There has been a rise in the number of studies relating to the role of artificial intelligence (AI) in healthcare. Its potential in Emergency Medicine (EM) has been explored in recent years with operational, predictive, diagnostic and prognostic emergency department
Highlights from this issue
In this month’s EMJ and associated Commentary we address the hotly debated topic of sepsis guidelines in the Emergency Department. Clinicians are under significant pressure to identify abnormal physiology and initiate treatment within 1 hour of arrival. However in Sabir
Lessons for injury epidemiology and control learned from the COVID-19 pandemic
In October 2021, the Organisation for Economic Co-operation and Development organised a virtual event on ‘Priority setting and coordination of research agendas: lessons learnt from the COVID-19 pandemic’.1 Over 4 days, the event addressed key issues around data collection, development
Highlights from this issue
Crowding kills As journal Editors we keep a keen eye on Altmetric scores, the weighted count of online attention that the articles we publish gain across mainstream news, social networks and blogs. This month two articles have received unprecedented attention
Infobugs: agent for contagious transmission of violence, suicide and other social events
The 2020–2021 was an unprecedented time, where the world experienced not one, but two major pandemics: COVID-19 and the incredible spread of violence. Both these pandemics profoundly impacted society as a whole and will have long-lasting consequences and implications for
Highlights from this issue
Welcome to the February 2022 issue of the Emergency Medicine Journal. COVID-19 continues to dominate headlines and remains important to our practice. In this issue, we have published four more articles relating to COVID-19. In addition, we have four valuable
Highlights from this issue
This first Primary Survey of 2022 marks the two-year anniversary of our awareness of SARS COVI-2 as a worldwide threat and one year since we began vaccinations. In this relatively short time frame, we have learnt a great deal about
Carpal bone fracture not to be missed
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
Is science still credible currency for decision-makers?
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
New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race
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
Call for emergency action to limit global temperature increases, restore biodiversity and protect health
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
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
Toxic Effects from Ivermectin Use Associated with Prevention and Treatment of Covid-19
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
Data in Crisis — Rethinking Disaster Preparedness in the United States
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
Intracardiac Cement Embolism
Figure 1.
Myocarditis after Covid-19 Vaccination in a Large Health Care Organization
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
Hard to Swallow
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
New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race
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
Grand challenges and global solutions: where does injury prevention fit in?
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?
Highlights from this issue
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
Treatment of Acute Uncomplicated Appendicitis
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.
Does My District Need a Mobile Stroke Unit?
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
Data in Crisis — Rethinking Disaster Preparedness in the United States
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
Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation
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
Hypervirulent Klebsiella pneumoniae
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
01 The effects of a leaflet-based intervention, ‘hypos can strike twice, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study
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
Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock
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
Establishing Medical Civil Rights
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
Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock
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
Establishing Medical Civil Rights
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
Substance Use among Men Who Have Sex with Men
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
Comminuted Lumbar Vertebral Fracture
Figure 1.
Covering the territory: can Injury Prevention do better?
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
Highlights from this issue
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
Case 21-2021: A 33-Year-Old Pregnant Woman with Fever, Abdominal Pain, and Headache
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
Comminuted Lumbar Vertebral Fracture
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
Immunotherapy for MIS-C — IVIG, Glucocorticoids, and Biologics
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
Nasal Cauterization with Silver Nitrate for Recurrent Epistaxis
Combating Anti-Asian Sentiment — A Practical Guide for Clinicians
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
BET 1: Everything in graduation: arterial/end-tidal CO2 gradient and the diagnosis of pulmonary embolism
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
Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest
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…
Immunotherapy for MIS-C — IVIG, Glucocorticoids, and Biologics
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
What Did I Sign Up For?
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
Audio Interview: Vaccinating Children
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
Intraocular Lens Dislocation
Figure 1.
Injury prevention decision science
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
Correction: 274 Thrombotic complications in patients with COVID-19 requiring hospitalisation: a single centre prospective service evaluation
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
Case 15-2021: A 76-Year-Old Woman with Nausea, Diarrhea, and Acute Kidney Failure
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
Thyrotoxic Periodic Paralysis
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
Audio Interview: India’s Covid-19 Crisis
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
Australian Firearm Regulation at 25 — Successes, Ongoing Challenges, and Lessons for the World
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
Establishing Medical Civil Rights
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
Audio Interview: Covid-19 Vaccines and Pregnancy — A Conversation with CDC Director Rochelle Walensky
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
Highlight from this issue
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
Race, Policing, and History — Remembering the Freedom House Ambulance Service
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
Audio Interview: Antibody Responses to Natural Infection and Vaccination
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
Audio Interview: Delivering Covid-19 Vaccines to Minority Communities
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
Case 9-2021: A 16-Year-Old Boy with Headache, Abdominal Pain, and Hypertension
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
Navigation apps are becoming a threat to road safety (beyond distraction)
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
Highlights from this issue
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
Audio Interview: Efficacy of Current Covid-19 Vaccines against Variant Viruses
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
No More Surprises — New Legislation on Out-of-Network Billing
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
Case 7-2021: A 19-Year-Old Man with Shock, Multiple Organ Failure, and Rash
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
Five-Year Outcomes of PFO Closure or Antiplatelet Therapy for Cryptogenic Stroke
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
Use of ICD-10-CM coded hospitalisation and emergency department data for injury surveillance
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
Audio Interview: A New SARS-CoV-2 Vaccine and a New Look at Treatment
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 Inequity of Isolation
“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
Case 6-2021: A 65-Year-Old Man with Eye Pain and Decreased Vision
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
Warming Up to Cold Perfusion
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
Highlights from this issue
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
Duration of Culturable SARS-CoV-2 in Hospitalized Patients with Covid-19
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…
Management of Antithrombotic Therapy after Acute Coronary Syndromes
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…
A Pulsating Leg
Figure 1.
Duration of Culturable SARS-CoV-2 in Hospitalized Patients with Covid-19
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…
Case 2-2021: A 26-Year-Old Pregnant Woman with Ventricular Tachycardia and Shock
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
Incarceration and Social Death — Restoring Humanity in the Clinical Encounter
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
Public health emergency changed the way we work
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
Correction: Elderly woman with headache
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
Left Ventricular Rupture
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…
Doctor as Street-Level Bureaucrat
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”
Left Ventricular Rupture
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…
Open-Book Pelvic Fracture
Figure 1.
Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden
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
Audio Interview: A Look at Covid-19 Prevention and Care in 2020
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
Highlights from this issue
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
Hearing Music while Checking a Pulse
Figure 1.
Racial Bias in Pulse Oximetry Measurement
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,
How Structural Racism Works — Racist Policies as a Root Cause of U.S. Racial Health Inequities
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.
Case 38-2020: A 52-Year-Old Man with Cancer and Acute Hypoxemia
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 Death of Daniel Prude — Reflections of a Black Neurosurgeon
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
The Bottom of the Health Care Rationing Iceberg
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
Cytokine Storm
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
The Bottom of the Health Care Rationing Iceberg
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
Cytokine Storm
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
The Bottom of the Health Care Rationing Iceberg
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
Cytokine Storm
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
The Bottom of the Health Care Rationing Iceberg
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
Wildfires, Global Climate Change, and Human Health
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
Highlights from this issue
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
Twenty-five years ago
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,
Wandering Spleen
Figure 1.
The Death of Daniel Prude — Reflections of a Black Neurosurgeon
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
Percutaneous Tracheostomy
SARS-CoV-2 Transmission among Marine Recruits during Quarantine
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
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
Auricular Hematoma
Figure 1.
Elective Surgery during the Covid-19 Pandemic
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.
Percutaneous Tracheostomy
Highlights from this issue
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
Covid-19 Molecular Diagnostic Testing — Lessons Learned
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
Case 32-2020: A 63-Year-Old Man with Confusion, Fatigue, and Garbled Speech
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).
Wildfires, Global Climate Change, and Human Health
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
Audio Interview: Covid-19 Testing and the Individual Physician
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
01 Major trauma triage tools study (MATTS) triage tools summary
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
Case 30-2020: A 54-Year-Old Man with Sudden Cardiac Arrest
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,
Injury prevention: maturation of the field
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
Drone Delivery of an Automated External Defibrillator
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…
Penetrating Injuries from “Less Lethal” Beanbag Munitions
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,
Naegleria fowleri
Figure 1.
Penetrating Injuries from “Less Lethal” Beanbag Munitions
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,
New Order, New Hope
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
A Curve Ball
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.
Taking Black Pain Seriously
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
Highlights from this issue
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
Traumatic Vascular Injury to the Hand
Figure 1.
Penetrating Injuries from “Less Lethal” Beanbag Munitions
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,
Caught in a Flare
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. . . .
Evaluation of an Unsanctioned Safe Consumption Site in the United States
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
Led Astray
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.
Evaluation of an Unsanctioned Safe Consumption Site in the United States
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
Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy
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
Covid-19 Crisis Triage — Optimizing Health Outcomes and Disability Rights
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
Highlights from this issue
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
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
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,…
Let me count that again
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
Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
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,
Acute Ischemic Stroke
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.
The Climate Crisis and Covid-19 — A Major Threat to the Pandemic Response
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
Case 21-2020: A 66-Year-Old Homeless Man with Covid-19
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
Audio Interview: A Covid-19–Related Syndrome in Children
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
Highlights from this issue
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
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
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,…
Salicylate Toxicity
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
Guillain–Barré Syndrome Associated with SARS-CoV-2
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
Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19
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…
Audio Interview: The Impact of Covid-19 on Minority Communities
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
Neurologic Features in Severe SARS-CoV-2 Infection
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
Highlights from this issue
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
How to Obtain a Nasopharyngeal Swab Specimen
Surgery Scheduling in a Crisis
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 with or without Intravenous Alteplase in Acute Stroke
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
After COVID-19, business as usual: is this the right goal?
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
Covid-19 Crisis Triage — Optimizing Health Outcomes and Disability Rights
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
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young
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
Collateral Effect of Covid-19 on Stroke Evaluation in the United States
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
Late-Onset Neonatal Sepsis in a Patient with Covid-19
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
Thrombolysis before Thrombectomy — To Be or DIRECT-MT?
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
Highlights from this issue
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
Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19
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
Virtually Perfect? Telemedicine for Covid-19
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
Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy
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
Audio Interview: Approaches to Covid-19 Vaccines and Antivirals
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,
French Pandemic Resistance
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
ST-Segment Elevation in Patients with Covid-19 — A Case Series
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
An Uncomplicated Delivery in a Patient with Covid-19 in the United States
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
Neurologic Features in Severe SARS-CoV-2 Infection
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
AI for the Eye — Automated Assistance for Clinicians Screening for Papilledema
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…
Case 11-2020: A 37-Year-Old Man with Facial Droop, Dysarthria, and Kidney Failure
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
Barrier Enclosure during Endotracheal Intubation
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
An Uncomplicated Delivery in a Patient with Covid-19 in the United States
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
Preexcited Atrial Fibrillation after a Blood Draw
Figure 1.
Festina Lente
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
Fair Allocation of Scarce Medical Resources in the Time of Covid-19
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
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…
Highlights from this issue
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
Opioid Prescribing in the Midst of Crisis — Myths and Realities
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
Am I Part of the Cure or Am I Part of the Disease? Keeping Coronavirus Out When a Doctor Comes Home
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
Against Medical Advice
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
Audio Interview: Making Decisions about Covid-19 Testing and Treatment for Your Patients
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,
Against Medical Advice
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
Audio Interview: What Clinicians Need to Know in Diagnosing and Treating Covid-19
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,
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Final Report
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…
The Modern Epidemic of Syphilis
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
Medical Journals and the 2019-nCoV Outbreak
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
The Modern Epidemic of Syphilis
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
Medical Journals and the 2019-nCoV Outbreak
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
Highlights from this issue
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
A Novel Coronavirus from Patients with Pneumonia in China, 2019
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
Stalled Federal Efforts to End Surprise Billing — The Role of Private Equity
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
Case 5-2020: A 32-Day-Old Male Infant with a Fall
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
Joining Forces against Delirium — From Organ-System Care to Whole-Human Care
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
Conservative versus Interventional Treatment for Spontaneous Pneumothorax
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.
Clearing the Air — A Conservative Option for Spontaneous Pneumothorax
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.
Conservative versus Interventional Treatment for Spontaneous Pneumothorax
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.
Clearing the Air — A Conservative Option for Spontaneous Pneumothorax
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.
Highlights from this issue
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
Heat-Induced Brain Vitrification from the Vesuvius Eruption in c.e. 79
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
Intelligence in injury prevention: artificial and otherwise
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
Suicide
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
Crazy Paving in Pulmonary Alveolar Proteinosis
Figure 1.