participants performed a 3-minute c-BLS or m-BLS on a manikin with a SkillReporter at random cross-over order. The paired mean difference with SE between c-BLS and m-BLS was assessed using paired t-test.</p><p><strong>Results: </strong>The m-BLS had reduced lag time before the initiation of CCs (with a mean estimated paired difference (SE) of -35.0 (90.4) s) (p<0.001). For CC, a significant increase in compression fraction and a higher number of CCs with correct depth were observed in m-BLS (with a mean estimated paired difference (SE) of 16.2% (0.6) and 26.9% (3.3), respectively) (all p<0.001). However, no significant paired difference was observed in the hand position, compression rate and interruption time. For ventilation, the mean tidal volumes did not differ. However, the number of breaths with correct tidal volume was higher in m-BLS than in c-BLS.</p><p><strong>Conclusion: </strong>In simulated lone-rescuer BLS, the m-BLS could deliver significantly earlier CCs than the c-BLS while maintaining high-quality cardiopulmonary resuscitation.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"357-362"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39317295","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":"Biomechanical analysis of force distribution in one-handed and two-handed adult chest compression: a randomised crossover observational study.","authors":"Chia-Lung Kao,&nbsp;Jui-Yi Tsou,&nbsp;Ming-Yuan Hong,&nbsp;Chih-Jan Chang,&nbsp;Chih-Hsien Chi","doi":"10.1136/emermed-2020-210363","DOIUrl":"https://doi.org/10.1136/emermed-2020-210363","url":null,"abstract":"<p><strong>Introduction: </strong>The standard method of chest compression for adults is a two-handed procedure. One-handed external chest compression (ECC) is used in some situations such as during transport of patients who had an out-of-hospital cardiac arrest, but the quality of one-handed ECC is still not well known. The distribution of force is related to the quality of chest compression and may affect the risk of injury. This study aimed to determine the differences in the quality and potential safety concern between one-handed ECC and two- handed ECC.</p><p><strong>Methods: </strong>In this randomised crossover study, participants recruited from National Cheng Kung University Hospital and the ambulance team from the fire bureau were asked to perform one-handed and two-handed ECC on the Resusci Anne manikin according to standard 2015 ECC guidelines. The MatScan Pressure Measurement system was used to investigate the compression pressure and force distribution.</p><p><strong>Results: </strong>Two-handed ECC had better results than one-handed ECC in terms of the median (IQR) depth (51.00 (41.50-54.75) mm vs 42.00 (27.00-49.00) mm, p=0.018), the proportion of depth accuracy (82.05% (13.95%-99.86%) vs 11.17% (0.00%-42.13%), p=0.028) and the proportion of incomplete recoil (0.23% (0.01%-0.44%) vs 2.42% (0.60%-4.21%), p=0.002). The maximum force (45.72 (36.10-80.84) kgf vs 35.64 (24.13-74.34) kgf, p<0.001) and ulnar-radial force difference (7.13 (-16.58 to 21.07) kgf vs 23.93 (11.19-38.74) kgf, p<0.001) showed statistically significant differences. The perceived fatigue of two-handed ECC versus one-handed ECC was 5.00 (3.00-6.00) vs 6.00 (5.00-8.00), p<0.001.</p><p><strong>Conclusion: </strong>The quality of one-handed ECC, based on depth and recoil, is worse than that of standard two-handed ECC. The pressure and force distribution of one-handed ECC result in greater ulnar pronation of the hand than that of two-handed ECC. One-handed ECC more easily causes operator fatigue. Acknowledging these findings and adjusting training for one-handed ECC would potentially improve the quality of cardiopulmonary resuscitation during transport.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"353-356"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39321440","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":"Extracorporeal life support programme for out-of-hospital cardiac arrest during competitive sport events: the experience of the Volleyball Men's World Championship Final Six in Turin (Italy).","authors":"Giancarlo Fornaro,&nbsp;Federico Giovanni Canavosio,&nbsp;Maria Luisa Contristano,&nbsp;Daniela Pasero,&nbsp;Gennaro Izzo,&nbsp;Paolo Centofanti,&nbsp;Matteo Attisani,&nbsp;Anna Chiara Trompeo,&nbsp;Gabriella Buono,&nbsp;Marcello Martore,&nbsp;Mauro Rinaldi,&nbsp;Luca Brazzi","doi":"10.1136/emermed-2019-209203","DOIUrl":"https://doi.org/10.1136/emermed-2019-209203","url":null,"abstract":"<p><p>The high incidence of out-of-hospital cardiac arrest refractory to standard resuscitation protocols, despite precompetitive screening, demonstrated the need for a prehospital team to provide an effective system for life support and resuscitation at the Volleyball Men's World Championship. The evolution of mechanical circulatory support suggests that current advanced cardiovascular life support protocols no longer represent the highest standard of care at competitive sporting events with large spectator numbers. Extracorporeal life support (ECLS) improves resuscitation strategies and offers a rescue therapy for refractory cardiac arrest that can no longer be ignored. We present our operational experience of an out-of-hospital ECLS cardiopulmonary resuscitation team at an international sporting event.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"376-379"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38798047","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":"Man with periumbilical redness and umbilical drainage.","authors":"Cho Natsuki,&nbsp;Taku Harada,&nbsp;Hiroshige Juichi","doi":"10.1136/emermed-2020-210944","DOIUrl":"https://doi.org/10.1136/emermed-2020-210944","url":null,"abstract":"17 McNarry AF, Goldhill DR. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow coma scale. Anaesthesia 2004;59:34–7. 18 Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83. 19 Hirst E, Irving A, Goodacre S. Patient and public involvement in emergency care research. Emerg Med J 2016;33:665–70. 20 Henning DJ, Puskarich MA, Self WH, et al. An emergency department validation of the SEP3 sepsis and septic shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med 2017;70:544–52. 21 Szakmany T, Lundin RM, Sharif B, et al. Sepsis prevalence and outcome on the general wards and emergency departments in Wales: results of a multicentre, observational, point prevalence study. PLoS One 2016;11:e0167230. 22 Williams JM, Greenslade JH, Dymond CA, et al. Characteristics, treatment and outcomes for all emergency department patients fulfilling criteria for septic shock: a prospective observational study. Eur J Emerg Med 2018;25:97–104. 23 de Groot B, Stolwijk F, Warmerdam M, et al. The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multicentre study. Scand J Trauma Resusc Emerg Med 2017;25:91. 24 Goulden R, Hoyle MC, Monis J, et al. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J 2018;35:345–9. 25 Redfern OC, Smith GB, Prytherch DR, et al. A comparison of the quick sequential (sepsisrelated) organ failure assessment score and the National early warning score in NonICU patients with/without infection. Crit Care Med 2018;46:1923–33. 26 Drumheller BC, Agarwal A, Mikkelsen ME, et al. Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. J Crit Care 2016;31:13–20. 27 Warmerdam M, Stolwijk F, Boogert A, et al. Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age. PLoS One 2017;12:e0185214. 28 Gray A, Ward K, Lees F, et al. The epidemiology of adults with severe sepsis and septic shock in Scottish emergency departments. Emerg Med J 2013;30:397–401.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"278-316"},"PeriodicalIF":3.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315121","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":"Daniel Horner,&nbsp;Anthony Kelly,&nbsp;Jemima Heap,&nbsp;Cameron Stocks,&nbsp;Eyad Tuma,&nbsp;Ashley Clews,&nbsp;Peter Kilgour","doi":"10.1136/emermed-2022-212414","DOIUrl":"https://doi.org/10.1136/emermed-2022-212414","url":null,"abstract":"Introduction This month’s update is from the Emergency Department at Salford Royal NHS Foundation Trust. We used a multimodal search strategy, drawing on free openaccess medical education resources and focused literature searches. We identified the five most interesting and relevant papers (decided by consensus, with editorial oversight) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: ► 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":"339-340"},"PeriodicalIF":3.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315120","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":"Put your hands up!","authors":"Caterina Barberi,&nbsp;Francesco Niccolai,&nbsp;Lorenzo Di Mento","doi":"10.1136/emermed-2021-211377","DOIUrl":"https://doi.org/10.1136/emermed-2021-211377","url":null,"abstract":"Data availability statement Data are available upon reasonable request. All collected data have been entered into an Excel data sheet and patient’s privacy information has been pseudonymised. The Excel document itself is password protected and saved upon a passwordprotected server of the Department of Emergency Medicine at Charité University Medicine Berlin with restricted access. Data protection is following the data protection declaration of the respective institution and will be available upon reasonable request.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"300-342"},"PeriodicalIF":3.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315122","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":"Is this heart failure?","authors":"Sittinun Thangjui,&nbsp;Omid Shah,&nbsp;Jerel Zoltick","doi":"10.1136/emermed-2021-211684","DOIUrl":"https://doi.org/10.1136/emermed-2021-211684","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"324-336"},"PeriodicalIF":3.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315123","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":"Management of patients presenting to the emergency department with sudden onset severe headache: systematic review of diagnostic accuracy studies","authors":"M. Walton, R. Hodgson, A. Eastwood, M. Harden, J. Storey, Taj Hassan, Marc Stuart Randall, Abu Hassan, John Williams, R. Wade","doi":"10.1136/emermed-2021-211900","DOIUrl":"https://doi.org/10.1136/emermed-2021-211900","url":null,"abstract":"Objective Advances in imaging technologies have precipitated uncertainty and inconsistency in the management of neurologically intact patients presenting to the Emergency Department (ED) with non-traumatic sudden onset severe headache with a clinical suspicion of subarachnoid haemorrhage (SAH). The objective of this systematic review was to evaluate diagnostic strategies in these patients. Methods Studies assessing any decision rule or diagnostic test for evaluating neurologically intact adults with a severe headache, reaching maximum intensity within 1 hour, were eligible. Eighteen databases (including MEDLINE and Embase) were searched. Quality was assessed using QUADAS-2. Where appropriate, hierarchical bivariate meta-analysis was used to synthesise diagnostic accuracy results. Results Thirty-seven studies were included. Eight studies assessing the Ottawa SAH clinical decision rule were pooled; sensitivity 99.5% (95% CI 90.8 to 100), specificity 24% (95% CI 15.5 to 34.4). Four studies assessing CT within 6 hours of headache onset were pooled; sensitivity 98.7% (95% CI 96.5 to 100), specificity 100% (95% CI 99.7 to 100). The sensitivity of CT beyond 6 hours was considerably lower (≤90%; 2 studies). Three studies assessing lumbar puncture (LP; spectrophotometric analysis) following negative CT were pooled; sensitivity 100% (95% CI 100 to 100), specificity 95% (95% CI 86.0 to 98.5). Conclusion The Ottawa SAH Rule rules out further investigation in only a small proportion of patients. CT undertaken within 6 hours (with expertise of a neuroradiologist or radiologist who routinely interprets brain images) is highly accurate and likely to be sufficient to rule out SAH; CT beyond 6 hours is much less sensitive. The CT–LP pathway is highly sensitive for detecting SAH and some alternative diagnoses, although LP results in some false positive results.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134331057","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":"Prognostic value of National Early Warning Scores (NEWS2) and component physiology in hospitalised patients with COVID-19: a multicentre study","authors":"L. Scott, Alison Tavare, E. Hill, L. Jordan, M. Juniper, Seema Srivastava, E. Redfern, H. Little, A. Pullyblank","doi":"10.1136/emermed-2020-210624","DOIUrl":"https://doi.org/10.1136/emermed-2020-210624","url":null,"abstract":"Background National Early Warning Scores (NEWS2) are used to detect all-cause deterioration. While studies have looked at NEWS2, the use of virtual consultation and remote monitoring of patients with COVID-19 mean there is a need to know which physiological observations are important. Aim To investigate the relationship between outcome and NEWS2, change in NEWS2 and component physiology in COVID-19 inpatients. Methods A multi-centre retrospective study of electronically recorded, routinely collected physiological measurements between March and June 2020. First and maximum NEWS2, component scores and outcomes were recorded. Areas under the curve (AUCs) for 2-day, 7-day and 30-day mortality were calculated. Results Of 1263 patients, 26% died, 7% were admitted to intensive care units (ICUs) before discharge and 67% were discharged without ICU. Of 1071 patients with initial NEWS2, most values were low: 50% NEWS2=0–2, 27% NEWS2=3–4, 14% NEWS2=5–6 and 9% NEWS2=7+. Maximum scores were: 14% NEWS2=0–2, 22% NEWS2=3–4, 17% NEWS2=5–6 and 47% NEWS2=7+. Higher first and maximum scores were predictive of mortality, ICU admission and longer length of stay. AUCs based on 2-day, 7-day, 30-day and any hospital mortality were 0.77 (95% CI 0.70 to 0.84), 0.70 (0.65 to 0.74), 0.65 (0.61 to 0.68) and 0.65 (0.61 to 0.68), respectively. The AUCs for 2-day mortality were 0.71 (0.65 to 0.77) for supplemental oxygen, 0.65 (0.56 to 0.73) oxygen saturation and 0.64 (0.56 to 0.73) respiratory rate. Conclusion While respiratory parameters were most predictive, no individual parameter was as good as a full NEWS2, which is an acceptable predictor of short-term mortality in patients with COVID-19. This supports recommendation to use NEWS2 alongside clinical judgement to assess patients with COVID-19.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131719683","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":"Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain","authors":"A. O’Cathain, R. Simpson, M. Phillips, E. Knowles","doi":"10.1136/emermed-2020-210271","DOIUrl":"https://doi.org/10.1136/emermed-2020-210271","url":null,"abstract":"Background There are concerns about high levels of demand for emergency health services. The aim was to identify the characteristics of the British population with a tendency to contact emergency medical services and EDs for minor or non-urgent problems. Methods A survey of the British adult population in 2018. Six vignettes were constructed about illness in adults (cough/sore throat or diarrhoea/vomiting), injury in adults (sore rib or back pain) and fever in children (occurring weekday or weekend). Results The response rate was 42%, with 2906 respondents. 11% (319/2716) of respondents selected to contact an ambulance and 43% ED, mainly for the vignettes about fever in children and sore rib. Males, people from ethnic minority communities and older people had a tendency to contact emergency services for minor problems. Tendency to call an ambulance was also characterised by ‘low resources’ (manual or unskilled occupations, no car, low health literacy), worry that a symptom might be serious, distress (feeling overwhelmed by health problems) and frequent use of EDs. For EDs, there was an attraction to EDs because of availability of tests. Conclusion Whereas use of emergency ambulances for minor or non-urgent problems appeared to be driven by people’s lack of resources, including lack of transport, use of EDs appeared to be driven by their attractive characteristic of offering tests quickly.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116460282","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}