PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (2538)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
2.  Five years on: some positives, some negatives 
doi:10.1136/emj.2007.054619
PMCID: PMC2658345  PMID: 18029506
3.  Emergency Medical Journal in the digital age 
Emergency Medicine Journal : EMJ  2007;24(12):809-810.
doi:10.1136/emj.2006.041152
PMCID: PMC2658346
4.  New methods for improved evaluation of patients with suspected acute coronary syndrome in the emergency department 
Emergency Medicine Journal : EMJ  2007;24(12):811-814.
This paper aims to identify and review new and unproven emergency department (ED) methods for improved evaluation in cases of suspected acute coronary syndrome (ACS). Systematic news coverage through PubMed from 2000 to 2006 identified papers on new methods for ED assessment of patients with suspected ACS. Articles found described decision support models, new ECG methods, new biomarkers and point‐of‐care testing, cardiac imaging, immediate exercise tests and the chest pain unit concept. None of these new methods is likely to be the perfect solution, and the best strategy today is therefore a combination of modern methods, where the optimal protocol depends on local resources and expertise. With a suitable combination of new methods, it is likely that more patients can be managed as outpatients, that length of stay can be shortened for those admitted, and that some patients with ACS can get earlier treatment.
doi:10.1136/emj.2007.048249
PMCID: PMC2658347  PMID: 18029508
6.  Generic qualitative research: a design for qualitative research in emergency care? 
Emergency Medicine Journal : EMJ  2007;24(12):816-819.
The frequency of qualitative studies in the Emergency Medicine Journal, while still low, has increased over the last few years. All take a generic approach and rarely conform to established qualitative approaches such as phenomenology, ethnography and grounded theory. This generic approach is no doubt selected for pragmatic reasons but can be weakened by a lack of rigor and understanding of qualitative research. This paper explores qualitative approaches and then focuses on “best practice” for generic qualitative research.
doi:10.1136/emj.2007.050641
PMCID: PMC2658349  PMID: 18029510
7.  An evaluation of the core physical exam in patients with minor peripheral chief complaints 
Emergency Medicine Journal : EMJ  2007;24(12):820-822.
Objective
We sought to determine (1) how often and why emergency medicine resident physicians perform core physical exams in patients with minor peripheral chief complaints (MCCs); and (2) the clinical impact this practice.
Methods
This prospective observational study was conducted at an urban emergency department with a 4 year emergency medicine residency. Charts of all emergency department patients presenting with MCCs in June–September 2003 were reviewed by blinded assistants for documentation of (1) core physical exams; (2) abnormal core physical exam findings; and (3) additional work up, treatment or follow up related to abnormal core physical exam findings. In May–June 2004 all emergency medicine residents were asked how often they perform core physical exams on emergency department patients with MCCs and their motivating factors for this practice.
Results
297 patients met MCC inclusion/exclusion criteria. Among the 591 total cardiac, lung and abdominal exams performed, 8 (1.4%, 95% confidence interval (CI) 0.7% to 2.7%) were abnormal and only 1 (0.1%, 95% CI 0% to 0.1%) finding led to further testing (ECG); none prompted change in treatment or follow up. All 46 eligible emergency medicine residents were evaluated; 72% (33) performed core physical exams in half or more patients with MCCs. Their primary reasons were to screen the underserved emergency department population, the belief that such exams are standard of care, and establishment of physician–patient rapport.
Conclusions
Because they want to screen an underserved population, establish rapport, and meet what they believe is a standard of care, most emergency medicine residents performed core exams on patients with MCCs. Abnormal core physical exam findings are unusual and rarely lead to further testing or change in management.
doi:10.1136/emj.2007.050336
PMCID: PMC2658350  PMID: 18029511
8.  Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta‐analysis 
Emergency Medicine Journal : EMJ  2007;24(12):823-830.
Objectives
To estimate the effect of intravenous and nebulised magnesium sulphate upon hospital admissions and pulmonary function in adults and children with acute asthma.
Methods
We undertook a systematic review and meta‐analysis of randomised and quasi‐randomised trials of intravenous or nebulised magnesium sulphate in acute asthma. Trials were identified by searches of the electronic literature, relevant journal websites and conference proceedings, and contact with authors and experts. Data were pooled using random effects meta‐analysis of the relative risk (RR) of hospital admission and the standardised mean difference (SMD) in pulmonary function.
Results
24 studies (15 intravenous, 9 nebulised) incorporating 1669 patients were included. Intravenous treatment was associated in adults with weak evidence of an effect upon respiratory function (SMD 0.25, 95% confidence interval (CI) −0.01 to 0.51; p = 0.05), but no significant effect upon hospital admission (RR 0.87, 95% CI 0.70 to 1.08; p = 0.22), and in children with a significant effect upon respiratory function (SMD 1.94, 95% CI 0.80 to 3.08; p<0.001) and hospital admission (RR 0.70, 95% CI 0.54 to 0.90; p = 0.005). Nebulised treatment was associated in adults with weak evidence of an effect upon respiratory function (SMD 0.17, 95% CI −0.02 to 0.36; p = 0.09), and hospital admission (RR 0.68, 95% CI 0.46 to 1.02; p = 0.06), and in children with no significant effect upon respiratory function (SMD −0.26, 95% CI –1.49 to 0.98; p = 0.69) or hospital admission (RR 2.0, 95% CI 0.19 to 20.93; p = 0.56).
Conclusion
Intravenous magnesium sulphate appears to be an effective treatment in children. Further trials are needed of intravenous and nebulised magnesium sulphate in adults and nebulised magnesium sulphate in children.
doi:10.1136/emj.2007.052050
PMCID: PMC2658351  PMID: 18029512
10.  Child protection procedures in emergency departments 
Emergency Medicine Journal : EMJ  2007;24(12):831-835.
Background
Emergency departments (EDs) may be the first point at which children who have been subject to abuse or neglect come into contact with professionals who are able to act for their protection. In order to ascertain current procedures for identifying and managing child abuse, we conducted a survey of EDs in England and Northern Ireland.
Methods
Questionnaires were sent to the lead professionals in a random sample of 81 EDs in England and 20 in Northern Ireland. Departments were asked to provide copies of their procedures for child protection. These were analysed qualitatively using a structured template.
Results
A total of 74 questionnaires were returned. 91.3% of departments had written protocols for child protection. Of these, 27 provided copies of their protocols for analysis. Factors judged to improve the practical usefulness of protocols included: those that were brief; were specific to the department; incorporated both medical and nursing management; included relevant contact details; included a single page flow chart which could be accessed separately. 25/71 (35.2%) departments reported that they used a checklist to highlight concerns. The most common factors on the checklists included an inconsistent history or one which did not match the examination; frequent attendances; delay in presentation; or concerns about the child's appearance or behaviour, or the parent–child interaction.
Conclusions
There is a lack of consistency in the approach to identifying and responding to child abuse in EDs. Drawing on the results of this survey, we are able to suggest good practice guidelines for the management of suspected child abuse in EDs. Minimum standards could improve management and facilitate clinical audit and relevant training.
doi:10.1136/emj.2007.051011
PMCID: PMC2658353  PMID: 18029514
11.  Percutaneous transhepatic gall bladder drainage: a better initial therapeutic choice for patients with gall bladder perforation in the emergency department 
Emergency Medicine Journal : EMJ  2007;24(12):836-840.
Objectives
To investigate clinical features and outcomes in patients with acute cholecystitis with gall bladder perforation receiving open cholecystectomy or percutaneous transhepatic gall bladder drainage in the emergency department.
Methods
From 1996 through 2005, 33 patients with non‐traumatic gall bladder perforation, among 585 patients with acute cholecystitis, were enrolled. Patients were divided into two groups: open cholecystectomy in 16 patients and percutaneous transhepatic gall bladder drainage in 17 patients. Medical records, including demographic data, past history of systemic diseases or gallbladder stones, initial clinical presentations, laboratory data, physical status, therapeutic interventions, and outcomes, were analysed.
Results
Mean patient age was 72.6 years (range 54–92 years). 28 patients (84.8%) were male. Median time of symptom onset before emergency department diagnosis was 5 days (range 0.5–30 days). Estimated incidence of gall bladder perforation was 5.6% (33/585). 27 patients (81.8%) had gallstones operatively or in image studies. All patients had either right upper quadrant pain/tenderness or epigastric pain/tenderness. Only 9 (27.3%) patients had positive Murphy's sign. Six patients in the percutaneous transhepatic gall bladder drainage group received further open cholecystectomy. Overall mortality was 24.2% (8/33). The direct cause of death was disease related sepsis in all patients. Patients receiving percutaneous transhepatic gall bladder drainage had a higher survival rate than those receiving open cholecystectomy (100% vs 50%, p<0.001). No differences in complications and length of hospital stay of survivors were observed between groups.
Conclusions
In this study, we delineated clinical features of patients with gall bladder perforation. Better clinical outcome is observed for percutaneous transhepatic gall bladder drainage, and this is suggested as an initial therapeutic choice, especially in high risk patients who are likely to need surgery.
doi:10.1136/emj.2007.052175
PMCID: PMC2658354  PMID: 18029515
12.  A rare penetrating neck trauma to zone III 
doi:10.1136/emj.2006.044586
PMCID: PMC2658355  PMID: 18029516
13.  Photographic wound documentation of open fractures: an update for the digital generation 
Emergency Medicine Journal : EMJ  2007;24(12):841-842.
Objective
To examine the availability of working cameras in UK emergency departments and to discuss the merits of digital imaging over Polaroid.
Design
This study was conducted by means of a telephone questionnaire to 50 UK emergency departments.
Results
It was found that 80% were able to produce either a working Polaroid or digital camera, and that 63% of emergency departments had a digital camera available.
Conclusions
We report a pronounced increase in the ability of emergency departments to photograph open fractures, due in part to the availability of digital cameras. We recommend the appropriate use of these tools in the management of open fractures.
doi:10.1136/emj.2007.049726
PMCID: PMC2658356  PMID: 18029517
14.  [No title available] 
PMCID: PMC2658357
15.  Is there still a place for emergency department thrombolysis following the introduction of the amended Joint Royal Colleges Ambulance Liaison Committee criteria for thrombolysis? 
Emergency Medicine Journal : EMJ  2007;24(12):843-845.
Objective
To apply the current (2004) and the amended (2006) Joint Royal Colleges Ambulance Liaison Committee (JRCALC) criteria for paramedic initiated thrombolysis to all patients who received thrombolytic treatment in an emergency department (ED) to determine if the amendments increase the proportion suitable for paramedic initiated thrombolysis.
Design
Retrospective descriptive analysis.
Method
The ED clinical notes, ambulance clinical record and the first recorded ECG (ED or ambulance) of all patients thrombolysed in the ED during a 12 month period were reviewed against the previous JRCALC guidelines (2004) and the amended JRCALC guidelines (2006) for thrombolysis.
Results
Using the JRCALC guidelines (2004), 26 of the 147 patients (17.7%) were eligible for paramedic initiated thrombolysis. Using the JRCALC guidelines (2006), this increased to 41 (27.9%). This difference was statistically significant (McNemar's χ2 test with 1 degree of freedom  =  15.00; p<0.001). The change to the blood pressure, age and pulse rate parameters has increased the percentage eligible for paramedic initiated thrombolysis by 10.2% (95% confidence interval 4.6% to 15.8%).
Conclusion
The amended JRCALC guidelines (2006) for paramedic initiated thrombolysis have successfully increased the proportion of patients suitable for prehospital thrombolysis by approximately 10%, although the ED retains an important role in the provision of prompt thrombolytic treatment for a proportion of patients.
doi:10.1136/emj.2007.049031
PMCID: PMC2658358  PMID: 18029518
16.  [No title available] 
Emergency Medicine Journal : EMJ  2007;24(12):846-847.
doi:10.1136/emj.2007.054981
PMCID: PMC2658359
17.  [No title available] 
Emergency Medicine Journal : EMJ  2007;24(12):848-849.
doi:10.1136/emj.2007.054999
PMCID: PMC2658360  PMID: 18029522
18.  [No title available] 
Emergency Medicine Journal : EMJ  2007;24(12):848-850.
doi:10.1136/emj.2007.055004
PMCID: PMC2658361  PMID: 18029521
19.  Commercial filming of prehospital patient care 
Emergency Medicine Journal : EMJ  2007;24(12):851-853.
Commercial filming of patients in the hospital and now the prehospital environment is becoming increasingly common. Television programmes that focus on medical emergencies with real footage of events remain highly successful and can make compelling viewing for both medical professionals and the general public alike. Recently several commentators have questioned the ethical aspects of filming in hospital emergency departments, and noted the lack of available evidence. This article reviews commercial filming and its impact in the prehospital environment and examines the ethical implications and current guidance in this unique setting.
doi:10.1136/emj.2007.049577
PMCID: PMC2658362  PMID: 18029523
20.  Contemporary simulation education for undergraduate paramedic students 
Emergency Medicine Journal : EMJ  2007;24(12):854-857.
doi:10.1136/emj.2007.046318
PMCID: PMC2658363  PMID: 18029524
21.  [No title available] 
PMCID: PMC2658364
23.  Anti‐flatulence treatment and status epilepticus: a case of camphor intoxication 
Emergency Medicine Journal : EMJ  2007;24(12):859-860.
We describe a case of a young child who lived in Hong Kong who presented with a severe epilepticus status after a return flight to Paris. Routine laboratory tests failed to establish a cause. Upon further questioning, the parents reported that the nanny had given an abdominal massage to the child with an unlabelled solution reported to have anti‐flatulence effects. Toxicological analysis of this solution revealed the presence of camphor. Although the highly toxic effects of camphor have long been established, the present case illustrates that camphor continues to be a source of paediatric exposure. This case highlights the importance of systematic questioning and recalls the extreme danger associated with camphor even when administered transcutaneously.
doi:10.1136/emj.2007.052308
PMCID: PMC2658366  PMID: 18029526
25.  Unsuspected 34‐week pregnancy presenting as acute hypoxaemic respiratory failure 
Emergency Medicine Journal : EMJ  2007;24(12):861-862.
An obese body habitus may interfere with diagnosis of potentially life‐threatening conditions. This report describes an obese woman who presented with acute hypoxemic respiratory failure and diffuse infiltrates. Her body habitus disguised her parturient abdomen and she could not provide a history because she was intubated and paralysed. Only after a urine pregnancy test was undertaken did it become apparent that she was pregnant and the diagnosis of pre‐eclampsia with pulmonary oedema was considered. Urine pregnancy tests are part of the standard work‐up for abdominal pain in women of childbearing age, but are not viewed as part of the work‐up for respiratory distress or diffuse radiographic infiltrates. This case illustrates the value of obtaining a pregnancy test in all women, particularly those with obese body habitus, who present with respiratory failure of unclear aetiology.
doi:10.1136/emj.2007.048967
PMCID: PMC2658368  PMID: 18029528

Results 1-25 (2538)