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Clinical introduction A young patient presented to the emergency department after a fight in which he sustained an injury to his right hand by punching. On clinical examination, there were no lacerations; there was noticeable swelling on the ulnar side

We all know a colleague, or maybe we have experienced it ourselves. We have clear scientific evidence to support a particular action but when we present this evidence to decision-makers, they ignore it. Inglorious examples can be found in recent

The glomerular filtration rate (GFR) is generally estimated from serum concentrations of endogenous filtration markers such as creatinine or cystatin C. During the past two decades, automated clinical laboratory reporting of GFR estimated with the use of creatinine (eGFRcr) has

Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the

Point-of-care ultrasonography (POCUS) is defined as the acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging performed by a treating clinician at the patient’s bedside rather than by a radiologist or cardiologist. POCUS is an inclusive term; it is not

To the Editor: Ivermectin is approved by the Food and Drug Administration as an oral treatment for intestinal strongyloidiasis and onchocerciasis and as a topical treatment for pediculosis and rosacea. It is also used as a treatment for parasites in

In 2017, Hurricane Maria’s devastating impact in Puerto Rico exposed significant flaws in the U.S. medical and public health response to natural disasters. The majority of the nearly 3000 excess deaths caused by the hurricane were attributable not to its

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In Israel, a nationwide campaign to administer the BNT162b2 messenger RNA (mRNA) vaccine (Pfizer–BioNTech) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started on December 20, 2020. By May 5, 2021, a total of 58.2% of the Israeli population had

A 20-year-old woman is admitted to the hospital after presenting to the emergency department with pain in her throat and the left side of her neck, fever, foul-smelling breath, and an inability to clear secretions. She reports three recent bouts

The glomerular filtration rate (GFR) is generally estimated from serum concentrations of endogenous filtration markers such as creatinine or cystatin C. During the past two decades, automated clinical laboratory reporting of GFR estimated with the use of creatinine (eGFRcr) has

While the burden of injury is large, injury does not feature on most people’s list of global grand challenges—climate change, equity, ageing, racism, human rights, poverty, COVID-19. Each person’s ‘grand challenge list’ is different. What is yours? Does injury feature?

Evidence and mass casualty events “I sat among the dead, dying and those fighting for life, I observed the pain and suffering and endured my own. I need to hear the truth to be able to move forward and I

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 authors’ clinical recommendations. Stage.

In their article in this issue of the Journal on emergency medical response in cases of stroke, Grotta and colleagues report several positive findings for mobile stroke units in comparison with conventional medical service ambulances. These include 22% greater access

In 2017, Hurricane Maria’s devastating impact in Puerto Rico exposed significant flaws in the U.S. medical and public health response to natural disasters. The majority of the nearly 3000 excess deaths caused by the hurricane were attributable not to its

The prognosis in patients who have out-of-hospital cardiac arrest is poor, with a mortality of up to 65% even among those who undergo successful resuscitation and admission to the hospital. Acute coronary syndrome accounts for up to 60% of out-of-hospital

A 45-year-old man with type 2 diabetes mellitus presented to the ophthalmology clinic with a 5-day history of pain and decreased vision in his left eye. His temperature was 39.2°C, and his pulse was 144 beats per minute. Examination of

Background Hypoglycaemia is a common complication of diabetes therapy needing prompt recognition and treatment. It often results in ambulance attendance incurring health services costs and patient morbidity. Patient education is important for maintaining glycaemic control and preventing recurrent hypoglycaemia. We

Cardiogenic shock is defined as a state of low cardiac output resulting in clinical and biochemical manifestations of end-organ hypoperfusion. Although emergency revascularization has been shown to reduce the risk of death in patients with myocardial infarction complicated by cardiogenic

If physicians were to amend the U.S. Constitution, the right to health care would almost certainly be guaranteed. Although the Constitution’s preamble offers the assurance of “general welfare,” the omission of an explicit right to health care from both the

Cardiogenic shock is defined as a state of low cardiac output resulting in clinical and biochemical manifestations of end-organ hypoperfusion. Although emergency revascularization has been shown to reduce the risk of death in patients with myocardial infarction complicated by cardiogenic

If physicians were to amend the U.S. Constitution, the right to health care would almost certainly be guaranteed. Although the Constitution’s preamble offers the assurance of “general welfare,” the omission of an explicit right to health care from both the

In recent years, the social acceptance of and legal protections extended to persons in sexual minority groups have been increasing in many countries, including the United States. Despite this progress, stigma, discrimination, and structural barriers to services persist, causing health

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The field of injury prevention has long struggled with the ‘splitting versus clumping’ dilemma. The most obvious example of this is our highlighting the burden of the injury as a whole (which is ever so much more a compelling figure

Welcome back to the latest edition of the EMJ. It’s high Summer here in the Northern Hemisphere and our hopes that COVID-19 would be a distant memory by now are sadly broken. We are in wave n+1 at the moment

Presentation of Case. Dr. Kathy M. Tran: A 33-year-old pregnant woman with ulcerative colitis was admitted to this hospital during the summer at 10 weeks of gestation because of fever, nausea, vomiting, abdominal pain and tenderness, and headache. The patient

A 19-year-old woman presented to the emergency department with a single gunshot wound to the abdomen. Her blood pressure was 99/58 mm Hg, and her heart rate was 93 beats per minute. On examination, she was unable to move her

Since the sudden emergence of multisystem inflammatory disease in children (MIS-C) in April 2020 as a novel and severe presentation of coronavirus disease 2019 (Covid-19), nearly 4000 cases of MIS-C and 35 deaths have been reported in the United States

Since March 2020, Asian Americans have experienced an alarming increase in racial discrimination and racially motivated violence. Commentators have attributed this distressing fact to the blame placed on China for causing the Covid-19 pandemic, given that the virus was initially

A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2. Three papers were selected to answer

International guidelines recommend targeted temperature management to prevent hypoxic–ischemic brain damage in patients with coma after cardiac arrest. The evidence to support these recommendations originated in trials involving patients who had been resuscitated from out-of-hospital cardiac arrest…

Since the sudden emergence of multisystem inflammatory disease in children (MIS-C) in April 2020 as a novel and severe presentation of coronavirus disease 2019 (Covid-19), nearly 4000 cases of MIS-C and 35 deaths have been reported in the United States

To say that the Covid-19 pandemic has changed all our lives dramatically is an understatement. The population of North Philadelphia is no exception. In a city where gun violence was rampant before Covid, bloodshed has only increased with the upheaval

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

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I have not met an executive yet, who thinks they are poor decision-makers. I have not met many scientists who do not believe that data speak for themselves. From an executive’s perspective, poor decisions are simply the consequence of flawed

In this meeting abstract the author Wadhi Habeichi’ should have been listed as ‘Wadih Habeichi’. Habeichi W, Bell J, Khawaja Z, et al. 274 Thrombotic complications in patients with COVID-19 requiring hospitalisation: a single centre prospective service evaluation. Emerg Med J

Presentation of Case. Dr. Arielle J. Medford: A 76-year-old woman with heart failure and type 2 diabetes mellitus was admitted to this hospital with nausea, diarrhea, and acute kidney failure. The patient normally lived independently, but she had been staying

A 25-year-old man presented to the emergency department with a sudden onset of weakness in his arms and legs. He reported a 3-month history of intermittent arm and leg weakness, palpitations, trembling, and insomnia. On examination, he had a heart

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

Twenty-five years ago, on Sunday, April 28, 1996, a 28-year-old man used a Colt AR-15 semiautomatic rifle to kill 35 people in the quiet tourist town of Port Arthur, tucked away in the southeast corner of Tasmania, a small island

If physicians were to amend the U.S. Constitution, the right to health care would almost certainly be guaranteed. Although the Constitution’s preamble offers the assurance of “general welfare,” the omission of an explicit right to health care from both 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

This edition of the Emergency Medicine Journal has ‘something for everyone’ (as always), and at least one article that will be of interest to everyone (I think). The two main themes in this edition are ‘the difficult airway’ and Paediatric

Americans protesting violent policing of Black communities are calling for law-enforcement budgets to be reallocated to community health services. Although such proposals are sometimes dismissed as naive or unrealistic, history provides an example of a transfer of power and resources

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

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

Presentation of Case. Dr. Neil D. Fernandes (Pediatrics): A 16-year-old boy was admitted to this hospital because of headache, nausea, vomiting, and abdominal pain. The patient had been well until 17 months before this admission, when he began to have

Road trauma is a pervasive threat to global health and sustainable development. It is estimated that over 1.3 million people die every year in road crashes worldwide, while a further 20–50 million are injured.1 Unequivocally, road safety is an important

Barriers to saving lives in OOHCA The Editor’s choice this month is a retrospective study assessing the barriers to effective dispatcher-assisted CPR when bystanders called the emergency medical services in China. The study found a median of 30 minutes delay

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

The passage of the No Surprises Act — which banned “surprise billing” in many scenarios — on December 27, 2020, was an unexpected step forward during an otherwise dysfunctional year of U.S. policymaking. As many as one in five patients

Presentation of Case. Dr. Alexandra T. Lucas (Pediatrics): A 19-year-old man was admitted to the pediatric intensive care unit (PICU) of this hospital because of shock, multiple organ failure, and rash. The patient had been well until 20 hours before

To the Editor: Closure of a patent foramen ovale (PFO) has been shown to reduce the risk of recurrent stroke in selected patients. Data on outcomes of PFO closure in patients who were followed for a median of 5.9 years

Injury surveillance, the ongoing, systematic collection, analysis, interpretation and dissemination of injury data, provides critical information to support public health efforts to reduce injury-related morbidity, mortality and disability.1 2 For the past several decades, state and local health departments and

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

“Cradle to grave” — that is the promise and privilege of family medicine: the opportunity to care for individuals and families at every stage of life. For a family medicine intern, this privilege has a slightly different flavor. It’s the

Presentation of Case. Dr. Bart K. Chwalisz: A 65-year-old man was admitted to this hospital because of bilateral eye pain and decreased vision. The patient had been in his usual state of health until 8 days before this admission, when

Each year, thousands of people in the United States die while awaiting lifesaving liver transplantation because there is an insufficient supply of donor organs. This crisis has prompted increased interest in expanding the organ supply through the promotion of both

From an Editorial perspective, this month’s EMJ makes for very happy reading. The quality and breadth of original and clinically relevant research within this issue is fantastic. From large observational analyses, qualitative research embedded within multicentre clinical trials and original

To The Editor: The duration of transmissibility of coronavirus disease 2019 (Covid-19) and the associated level of contagion have been uncertain. We cultured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in serial respiratory samples obtained from hospitalized patients with Covid-19…

Because of rapidly changing guidelines in response to multiple clinical trials of new therapies, the management of antithrombotic agents for patients after an acute coronary syndrome is becoming increasingly complex. Patients and clinicians must make treatment decisions by weighing the…

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To The Editor: The duration of transmissibility of coronavirus disease 2019 (Covid-19) and the associated level of contagion have been uncertain. We cultured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in serial respiratory samples obtained from hospitalized patients with Covid-19…

Presentation of Case. Dr. Sunu S. Thomas: A 26-year-old pregnant woman was transferred to this hospital for evaluation and treatment of cardiogenic shock after a cardiac arrest resulting from ventricular tachycardia. The patient had had two previous uncomplicated pregnancies and

Mr. S. a 28-year-old Black man, arrived at our emergency department (ED) by ambulance after exhibiting altered mental status and agitation in jail. While in solitary confinement for 4 days, he repeatedly and unsuccessfully sought the attention of the medical

The public health emergency changed the way we work, shop, access education and interact socially. It has also changed the way we travel. Understanding the results of those changes in travel behaviour is an evolving process that benefits from the

Lee K, Lee W. Elderly woman with headache. Emerg Med J 2020;37:466–79. In the answer part of this Image challenge, the correct answer option was mistakenly listed as ‘D. Tongue Cancer’. It has now been revised to the correct answer

A 72-year-old woman with hypertension presented to a local hospital with a 5-day history of nausea, sharp epigastric pain, shortness of breath, and malaise. Electrocardiography revealed anterolateral ST-segment elevations, which prompted her transfer to a tertiary care facility for primary…

One slow afternoon in urgent care, the triage nurse came and found me in the doctors’ room to tell me a patient had arrived. He handed me a vitals sheet, wrote the patient’s initials on the white board with “pneumonia”

A 72-year-old woman with hypertension presented to a local hospital with a 5-day history of nausea, sharp epigastric pain, shortness of breath, and malaise. Electrocardiography revealed anterolateral ST-segment elevations, which prompted her transfer to a tertiary care facility for primary…

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To the Editor: In mid-March 2020, many countries decided to close schools in an attempt to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (Covid-19). Sweden was one of the few

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

Winter is now in full swing in the Northern Hemisphere as we deal with the continuing impact of COVID-19 combined with the usual stresses of these darker months. This month the journal reflects our current trials as we feature papers

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To the Editor: Oxygen is among the most frequently administered medical therapies, with a level that is commonly adjusted according to the reading on a pulse oximeter that measures patients’ oxygen saturation. Questions about pulse oximeter technology have been raised,

In the 5 years since one of us published “#BlackLivesMatter — A Challenge to the Medical and Public Health Communities” in the Journal, we have seen a sea change in the recognition of racism as a durable feature of U.S.

Presentation of Case. Dr. Margaret B. Allison (Medicine): A 52-year-old man was urgently evaluated because of hypoxemia that occurred on the fifth day he was at this hospital for suspected cancer. The patient had been in his usual state of

The email message’s first words — “Daniel Prude. Say his Name.” — seemed to tell me all I needed to know. Then, my heart racing, I learned that Prude was murdered in my city, where he’d been admitted to my

A stink filled the room as my patient eased coal-black toes out of his shoes. After spending winter nights in a tattered sleeping bag behind a local grocery store, he had developed frostbite and then gangrene. In the hospital, we

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has reminded us of the critical role of an effective host immune response and the devastating effect of immune dysregulation. This year marks 10 years since the first description of a

A stink filled the room as my patient eased coal-black toes out of his shoes. After spending winter nights in a tattered sleeping bag behind a local grocery store, he had developed frostbite and then gangrene. In the hospital, we

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has reminded us of the critical role of an effective host immune response and the devastating effect of immune dysregulation. This year marks 10 years since the first description of a

A stink filled the room as my patient eased coal-black toes out of his shoes. After spending winter nights in a tattered sleeping bag behind a local grocery store, he had developed frostbite and then gangrene. In the hospital, we

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has reminded us of the critical role of an effective host immune response and the devastating effect of immune dysregulation. This year marks 10 years since the first description of a

A stink filled the room as my patient eased coal-black toes out of his shoes. After spending winter nights in a tattered sleeping bag behind a local grocery store, he had developed frostbite and then gangrene. In the hospital, we

The world has already observed many devastating effects of human-induced climate change. A vivid manifestation is the several large wildfires that have occurred recently — in some cases, fires of unprecedented scale and duration — including wildfires in Australia in

Welcome to the December edition of Emergency Medicine Journal, the final one for 2020. This has been an ‘interesting’ year for Emergency Physicians and their departments, with many changes to working practices. We hope you are keeping well in these

The first issue of Injury Prevention appeared in March 1995. Its birth followed a tough gestation, but with the support of Alex Williamson and the blessings of Richard Smith, the BMJ Publishing group brought it to life. With much pride,

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The email message’s first words — “Daniel Prude. Say his Name.” — seemed to tell me all I needed to know. Then, my heart racing, I learned that Prude was murdered in my city, where he’d been admitted to my

Prospective studies may be useful to inform strategies to mitigate the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly in group settings among young adults. U.S. Department of Defense installations have implemented recommended public health interventions.…

Migraine is a ubiquitous neurologic disorder that is estimated to affect approximately 1 billion people worldwide, predominantly females. According to the Global Burden of Disease Study 2016, migraine is the second leading cause of disability and accounts for more disability

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In the scenario described in the vignette, it is perfectly reasonable to continue scheduling elective surgical procedures. The vignette states that the rate of new Covid-19 cases is 30 cases per day per 100,000 people, expressed as a 7-day average.

Headlines Every year approximately 1.4 million people attend the ED in the UK with a head injury. The National Institute for Health and Care Excellence (NICE) recommends routine CT imaging of all patients with mild head injury taking anticoagulants within

On February 4, 2020, the U.S. secretary of health and human services declared that emergency use of diagnostics for SARS-CoV-2 was justified, triggering emergency authority for the Food and Drug Administration (FDA) to grant an emergency use authorization (EUA) for

Presentation of Case. Dr. Kevin L. Ard: A 63-year-old man was evaluated at this hospital in the spring because of fever, confusion, headache, garbled speech, fatigue, vision changes, lymphocytic pleocytosis, and an elevated protein level in the cerebrospinal fluid (CSF).

The world has already observed many devastating effects of human-induced climate change. A vivid manifestation is the several large wildfires that have occurred recently — in some cases, fires of unprecedented scale and duration — including wildfires in Australia in

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

Introduction The aim of this project is to identify major trauma triage tools currently in use by ambulance services in England, Wales and internationally and subsequently complete a detailed document analysis of these tools. The review will aim to detect

Presentation of Case. Dr. Jacqueline B. Henson (Medicine): A 54-year-old man was evaluated at this hospital after cardiac arrest associated with ventricular fibrillation. The patient had been in his usual state of health until midday on the day of admission,

One of the privileges of being the editor of Injury Prevention is the opportunity to read 600 or so prepublication reports of the latest research in the injury prevention field—each year, year in year out. After some years of doing

To the Editor: Every year, an estimated 350,000 persons in the United States have an out-of-hospital cardiac arrest; only approximately 10% survive. The probability of survival doubles when a bystander administers cardiopulmonary resuscitation (CPR) and uses an automated external defibrillator…

To the Editor: In the spring of 2020, after the death of George Floyd in police custody, protests against racial injustice and police brutality broke out across the country. In Austin, Texas, tensions culminated in 2 days of vigorous protest,

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To the Editor: In the spring of 2020, after the death of George Floyd in police custody, protests against racial injustice and police brutality broke out across the country. In Austin, Texas, tensions culminated in 2 days of vigorous protest,

In the simpler times before Covid-19, I used to play a game with medical students who joined me in the operating room. “There’s a giant flood coming that will devastate the earth and its inhabitants. You’ve got a big boat

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.

The 40-something father and husband had fallen down the stairs 2 weeks earlier and was reporting chest pain and difficulty breathing. He’d already sought care at two other facilities. An x-ray obtained during his first visit was negative for rib

Community care? Our Editor’s Choice this month explores a novel approach to care delivery, the Physician Response Unit (PRU), which aims to reduce ED attendances by finding a community solution to the emergency complaint. Joy and colleagues’ retrospective analysis of

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To the Editor: In the spring of 2020, after the death of George Floyd in police custody, protests against racial injustice and police brutality broke out across the country. In Austin, Texas, tensions culminated in 2 days of vigorous protest,

A 24-year-old woman presented to her primary care doctor with a 1-month history of worsening fatigue, diffuse arthralgias, a rash on her face and arms, and swelling in her legs. She also reported frequent urination. . . .

To the Editor: Nearly 70,000 people in the United States die each year from a drug overdose. Opioid-involved overdose deaths may be preventable by the timely administration of naloxone. Eleven countries have responded to health concerns regarding people who use

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.

To the Editor: Nearly 70,000 people in the United States die each year from a drug overdose. Opioid-involved overdose deaths may be preventable by the timely administration of naloxone. Eleven countries have responded to health concerns regarding people who use

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

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

The human connection When writing this primary survey under the cloud of COVID-19, it is encouraging to see so many excellent papers being submitted to EMJ knowing that many of these have been written and re written in a time

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,…

How much data are enough? How accurate do they have to be before they are useful? Do data have to be collected from us for them to be relevant to me? Well, it depends, on a lot of things, but

Among patients with an acute ischemic stroke or transient ischemic attack (TIA), the risk of a subsequent ischemic stroke is approximately 5 to 10% in the first few months. Aspirin has been used to prevent a stroke in these patients,

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.

Just as an active 2020 Atlantic hurricane season is getting under way, the entire U.S. hurricane coast, from Texas to the Carolinas, is witnessing explosive outbreaks of Covid-19 cases in communities where physical distancing restrictions have been eased. As an

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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Figure 1.

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

Figure 1.

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.