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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,

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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,

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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

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

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

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