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Presentation of Case. Dr. Denise De Las Nueces: A 66-year-old homeless man who had sought refuge at a local men’s congregate shelter for the past several years was evaluated for cough and rhinorrhea during the pandemic of coronavirus disease 2019

The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal. In this

We hope you are keeping well in these difficult times. The ongoing COVID-19 pandemic continues be a main feature in this issue of the EMJ, as it has in recent editions. Quality and safety in emergency departments Two articles in

The coronavirus disease 2019 (Covid-19) pandemic has caused catastrophic disease worldwide, although children have been relatively spared. Severe lung involvement with acute respiratory failure is the most common complication of Covid-19 in adults, but many have complications in multiple organs,…

On presentation to the emergency department, patients with fever, tachypnea, rales on lung examination, and acid–base disturbances are often given a suspected diagnosis of viral infection, yet persons with salicylate toxicity may present with similar symptoms. This article highlights the

To the Editor: From February 28 through March 21, 2020, in three hospitals in northern Italy, we examined five patients who had Guillain–Barré syndrome after the onset of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), can infect host cells by means of interaction with membrane-bound angiotensin-converting enzyme 2 (ACE2) on respiratory epithelium. ACE2 is part of the…

The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal. In this

To the Editor: We report the neurologic features in an observational series of 58 of 64 consecutive patients admitted to the hospital because of acute respiratory distress syndrome (ARDS) due to Covid-19. The patients received similar evaluations by intensivists in

Welcome to the June issue of the EMJ, and we hope that you are keeping well. As the current pandemic continues to affect our working and personal lives, this Primary Survey has identified two COVID-19 related articles of interest. We

To rapidly communicate short reports of innovative responses to Covid-19 around the world, along with a range of current thinking on policy and strategy relevant to the pandemic, the Journal has initiated the Covid-19 Notes series. On March 15, 2020,

Endovascular thrombectomy has become part of the standard treatment for patients who have acute ischemic stroke due to large-vessel occlusion in the anterior cerebral circulation, when the procedure is available and can be performed in a timely fashion or is

At a personal and public level, the world is experiencing true devastation. In homes, hospitals, streets and societies, loss is profound. Public health, and what it means in terms of individual and collective responsibility, is forefront in public and political

On March 28, 2020, the Office of Civil Rights at the Department of Health and Human Services (HHS) opened investigations into recently released critical care crisis triage protocols. Disability rights advocates are urging Congress to prohibit crisis triage based on

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

To the Editor: The effect of the Covid-19 pandemic on medical care for conditions other than Covid-19 has been difficult to quantify. Any decrease in care for patients with acute conditions such as ischemic stroke may be consequential because timely

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

Endovascular thrombectomy has been shown to be safe and effective for the treatment of appropriately selected patients with acute ischemic stroke up to 24 hours after symptom onset. Several trials are attempting to expand the selection criteria for thrombectomy, in

Welcome to the May 2020 edition of the Emergency Medicine Journal. As Emergency Departments (EDs) face up to the unprecedented challenge of the COVID-19 pandemic, in this issue we have a range of very pertinent papers to assist you with

Studies in animals have shown that angiotensin-converting enzyme 2 (ACE2), a membrane-bound aminopeptidase that is abundantly expressed in the lungs, the heart, and other tissues, is used by coronaviruses as a functional receptor for their entrance into the cells. Angiotensin-receptor

Recognizing that patients prioritize convenient and inexpensive care, Duffy and Lee recently asked whether in-person visits should become the second, third, or even last option for meeting patient needs. Previous work has specifically described the potential for using telemedicine in

To the Editor: Despite the risk of rapid respiratory failure and cardiac complications due to Covid-19, it is unclear whether there is an association between Covid-19 and out-of-hospital cardiac arrest. The Lombardy region of Italy was among the first areas

The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission,

To rapidly communicate short reports of innovative responses to Covid-19 around the world, along with a range of current thinking on policy and strategy relevant to the pandemic, the Journal has initiated the Covid-19 Notes series. “It is as if

To the Editor: Myocardial injury with ST-segment elevation has been observed in patients with coronavirus disease 2019 (Covid-19). Here, we describe our experience in the initial month of the Covid-19 outbreak in New York City. Patients with confirmed Covid-19 who

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

To the Editor: We report the neurologic features in an observational series of 58 of 64 consecutive patients admitted to the hospital because of acute respiratory distress syndrome (ARDS) due to Covid-19. The patients received similar evaluations by intensivists in

Accurate assessment of the optic-nerve head, the optic disk, by funduscopy is an important, cost-effective, and noninvasive diagnostic tool for a variety of ocular, neurologic, and inflammatory conditions. Unfortunately, reliable funduscopic assessment is challenging for clinicians working with…

Presentation of Case. Dr. Sarimer Sanchez (Medicine): A 37-year-old man was admitted to this hospital because of a facial droop, dysarthria, and kidney failure. The patient had been well until 1 week before admission, when weakness of the right arm

To the Editor: Clinicians with inadequate access to standard personal protective equipment (PPE) have been compelled to improvise protective barrier enclosures for use during endotracheal intubation. We describe one such barrier that is easily fabricated and may help protect clinicians

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

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This Latin, and before that Greek, adage (perhaps more recognisable in the form of its English equivalent ‘More haste less speed’) has stood the test of time. Speed is a known determinant of road crash death. The maximum vehicle travel

Covid-19 is officially a pandemic. It is a novel infection with serious clinical manifestations, including death, and it has reached at least 124 countries and territories. Although the ultimate course and impact of Covid-19 are uncertain, it is not merely

Hereditary angioedema is a rare, potentially life-threatening disorder characterized by attacks of cutaneous and submucosal swelling. Quincke first described its clinical presentation, and Osler’s recognition of the autosomal dominant inheritance pattern followed in 1888. The initial name of the…

Achieving the right care The Right Care Alliance (RCA) is a US based coalition of clinicians, patients and community members who aim to achieve the best healthcare outcomes at the fairest price without any over diagnosis, investigation or treatment. In

The once-simple act of writing an opioid prescription has become fraught. Physicians must check prescription monitoring databases to review patients’ histories, make sure their prescription complies with state limits on dose or number of days’ supply, and consider any practice-quality

Last year, after a month of dry cough and shortness of breath while walking up the steep steps of Fillmore Street in San Francisco, Mary, my mother-in-law and housemate, noticed that she was becoming more and more easily winded. When

Before she arrived, it was as if she had already left. Her chart was riddled with indicators. This past February, when she had her first stroke, she had left the hospital against medical advice. Two months later, when she had

The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission,

Before she arrived, it was as if she had already left. Her chart was riddled with indicators. This past February, when she had her first stroke, she had left the hospital against medical advice. Two months later, when she had

The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission,

Electronic cigarettes, or e-cigarettes, include a diverse group of battery-powered devices that allow users to inhale aerosolized substances. E-cigarette aerosol generally contains fewer toxic chemicals than conventional cigarette smoke. However, e-cigarette aerosol is not harmless; it can expose…

Syphilis was first recognized in Europe in the late 15th century; its cause, Treponema pallidum subspecies pallidum, was identified four centuries later. The advent of penicillin, together with effective public health measures, was responsible for a marked decline in syphilis

At the Journal, we work with authors to craft their messages to provide readers the best information from rigorous medical practice and basic science. The process can take time, with careful peer review, editing, and graphics often involving multiple rounds

Syphilis was first recognized in Europe in the late 15th century; its cause, Treponema pallidum subspecies pallidum, was identified four centuries later. The advent of penicillin, together with effective public health measures, was responsible for a marked decline in syphilis

At the Journal, we work with authors to craft their messages to provide readers the best information from rigorous medical practice and basic science. The process can take time, with careful peer review, editing, and graphics often involving multiple rounds

Emergency Medicine loves a clinical prediction tool. Traditionally, these take a common condition and identify clinical factors to justify further testing. Our first paper this month focuses on a thankfully uncommon condition, abusive head trauma in children, and evaluates a

Emerging and reemerging pathogens are global challenges for public health. Coronaviruses are enveloped RNA viruses that are distributed broadly among humans, other mammals, and birds and that cause respiratory, enteric, hepatic, and neurologic diseases. Six coronavirus species are known to

The year 2019 looked to be the one in which the U.S. Congress would solve the problem of surprise medical bills, the unexpected and unavoidable bills that result when a patient sees an out-of-network provider in an emergency or at

Presentation of Case. Dr. Madeline L. Keyes (Pediatrics): A 32-day-old male infant was transferred to the emergency department and admitted to this hospital for evaluation of suspected abusive head trauma. On the evening of admission, the patient’s mother called emergency

I walked into the hospital room in the early morning and observed the patient from across the room. As a physician, you start observing, gathering clues, from the moment you enter the door. The patient was disheveled, sprawled in bed

The annual rate of hospitalization for spontaneous pneumothorax among persons 15 years of age or older in England is approximately 140 per million. One third of cases are primary, with no known previous pneumothorax or clinically apparent underlying lung disease.

For the patient who presents with a large primary pneumothorax (i.e. a pneumothorax with no clear underlying lung disease), there is little evidence to guide management. There is general agreement that the air in the pleural space should be removed.

The annual rate of hospitalization for spontaneous pneumothorax among persons 15 years of age or older in England is approximately 140 per million. One third of cases are primary, with no known previous pneumothorax or clinically apparent underlying lung disease.

For the patient who presents with a large primary pneumothorax (i.e. a pneumothorax with no clear underlying lung disease), there is little evidence to guide management. There is general agreement that the air in the pleural space should be removed.

The profile of major trauma is changing; the very young and the very old are now as likely to be victims of trauma as the middle-aged man in a road traffic injury or a youth victim of stabbing. This month’s

To the Editor: Cerebral tissues in human remains are rare archaeological discoveries. These tissues are typically saponified, meaning that their triglycerides have been converted to glycerol and fatty acid salts, or soap. In c.e. 79, a volcanic hot ash avalanche

In its modern form, injury prevention is about 60 years old.1 2 For all of this time injury prevention has been a leader in the field of academic public health. Injury prevention has led the way in multidisciplinary and transdisciplinary

Throughout the world, approximately 800,000 people die by suicide every year, accounting for 1.5% of all deaths. Suicide is the 10th leading cause of death in North America and the foremost cause of death worldwide among persons 15 to 24

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Climate change has been linked to changes in Atlantic hurricane behavior, making storms more destructive to the built environment and vital infrastructure, more harmful to the physical and mental health of island-based and coastal populations, and more deadly in their

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Vitamin D may improve outcomes in critically ill patients. Preclinical data suggest that vitamin D is a potent immunomodulatory agent that is essential for lung development and function. Observational data and initial clinical trial data indicate that vitamin D deficiency

Presentation of Case. Dr. Marcus T. Altman (Medicine): A 26-year-old woman with a history of migraines was evaluated in the emergency department of this hospital during the winter because of headache. Three weeks before this presentation, the patient had traveled

Vitamin D may improve outcomes in critically ill patients. Preclinical data suggest that vitamin D is a potent immunomodulatory agent that is essential for lung development and function. Observational data and initial clinical trial data indicate that vitamin D deficiency

As of December 12, 2019, the ongoing national outbreak of electronic-cigarette, or vaping, product use–associated lung injury (EVALI) has affected more than 2400 hospitalized patients across all 50 states, the District of Columbia, the U.S. Virgin Islands, and Puerto Rico.

Welcome to the January edition of the EMJ. A new decade starts a time of heavy clinical activity here in the UK, but despite that workload there is still much to learn and love about emergency medicine. This month sees

In accordance with the 2015 guidelines of the International Liaison Committee on Resuscitation (ILCOR), targeted temperature management with a target of 32°C to 36°C (moderate therapeutic hypothermia) is currently advocated for all patients with coma after successful resuscitation from cardiac…

Vitamin D may improve outcomes in critically ill patients. Preclinical data suggest that vitamin D is a potent immunomodulatory agent that is essential for lung development and function. Observational data and initial clinical trial data indicate that vitamin D deficiency

Migraine is a chronic disease characterized by episodic attacks of headache, sensitivity to light and sound, and nausea. The major classes of medications for acute migraine treatment are analgesics, including nonsteroidal antiinflammatory drugs, ergots, and triptans. Triptans have been the

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The primary goal of diagnostic testing for pulmonary embolism is to identify which patients should be treated with anticoagulant agents and which should not. The patients who should be treated are those who have pulmonary embolism that has a substantial

Large clinical trials involving patients with type 2 diabetes have shown that inhibitors of sodium–glucose cotransporter 2 (SGLT2) reduce the risk of hospitalization for heart failure. Most patients in these trials did not have heart failure at baseline, so the

Do we know what older patients want from emergency care? We are increasingly aware of the preponderance of older patients attending our emergency departments as well as the fact that they are often acutely unwell. It is heartening then to

One of the defining characteristics of a profession is that its members take responsibility for enabling, educating and training emerging professionals in their field. This education role goes hand-in-hand with a profession’s responsibility to monitor members’ adherence to ethical, technical

Acute upper airway obstruction is a life-threatening emergency and requires immediate assessment and intervention with little margin for error, making it a constant challenge for clinicians. Substantial advances have been made in preventive medicine, our understanding of the pathophysiology of…

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage.

Concerns have been raised about the risk of several neurodegenerative diseases, such as Alzheimer’s disease, amyotrophic lateral sclerosis, and chronic traumatic encephalopathy (CTE), associated with participation in contact sports. Recognition of the pathologic changes of CTE in former players who…

To the Editor: Despite the accumulating data on the clinical and imaging features of vaping-associated lung injury, its pathology is poorly understood. We reviewed lung biopsies from 17 patients (13 men; median age, 35 years [range, 19–67]), all of whom

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Concerns have been raised about the risk of several neurodegenerative diseases, such as Alzheimer’s disease, amyotrophic lateral sclerosis, and chronic traumatic encephalopathy (CTE), associated with participation in contact sports. Recognition of the pathologic changes of CTE in former players who…

Is it OK to close emergency departments? Many emergency physicians would be very concerned by any talk about closing Emergency Departments (EDs). We may have experienced it in our own regions, and we may have our own opinions about its

According to the American Heart Association, approximately 720,000 persons in the United States will have a first episode of an acute coronary syndrome and approximately 335,000 will have a recurrent coronary event in 2019. Dual antiplatelet therapy (an adenosine diphosphate

The opioid overdose crisis has claimed more than 400,000 lives in the United States since 1999. As part of efforts to reduce overdose deaths and increase enrollment in treatment, lawmakers in some states are contemplating enacting or expanding emergency hold

To the Editor: Lung injury associated with vaping — the use of electronic nicotine delivery systems (ENDS) — has been recognized in the medical literature, and a case series of such injuries is now published in the Journal. If vaping

To the Editor: Despite the accumulating data on the clinical and imaging features of vaping-associated lung injury, its pathology is poorly understood. We reviewed lung biopsies from 17 patients (13 men; median age, 35 years [range, 19–67]), all of whom

In accordance with the 2015 guidelines of the International Liaison Committee on Resuscitation (ILCOR), targeted temperature management with a target of 32°C to 36°C (moderate therapeutic hypothermia) is currently advocated for all patients with coma after successful resuscitation from cardiac…

To the Editor: Despite the accumulating data on the clinical and imaging features of vaping-associated lung injury, its pathology is poorly understood. We reviewed lung biopsies from 17 patients (13 men; median age, 35 years [range, 19–67]), all of whom

In October 2018, Alin Gragossian, an emergency medicine resident at Philadelphia’s Hahnemann University Hospital, developed a cough. She thought little of it until, a few months later, her attending physician on an ICU rotation noticed that she was stopping to

Background The use of the 12-lead ECG is common in UK paramedic practice but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but

My starting point for this discussion is where we left the topic in an editorial 12 months ago; that is, the need for more ‘Public involvement in the production, dissemination and implementation of injury prevention research.’1 In this issue, Jennifer

Five days after undergoing major surgery, Mr. Jackson is found to have a subsegmental pulmonary embolus, with symptoms for which no alternative diagnosis is found. Regardless of whether we consider this to be a symptomatic or incidental embolus, the patient

To the Editor: Pennsylvania legalized medical marijuana in 2016, and since then its use has skyrocketed. The doses of the active ingredients of marijuana — tetrahydrocannabinol (THC) and cannabidiol (CBD) — are not standardized, product concentrations are not regulated, and

To the Editor: Recent case clusters of a respiratory syndrome associated with e-cigarette use (vaping) have been identified, as now reported in the Journal by Layden et al. We describe clinical features of six cases in Utah that help characterize

Electronic cigarettes, or e-cigarettes, include a diverse group of battery-powered devices that allow users to inhale aerosolized substances. E-cigarette aerosol generally contains fewer toxic chemicals than conventional cigarette smoke. However, e-cigarette aerosol is not harmless; it can expose…

To the Editor: Recent case clusters of a respiratory syndrome associated with e-cigarette use (vaping) have been identified, as now reported in the Journal by Layden et al. We describe clinical features of six cases in Utah that help characterize

Presentation of Case. Dr. Hung M. Le (Pediatrics): A 16-year-old girl was seen in the sports concussion clinic at this hospital because of headache, dizziness, balance problems, fatigue, irritability, and difficulties with sleep and concentration after she had head trauma

Glucocorticoid replacement therapy, available since the 1950s, has prolonged the survival of patients with adrenal insufficiency. However, adrenal crises, which are life-threatening medical emergencies, still develop in many affected patients. Adrenal crisis appears to be increasing in frequency,…

Presentation of Case. Dr. Hung M. Le (Pediatrics): A 16-year-old girl was seen in the sports concussion clinic at this hospital because of headache, dizziness, balance problems, fatigue, irritability, and difficulties with sleep and concentration after she had head trauma

Presentation of Case. Dr. Andrew Cruz (Psychiatry): A 27-year-old woman was evaluated at this hospital because of a suicide attempt. Approximately 3 months before admission, the patient became homeless and was staying intermittently with friends. Two months before admission, she

Abstracts from international Emergency Medicine journals. Emerg Med J 2019;36:511–3. 10.1136/emermed-2019-208938. In this article under the journal Annals of Emergency Medicine, the title and author list was incorrect. The details were duplicated from the African Journal of Emergency Medicine. The Annals

Presentation of Case. Dr. Madhukar S. Patel (Surgery): A 41-year-old pregnant woman was seen in the emergency department of this hospital at 36 weeks 3 days of gestation because of abdominal pain. Six and a half months before this evaluation,

Presentation of Case. Dr. Kelsey Hills-Evans (Medicine): A 39-year-old woman with cyclic vomiting syndrome and polysubstance use disorder was seen in the emergency department of this hospital because of abdominal pain and vomiting. Eleven weeks before the current presentation, the

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows.

Presentation of Case. Dr. Lila M. Martin (Medicine): A 52-year-old man was transferred to this hospital for evaluation and treatment of hypoxemia. The patient had been in his usual state of health until 7 days before transfer to this hospital,

Diagnostic uncertainty and physician experience We commonly use chest x-ray (CXR) to diagnose community-acquired pneumonia (CAP) in the Emergency Department. The 2015 ESCAPED study found that in patients without parenchymal infiltrates on CXR, routine thoracic CT scan was positive for

Venous thromboembolism is common after major trauma. A prospective surveillance study involving 349 consecutive severely injured patients showed that without prophylactic anticoagulation, proximal deep-vein thrombosis occurred in 18% of patients, and pulmonary embolism occurred in 11%. More…

Drug-induced liver injury is an uncommon but challenging clinical problem with respect to both diagnosis and management. Its incidence is estimated to be 14 to 19 cases per 100,000 persons, with jaundice accompanying 30% of cases. Drug-induced liver injury is

Editorials throughout 2018 made explicit the journal’s editorial direction. In particular, we drew readers’ attention to the process of manuscript selection1 and the purpose selection was aiming to achieve.2 Rather than being a passive filtering process, editorial selection aims to

During my residency in emergency medicine, an attending physician watching me place a central venous catheter spoke up. “Don’t let go of the wire!” he warned. “Right,” I agreed. But secretly, I thought, “Why not? It’s not going anywhere.” I’ve

Reducing repeat emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions Paediatric Emergency medicine continues to evolve as a specialty around the world and with it, an increasing demand on those services, in the emergency

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“Not so hard!” howled the man with abdominal pain, his body tense against his stretcher. His skin looked sallow under the fluorescents illuminating the crowded emergency department (ED) hallway. My fingers had barely brushed his belly. Although we’d just met,

Figure 1.

“Not so hard!” howled the man with abdominal pain, his body tense against his stretcher. His skin looked sallow under the fluorescents illuminating the crowded emergency department (ED) hallway. My fingers had barely brushed his belly. Although we’d just met,

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Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or [is] described in terms of such damage” when there is no physical derangement. The function of pain is to protect the body by making

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Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or [is] described in terms of such damage” when there is no physical derangement. The function of pain is to protect the body by making

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Many scientific journals these days have taken to designating a particularly intriguing, important or extremely well done paper that appears in that month’s issue. At the EMJ, we actually have several such papers, and I was thinking that perhaps our

Results from randomised controlled trials make an important contribution to improvements in injury-related health. However, publication of findings from randomised controlled trials remains a rarity in the injury prevention literature. Increasing the quantity of randomised controlled trials research need not

Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to

A little perspective It’s a pleasure to open this issue of EMJ with a healthy dose of perspectiven our constant quest for more and more resources to deliver excellence in healthcare, it’s all too easy to lose sight of how

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It is 70 years since John Gordon wrote ‘The epidemiology of accidents’ in the American Journal of Public Health1 and 55 years since Haddon W Jr and colleagues edited the text book ‘Accident Research: Methods and Approaches’ published by Harper

Clinicians generally know that many practices persist in medicine without clear evidence to support them. One such example is the approach to endotracheal intubation of critically ill patients in the intensive care unit (ICU), where intubation is typically fraught with

More than 1.5 million patients undergo tracheal intubation each year in the United States. Up to 40% of tracheal intubations in the intensive care unit (ICU) are complicated by hypoxemia, which may lead to cardiac arrest and death. For critically

All you need is nitrous We are privileged to publish a wonderful randomised controlled trial this month. Seiler et al randomised children undergoing painful procedures under sedation with 70% nitrous oxide to receive additional intranasal fentanyl or a placebo. They

To the Editor: The drug-overdose epidemic has led to an increase in the number of organ donors dying from drug intoxication; this pattern is confined to the United States and has not been observed in Europe. Geographic disparity in the

Presentation of Case. Dr. Fabian J. Scheid: An 18-year-old male professional athlete was admitted to this hospital because of fevers, abdominal pain, and hematochezia. The patient had been well until 20 days before this admission, when fevers and pain in

On November 6, 2018, in response to a position paper on firearm injuries and death from the American College of Physicians, the National Rifle Association (NRA) fired off a tweet admonishing “self-important anti-gun doctors to stay in their lane.” Physicians

Best evidence topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to

With an average gross domestic product (GDP) growth of nearly 10% per year over the past few decades, China has demonstrated the most rapid sustained economic growth of any major economy in history. However, with economic growth has also come

We begin this primary in an unusual way, by pointing you to this month’s View from Here. There are a number of published and quite poignant accounts by physicians of what it’s like to put on that backless hospital gown

The phone rings in our emergency department. It’s a call from a community hospital, which is sending us a 70-year-old patient in need of an urgent procedure. His aortic endoprosthesis, inserted a few years back, appears to be out of

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The end of the year is a conventional time to take stock and assess ones performance over the preceding 12-month period. Comparisons are invariably the currency of these evaluations. Both the notion of evaluation, and the use of comparisons as

Palliative care in the ED Heart failure, a common presentation in the ED is associated with significant morbidity and mortality. This is a patient group that have a poor quality of life and would benefit from early palliative care but

Early revascularization has been shown to reduce mortality among patients with acute myocardial infarction that is complicated by cardiogenic shock. Most patients with cardiogenic shock present with multivessel coronary artery disease, which is associated with higher mortality than single-vessel…

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Matsuyama et al report on the characteristics and outcomes of accidental hypothermia. In total, 537 patients were finally included in the analysis, which makes it one of the largest patient cohorts on accidental hypothermia hitherto.1 Until now, most studies on

Background Accidental hypothermia (AH) has higher incidence and mortality in geriatric populations. Japan has a rapidly ageing population, and little is known about the epidemiology of hypothermia in this country. Methods We created an AH registry based on retrospective review

Accidental hypothermia has become much better understood over the last 25 years. Not only is it recognised that it significantly worsens the prognosis if it occurs alongside many medical conditions including major trauma1 2 and elective surgery,3 but it is

Aim The management of hypothermic casualties is a challenge faced by all prehospital and search and rescue (SAR) teams. It is not known how the practice of these diverse teams compare. The aim of this study was to review prehospital

It’s getting cold out there In this issue of the journal, you will note that we have a special focus on accidental hypothermia. In fact, we have no less than four articles covering this issue: two original articles and two

To the Editor: Head injury is associated with substantial morbidity and mortality, but the extent of the problem in the general U.S. population has not been well characterized. We studied a nationally representative sample in the United States from the

Presentation of Case. Dr. Jordan P. Bloom (Surgery): A 37-year-old man was admitted to the surgical intensive care unit (ICU) of this hospital because of a self-inflicted gunshot wound. The patient had been in his usual state of health until

Background The term ‘moral injury’ may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and

Objectives To discover if healthcare professionals working within an ED are able to make a diagnosis of female genital mutilation (FGM) in those patients who have previously undergone the procedure and report it as per UK law. Design A retrospective

Clinical introduction A 24-year-old Filipino man attended the ED with a 1-month history of a discrete swelling over his upper anterior chest wall that was rapidly increasing in size and tenderness. He denied any other symptoms. His medical history was unremarkable.

It is estimated that 200 million women have undergone female genital mutilation (FGM) and of these, 44 million are girls younger than 15.1 FGM is the removal of part or all of the female genitalia or organs for non-medical reasons

Female genital mutilation Female genital mutilation (FGM) may be more common than we think (see page 587). In 16 months a single UK hospital (with a low percentage of population from high-risk countries) identified 34 women in antenatal services who

Background Vietnam has prioritised the establishment of a civil registration system for deaths but as yet is unable to report accurate national statistics for the population of 93.5 million people due to inadequate mortality data. Verbal autopsy data suggest that

A review of the material published in Injury Prevention highlights the interdisciplinary nature of our field. From identifying the number and nature of injuries in different settings to implementing and evaluating the injury control measures we develop, a range of

The practice of injury prevention requires that each of us, as citizens and members of the public whose absolute risk of serious injury is low1 and who believe we are at lower risk than our peers,2 complies with principles and

Background Unintentional injuries are a leading reason for seeking emergency care. Refugees face vulnerabilities that may contribute to injury risk. We aimed to compare the rates of unintentional injuries in immigrant children and youth by visa class and region of

Objective To assess frequency, duration and costs of Medicaid conversions that occur when severe injury causes patients to enrol in Medicaid to pay their hospital bills. Once enrolled, Medicaid pays all their medical bills, not simply their injury bill. Data

Early revascularization has been shown to reduce mortality among patients with acute myocardial infarction that is complicated by cardiogenic shock. Most patients with cardiogenic shock present with multivessel coronary artery disease, which is associated with higher mortality than single-vessel…

The administration of epinephrine has been part of the resuscitation of patients with cardiac arrest since the 1960s. The rationale for the use of epinephrine includes evidence from studies in animals and from clinical trials in humans that increasing vasomotor

In attempting to reduce the rate of death and disability associated with cardiac arrest worldwide, emergency medical workers have few effective treatments other than early initiation of cardiopulmonary resuscitation (CPR) and prompt defibrillation. For more than 50 years, treatment strategies

Time is a critical determinant of patient eligibility for intravenous thrombolysis in acute stroke. In such patients, intravenous alteplase is routinely administered up to 4.5 hours after the onset of symptoms, but even within this window, earlier treatment leads to