Emergency medicine journal : EMJ最新文献

{"title":"SONO case series: 39-year-old man with leg swelling and pain.","authors":"Nancy Anaya, Kavita Gandhi, Sally Graglia","doi":"10.1136/emermed-2020-209547","DOIUrl":"https://doi.org/10.1136/emermed-2020-209547","url":null,"abstract":"CASE PRESENTATION A 39yearold man presented to the ED with 1 week of right lower extremity (RLE) swelling, redness and pain. His pain is currently rated at 10/10. His pain began after a long run. He denies trauma during this run. He was recently treated with an antibiotic for a skin infection. He denies any fevers, recent surgeries or hospitalisations. He denies any recent long car trips or flights. The patient denies any medical history. He has never had any surgeries. He is not taking any medications and has no allergies.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"230-232"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39652892","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":"Bed downtime: the novel use of a quality metric allows inpatient providers to improve patient flow from the emergency department.","authors":"Benjamin Bodnar,&nbsp;Erin M Kane,&nbsp;Hetal Rupani,&nbsp;Henry Michtalik,&nbsp;Veena G Billioux,&nbsp;Ashley Pleiss,&nbsp;Linda Huffman,&nbsp;Kimiyoshi Kobayashi,&nbsp;Rohit Toteja,&nbsp;Daniel J Brotman,&nbsp;Carrie Herzke","doi":"10.1136/emermed-2020-209425","DOIUrl":"https://doi.org/10.1136/emermed-2020-209425","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) boarding time is associated with increased length of stay (LOS) and inpatient mortality. Despite the documented impact of ED boarding on inpatient outcomes, a disparity continues to exist between the attention paid to the issue by inpatient and ED providers. A perceived lack of high yield strategies to address ED boarding from the perspective of the inpatient provider may discourage involvement in improvement initiatives on the subject. As such, further work is needed to identify inpatient metrics and strategies to address patient flow problems, and which may improve ED boarding time.</p><p><strong>Methods: </strong>After initial system analysis, our multidisciplinary quality improvement (QI) group defined the process time metric 'bed downtime'-the time from which a bed is vacated by a discharged patient to the time an ED patient is assigned to that bed. Using the Lean Sigma QI approach, this metric was targeted for improvement on the internal medicine hospitalist service at a tertiary care academic medical centre.</p><p><strong>Interventions: </strong>Interventions included improving inpatient provider awareness of the problem, real-time provider notification of empty beds, a weekly retrospective emailed performance dashboard and the creation of a guideline document for admission procedures.</p><p><strong>Results: </strong>This package of interventions was associated with a 125 min reduction in mean bed downtime for incoming ED patients (254 min to 129 min) admitted to the intervention unit.</p><p><strong>Conclusion: </strong>Use of the bed downtime metric as a QI target was associated with marked improvements in process time during our project. The use of this metric may enhance the ability of inpatient providers to participate in QI efforts to improve patient flow from the ED. Further study is needed to determine if use of the metric may be effective at reducing boarding time without requiring alterations to LOS or discharge patterns.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"224-229"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25374824","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":"Unilateral perirobital swelling.","authors":"Geng Ju Tuang,&nbsp;Farah Dayana Zahedi,&nbsp;Poh Ling Lim","doi":"10.1136/emermed-2020-210932","DOIUrl":"https://doi.org/10.1136/emermed-2020-210932","url":null,"abstract":"Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peerreviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"229-241"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39943355","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 blurry vision following fever.","authors":"Ching Hsiung Chang,&nbsp;Chi-Tung Peng,&nbsp;Chi-Wei Chen","doi":"10.1136/emermed-2020-210952","DOIUrl":"https://doi.org/10.1136/emermed-2020-210952","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"190-242"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39943353","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":"Older medical outliers on surgical wards: impact on 6-month outcomes.","authors":"Claire Patry,&nbsp;Anne Perozziello,&nbsp;Clio Pardineille,&nbsp;Christiane Aubert,&nbsp;Pauline de Malglaive,&nbsp;Christophe Choquet,&nbsp;Agathe Raynaud-Simon,&nbsp;Manuel Sanchez","doi":"10.1136/emermed-2020-210192","DOIUrl":"https://doi.org/10.1136/emermed-2020-210192","url":null,"abstract":"<p><strong>Background: </strong>Medical patients are on occasion admitted transiently to surgical wards when more appropriate wards are at capacity, potentially leading to suboptimal care. The aim of this study was to compare 6-month outcomes in older adults diagnosed with medical conditions in the ED then admitted inappropriately to surgical wards (defined as outliers), with outcomes in comparable patients admitted to medical wards (controls).</p><p><strong>Methods: </strong>In a matched cohort study, 100 consecutive medical outliers from the ED aged 75 years and over were matched according to age, sex and diagnosis to 200 controls. Collected data included number of diagnoses reported in acute care, level of patient illness severity, length of stay, mortality and destination of patients discharged from acute care units (home, rehabilitation facility, nursing home or palliative care facility). An assessment was made of patient vital status and living environment (home, nursing home or hospital) at 6 months post-ED admission.</p><p><strong>Results: </strong>Mean age was 85.6 years. The most common ED diagnoses were gait disorders/falls (18%), neurological disorders (17%) and exhaustion (16%). Outliers displayed lower illness severity levels (0.001) and shorter lengths of stay from ED admission to acute care discharge (p=0.040). Subsequent to acute care, outliers were less commonly discharged home (45% vs 59%) and more commonly discharged to rehabilitation facilities (42% vs 28%). At 6 months post-ED admission, multivariable regression analysis showed that outlier status (OR=0.44 (0.25-0.83); p=0.011) and numbers of diagnoses reported in acute care (OR=0.87 (0.76-0.98); p=0.028) were independently associated with lower probability of living at home.</p><p><strong>Conclusion: </strong>Outlying of older patients to surgical wards negatively affects their prospects of living at home at 6 months after hospital admission. Older patients hospitalised via the ED are entitled to appropriate medical care.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"181-185"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39241560","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":"Survey evaluating clinical equipoise around platelet transfusion after head injury and traumatic intracranial haemorrhage (ICH) in patients on antiplatelet medications.","authors":"Catherine Ashton,&nbsp;M Laffan,&nbsp;P J Hutchinson,&nbsp;Fiona Lecky,&nbsp;S Ralhan,&nbsp;Jason E Smith,&nbsp;Jonathan P Coles,&nbsp;Simon Stanworth,&nbsp;Nicola Curry","doi":"10.1136/emermed-2021-211189","DOIUrl":"https://doi.org/10.1136/emermed-2021-211189","url":null,"abstract":"<p><strong>Introduction: </strong>Patients aged 60 or over account for over half of the severely injured trauma patients and a traumatic brain injury is the most common injury sustained. Many of these patients are taking antiplatelet medications but there is clinical equipoise about the role of platelet transfusion in patients with traumatic intracranial haemorrhage (ICH) taking prior antiplatelet medications.</p><p><strong>Method: </strong>A prepiloted survey was designed to explore a range of clinical issues in managing patients taking antiplatelet medications admitted with a traumatic brain injury. This was sent via email to consultants and specialty registrar members of a variety of relevant UK societies and working groups in the fields of emergency medicine, critical care, neurosurgery and haematology.</p><p><strong>Results: </strong>193 responses were received, mostly from colleagues in emergency medicine, neurosurgery, anaesthesia and haematology. Respondents indicated that there is a lack of evidence to support the use of platelet transfusion in this patient population but also lack of evidence of harm. Results also demonstrate uncertainties as to whether platelets should be given to all or some patients and doubt regarding the value of viscoelastic testing.</p><p><strong>Discussion: </strong>Our survey demonstrates equipoise in current practice with regards to platelet transfusion in patients with a traumatic ICH who are taking antiplatelet medication. There is support for additional trials to investigate the effect of platelet transfusion in this rising population of older, high-risk patients, in order to provide a better evidence-base for guideline development.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"220-223"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39095586","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":"Unusual wound with increasing prevalence caused by artificial fingernail glue.","authors":"Rachel V Currie,&nbsp;Serena V Martin,&nbsp;Khalid Khan","doi":"10.1136/emermed-2021-211130","DOIUrl":"https://doi.org/10.1136/emermed-2021-211130","url":null,"abstract":"<p><p>Clinical introductionA healthy 17-year-old girl presents with a wound on her left medial thigh (figure 1). Two days earlier while applying acrylic nail tips, she spilled nail glue on her jeans in the area of concern. Despite noticing an immediate irritable sensation, she did not perform any first aid nor did she remove her clothing to check the underlying skin.emermed;39/3/185/F1F1F1Figure 1Wound left medial thigh. QUESTION: What is the pathological process of this wound?De-epithelialisation due to removal of clothing glued to skin.Chemical burn.Partial thickness thermal burn.Allergic reaction to nail glue. <i>For answer see page 02</i>.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"185-205"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39943351","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":"Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury.","authors":"Pia Koivikko,&nbsp;Jussi P Posti,&nbsp;Mehrbod Mohammadian,&nbsp;Linnea Lagerstedt,&nbsp;Leire Azurmendi,&nbsp;Iftakher Hossain,&nbsp;Ari J Katila,&nbsp;David Menon,&nbsp;Virginia F J Newcombe,&nbsp;Peter John Hutchinson,&nbsp;Henna-Riikka Maanpää,&nbsp;Jussi Tallus,&nbsp;Henrik Zetterberg,&nbsp;Kaj Blennow,&nbsp;Olli Tenovuo,&nbsp;Jean-Charles Sanchez,&nbsp;Riikka S K Takala","doi":"10.1136/emermed-2020-209471","DOIUrl":"https://doi.org/10.1136/emermed-2020-209471","url":null,"abstract":"<p><strong>Background: </strong>There is substantial interest in blood biomarkers as fast and objective diagnostic tools for traumatic brain injury (TBI) in the acute setting.</p><p><strong>Methods: </strong>Adult patients (≥18) with TBI of any severity and indications for CT scanning and orthopaedic injury controls were prospectively recruited during 2011-2013 at Turku University Hospital, Finland. The severity of TBI was classified with GCS: GCS 13-15 was classified as mild (mTBI); GCS 9-12 as moderate (moTBI) and GCS 3-8 as severe (sTBI). Serum samples were collected within 24 hours of admission and biomarker levels analysed with high-performance kits. The ability of biomarkers to distinguish between severity of TBI and CT-positive and CT-negative patients was assessed.</p><p><strong>Results: </strong>Among 189 patients recruited, neurofilament light (NF-L) was obtained from 175 patients with TBI and 40 controls. S100 calcium-binding protein B (S100B), heart fatty-acid binding protein (H-FABP) and interleukin-10 (IL-10) were analysed for 184 patients with TBI and 39 controls. There were statistically significant differences between levels of all biomarkers between the severity classes, but none of the biomarkers distinguished patients with moTBI from patients with sTBI. Patients with mTBI discharged from the ED had lower levels of IL-10 (0.26, IQR=0.21, 0.39 pg/mL), H-FABP (4.15, IQR=2.72, 5.83 ng/mL) and NF-L (8.6, IQR=6.35, 15.98 pg/mL) compared with those admitted to the neurosurgical ward, IL-10 (0.55, IQR=0.31, 1.42 pg/mL), H-FABP (6.022, IQR=4.19, 20.72 ng/mL) and NF-L (13.95, IQR=8.33, 19.93 pg/mL). We observed higher levels of H-FABP and NF-L in older patients with mTBI. None of the biomarkers or their combinations was able to distinguish CT-positive (n=36) or CT-negative (n=58) patients with mTBI from controls.</p><p><strong>Conclusions: </strong>S100B, H-FABP, NF-L and IL-10 levels in patients with mTBI were significantly lower than in patients with moTBI and sTBI but alone or in combination, were unable to distinguish patients with mTBI from orthopaedic controls. This suggests these biomarkers cannot be used alone to diagnose mTBI in trauma patients in the acute setting.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"206-212"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39731845","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":"BET 1: should Colles' fractures be splinted in a long or short arm cast?","authors":"Sophie Ramsden,&nbsp;Lauren Beals","doi":"10.1136/emermed-2022-212327.2","DOIUrl":"https://doi.org/10.1136/emermed-2022-212327.2","url":null,"abstract":"<p><p>A short-cut review of the available medical literature was carried out to establish whether elbow immobilisation is required after closed reduction of a distal radial fracture. After abstract review, six papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that elbow immobilisation is not required.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"237-238"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39943352","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 lay perspective and commentary on the association between delays to patient admission from the emergency department and all-cause 30-day mortality.","authors":"Derek Prentice","doi":"10.1136/emermed-2021-212106","DOIUrl":"https://doi.org/10.1136/emermed-2021-212106","url":null,"abstract":"A&E is a brand; it is among the best known brands in the UK and is trusted and loved by the UK public. Why? Because they know when all else fails, when other agencies just don’t or won’t respond, their local A&E department will be there for them 24/7, 365 days a year. Confirmation of this is available daily in every emergency department in the UK, with patient attendances at the highest since the inception of the National Health Service (NHS). Yet, as the paper by Moulton and colleagues reports, this trust and indeed the dedicated service of the clinicians is being undermined by a killer and one that for far too long the government, NHS leadership, trust boards and their chief executives have chosen to ignore or simply blame patients for having the temerity to turn up. For at least the last 12 years and more, we have seen cuts after cuts to the budget of the NHS, leading to reduced bed numbers and staffing. This is bad enough in itself but has been further compounded by repeated large reductions in central government financial support to local authorities, with a devastating impact on social care. The result has been fewer beds in hospitals and a grave lack of social care provision for those patients ready for discharge, or as it is called, exit block and delayed timely admission. Thanks to this report, we now have confirmation that such delay kills patients. UK patients and the population as a whole love their NHS, they know only too well that it is not perfect, and they are prepared to be forgiving when things go wrong, perhaps too forgiving. Most people, for instance, wait patiently for hours to be seen in A&E. However, patients have an absolute right to be informed when their trust in a service has serious consequences for their wellbeing and also, possibly, their life. As ever, it is the elderly/frail and those living in deprived communities who are most likely to be affected. From the perspective of the patient, and certainly from those of us who have the privilege to represent patient interest, one statement and one fact stand out. Within the Conclusions it states:","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"166-167"},"PeriodicalIF":3.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39944392","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}