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.
Axillary Artery Occlusion after TAVR
Figure 1.
Double Environmental Injustice — Climate Change, Hurricane Dorian, and the Bahamas
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
Crepitus and Subcutaneous Emphysema
Figure 1.
Early High-Dose Vitamin D3 for Critically Ill, Vitamin D–Deficient Patients
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
Case 40-2019: A 26-Year-Old Returning Traveler with Headache
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
Early High-Dose Vitamin D3 for Critically Ill, Vitamin D–Deficient Patients
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
Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI
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.
Highlights from this issue
Welcome to the January edition of the EMJ. A new decade starts a time of heavy clinical activity here in the UK, but despite that workload there is still much to learn and love about emergency medicine. This month sees
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
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…
Early High-Dose Vitamin D3 for Critically Ill, Vitamin D–Deficient Patients
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
Ubrogepant for the Treatment of Migraine
Migraine is a chronic disease characterized by episodic attacks of headache, sensitivity to light and sound, and nausea. The major classes of medications for acute migraine treatment are analgesics, including nonsteroidal antiinflammatory drugs, ergots, and triptans. Triptans have been the
Retinal Hemorrhage from Blunt Ocular Trauma
Figure 1.
Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability
The primary goal of diagnostic testing for pulmonary embolism is to identify which patients should be treated with anticoagulant agents and which should not. The patients who should be treated are those who have pulmonary embolism that has a substantial
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction
Large clinical trials involving patients with type 2 diabetes have shown that inhibitors of sodium–glucose cotransporter 2 (SGLT2) reduce the risk of hospitalization for heart failure. Most patients in these trials did not have heart failure at baseline, so the
Highlights from this issue
Do we know what older patients want from emergency care? We are increasingly aware of the preponderance of older patients attending our emergency departments as well as the fact that they are often acutely unwell. It is heartening then to
Professional education in the field of injury prevention
One of the defining characteristics of a profession is that its members take responsibility for enabling, educating and training emerging professionals in their field. This education role goes hand-in-hand with a profession’s responsibility to monitor members’ adherence to ethical, technical
Acute Upper Airway Obstruction
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…
Acute Severe Hypertension
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.
Neurodegenerative Disease Mortality among Former Professional Soccer Players
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…
Pathology of Vaping-Associated Lung Injury
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
Posterior-Wall Myocardial Infarction
Figure 1.
Neurodegenerative Disease Mortality among Former Professional Soccer Players
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…
Highlights from this issue
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
Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes
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
Will Emergency Holds Reduce Opioid Overdose Deaths?
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
Imaging of Vaping-Associated Lung Disease
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
Pathology of Vaping-Associated Lung Injury
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
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
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…
Pathology of Vaping-Associated Lung Injury
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
Losing Hahnemann — Real-Life Lessons in “Value-Based” Medicine
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
01 Accuracy of ECG chest lead placements by paramedics
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
Research ‘with not ‘on, yes, but with whom and how?
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
Anticoagulation for Subsegmental Pulmonary Embolism
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
Closed Reduction of a Fractured and Dislocated Ankle
Medical Marijuana Miscalculation
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
Pulmonary Lipid-Laden Macrophages and Vaping
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
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary 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…
Pulmonary Lipid-Laden Macrophages and Vaping
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
Case 27-2019: A 16-Year-Old Girl with Head Trauma during a Sailboat Race
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
Adrenal Crisis
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,…
Case 27-2019: A 16-Year-Old Girl with Head Trauma during a Sailboat Race
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
Case 26-2019: A 27-Year-Old Woman with Opioid Use Disorder and Suicidal Ideation
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
Correction: Abstracts from international Emergency Medicine journals
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
Case 25-2019: A 41-Year-Old Pregnant Woman with Abdominal Pain
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,
Case 24-2019: A 39-Year-Old Woman with Palpitations, Abdominal Pain, and Vomiting
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
A Diagnosis to Chew On
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.
Case 23-2019: A 52-Year-Old Man with Fever, Cough, and Hypoxemia
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,
Highlights from this issue
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
A Multicenter Trial of Vena Cava Filters in Severely Injured Patients
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 — Types and Phenotypes
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
The impact of editorial policy
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
A “Never Event” That Could Kill Millions
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
Highlights from this issue
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
“Double Tongue” Appearance in Ludwig’s Angina
Figure 1.
Taking Note
“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,
Pneumoperitoneum from a Gastric Perforation
Figure 1.
Taking Note
“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,
Pneumoperitoneum from a Gastric Perforation
Figure 1.
Nonnarcotic Methods of Pain Management
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
Nonbacterial Thrombotic Endocarditis
Figure 1.
Nonnarcotic Methods of Pain Management
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
Nonbacterial Thrombotic Endocarditis
Figure 1.
Our choices
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
We need more randomised controlled trials in injury prevention
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
Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary
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
Highlights from this issue
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
Pneumatosis Cystoides Intestinalis with Pneumoperitoneum
Figure 1.
Examination of the Hand and Wrist
Forging the future: is the injury prevention community a learning organisation?
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
Preventing Dogma from Driving Practice
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
Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults
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
Highlights from this issue
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
Organ Donation and Drug Intoxication–Related Deaths in the United States
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
Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia
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
#ThisIsOurLane — Firearm Safety as Health Care’s Highway
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
Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary
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
Advancing injury prevention in China
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
Highlights from this issue
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
Walking Away from Conveyor-Belt Medicine
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
Portal Venous Gas
Figure 1.
In review
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
Highlights from this issue
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
One-Year Outcomes after PCI Strategies in Cardiogenic Shock
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…
Spinal Brucellosis
Figure 1.
Indoor accidental hypothermia in the elderly: an emerging lethal entity in the 21st century
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
Characteristics and outcomes of accidental hypothermia in Japan: the J-Point registry
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
Managing accidental hypothermia: progress but still some way to go
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
Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers
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
Highlights from this issue
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
Prevalence of Self-Reported Head Injury in the United States
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
Case 31-2018: A 37-Year-Old Man with a Self-Inflicted Gunshot Wound
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
Are medical students in prehospital care at risk of moral injury?
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
A retrospective analysis of 34 potentially missed cases of female genital mutilation in the emergency department
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
Chest wall mass: what lies beneath?
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.
The eye cannot see what the mind does not know: female genital mutilation
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
Highlights from this issue
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
Enduring enrolments in West Virginias Medicaid programme due to severe injury
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
Improving hospital death certification in Vietnam: results of a pilot study of injury-related fatalities
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
Growing the next generation of researchers in injury prevention
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
Public involvement in the production, dissemination and implementation of injury prevention research
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
Unintentional injuries among refugee and immigrant children and youth in Ontario, Canada: a population-based cross-sectional study
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
Peripheral Nerve Blocks for Hand Procedures
One-Year Outcomes after PCI Strategies in Cardiogenic Shock
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…
Testing Epinephrine for Out-of-Hospital Cardiac Arrest
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
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest
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
MRI-Guided Intravenous Alteplase for Stroke — Still Stuck in Time
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