EM Ottawa

JUNE 19, 2025

Blunt cerebrovascular injury (BCVI) involves vessel injuries that occur from trauma mechanisms commonly seen in the emergency department: falls down stairs, motor vehicle collisions, and facial trauma. By identifying high-risk patients early, we can decrease the risk of stroke by up to 15% with the use of aspirin. In part 1 we explored the physiology, mechanism […] The post Navigating Twists, Turns and Tears: BCVI in the ED (Part 2) appeared first on EMOttawa Blog.

Stroke 102

Stroke Emergency Department Documentation/Coding Radiology 102

Sensible Medicine

JUNE 19, 2025

I have trouble understanding the recent animosity to the phrase “First, Do No Harm” as it applies to medical practice. I have always accepted it as a guide for medical practice. Way back in 2012, when Vinay and I published A medical burden of proof: Towards a new ethic , we built our arguments on Primum non nocere , which we referred to as ‘the most fundamental principle of medicine.’ In this essay, Dr.

Academics 125

Academics 125

Emergency Medicine Journal

JUNE 19, 2025

Background Increasing demand and crowding in emergency departments (EDs) remain persistent challenges for healthcare systems worldwide. A portion of these visits is avoidable, indicating they could have been effectively managed in non-ED care settings. There has been increased attention on paramedics redirecting avoidable visits to community-based care before ED transport.

Emergency Department 40

Emergency Department Hospitals Academics 40

Total Medical ComplianceHIPAA

JUNE 19, 2025

Nancy Ware, HIPAA Compliance Specialist at Total Medical Compliance, recently joined the RippleFX podcast to cut through the noise surrounding “HIPAA 2.0.” With so much speculation about upcoming changes to the HIPAA Security Rule, Nancy provides clear, practical insight into what’s actually proposed—and what it means for healthcare providers. While no final rule has been released, the proposed updates could significantly impact medical and dental practices, especially in areas like breach notif

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Speaker: Dr. Christine Gall, DrPH, MS, BSN, RN

The promise of virtual care is no longer theoretical and is now a critical solution to many of healthcare’s most urgent challenges. Yet many healthcare leaders remain unsure how to build a business case for investment and launching the right program at the right time can be the difference between value and failure. For organizations seeking a financially sound, clinically effective entry point, Virtual Patient Observation (VPO) offers a compelling case to lead with.

Operations

Emergency Medicine Journal

JUNE 19, 2025

Background Excessive workload in emergency departments (ED) negatively affects patient safety, often leading to missed critical tasks due to time constraints. The Workload Assessment of Nurses on Emergency (WANE) scale developed in Belgium offers a detailed measurement of nursing workload, but its complexity makes it hard to use in practice. Our study aims to find a simpler method for assessing nursing workload in EDs.

Emergency Department 40

Emergency Department Patient Safety Hospitals 40

The Bottom Line

JUNE 19, 2025

A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline L McIntyre. NEJM 2025; DOI: 10.1056/NEJMoa2416761 Clinical Question In hospitalised patients, does the use of Lactated Ringers (LR) vs Normal Saline (NS) lower the incidence of death or readmission to the hospital within 90 days after the index admission?

Hospitals 75

Hospitals Operations 75

PulmCCM

JUNE 19, 2025

These are the Real-World Boards. As in the real world, there might be no single right answer, and you are only competing against yourself. Please share your experiences, discuss and critique this question below. Good luck! -Ed. An 82-year-old woman is brought from a nursing home by EMS to the emergency department in ventricular fibrillation. She was found unresponsive about 15 minutes ago after an unknown period.

CPR 59

CPR Shock Resuscitation Outcomes 59

Emergency Medicine Journal

JUNE 19, 2025

Objectives We aimed to evaluate the impact of the COVID-19 pandemic and subsequent introduction of the Victorian Virtual Emergency Department (VVED) consultation service for paramedics on paramedic-to-general practitioner (GP) referral patterns, case time burden and ambulance reattendance rates. Methods We conducted interrupted time series regression assessing paramedic-to-GP referrals with the following two interruptions: (1) the COVID-19 pandemic in March 2020 and (2) VVED integration in July

Emergency Department 40

Emergency Department EMS 40

Emergency Medicine Journal

JUNE 19, 2025

Objectives Presentations to ED are growing, worsening pressure on the health system. A discrete choice experiment (DCE) was undertaken to determine the factors that influence why patients choose the ED over primary care for low-acuity presentations. Methods A DCE was carried out at two tertiary hospital EDs between October 2022 and February 2023 in adult patients with lower triage scores.

Emergency Department 40

Emergency Department Hospitals 40

Emergency Medicine Journal

JUNE 19, 2025

The wellbeing of emergency department (ED) staff has been identified by the Royal College of Emergency Medicine (RCEM) as a priority area for research, 1 and successive years of General Medical Council survey data have identified emergency medicine (EM) as the specialty with the highest burnout levels. 2 There is currently little evidence on the impact of rota design on the wellbeing of ED staff, although RCEM published guidance on implementing self-rostering in 2019. 3 One previous report indic

EMS 40

EMS Emergency Department Research 40

Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

Outcomes

Emergency Medicine Journal

JUNE 19, 2025

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 40

Research 40

Emergency Medicine Journal

JUNE 19, 2025

Background and aims There is growing recognition among practitioners worldwide of the benefits of practising emergency medicine in different countries and healthcare settings. A recent survey by the Royal College of Emergency Medicine found interest and experience in global health (GH) work among college members, but many struggled with barriers that limited their contribution to this work.

Leadership 40

Leadership Wellness 40

Emergency Medicine Journal

JUNE 19, 2025

This month’s update is by the Johns Hopkins Emergency Department Team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

Emergency Department 40

Emergency Department Outcomes 40

Emergency Medicine Journal

JUNE 19, 2025

A short systematic review was completed to answer the three-part question: in patients presenting with acute unilateral testicular pain, is an absent cremasteric reflex an accurate sign for diagnosis of testicular torsion (TT)? MEDLINE, Embase and Cochrane databases were searched on 05 January 2025 using the outlined search strategy. 67 unique papers were found and screened for relevance. 13 relevant papers were identified.

Outcomes 40

Outcomes 40

Emergency Medicine Journal

JUNE 19, 2025

Nursing workload in EDs not only impacts patient safety but determines timely assessments, time-sensitive interventions, patient flow, communication with patients regarding ED processes, the ongoing provision of care for patients awaiting admission and the provision of comprehensive advice on discharge or transfer. In addition, nursing staff in EDs are increasingly managing higher patient volumes, increasing patient complexity and crowding.

Emergency Department 40

Emergency Department Emergency Nursing Patient Safety Outcomes 40

Emergency Medicine Journal

JUNE 19, 2025

Pulse oximetry is a non-invasive and inexpensive method of detecting oxygenation, which could help to reduce unnecessary scrotal exploration and expedite diagnosis if shown to be accurate in patients with suspected testicular torsion. A short systematic review was conducted to address the following three-part question: in emergency settings, can the use of testicular pulse oximetry aid the diagnosis of testicular torsion?

Research 40

Research Outcomes 40

Emergency Medicine Journal

JUNE 19, 2025

The UK NHS measures the percentage of patients presenting to emergency departments (ED) who are either admitted, transferred or discharged within 4 hours. Between 2011 and 2014, ED successfully met this target for 95% of patients. 1 However, in December 2023, only 55% of patients left an ED within 4 hours of arrival. 1 This has resulted in crowding, with insufficient space to manage routine patient load.

Emergency Department 40

Emergency Department 40

Emergency Medicine Journal

JUNE 19, 2025

In aeromedical retrieval and commercial air flights, clinicians may need to perform lung or heart examinations if an emergency arises. The airplane represents a low-resource environment where auscultation may be the only available medical device to assess cardiac or lung disease diagnoses that may require immediate action. Conventional stethoscopes are essentially unusable in the aircraft cabin due to the noise. 1–3 A new digital stethoscope, Eko Core 500, with active noise cancelling and

Administration 40

Administration 40

Emergency Medicine Journal

JUNE 19, 2025

Summer is upon us, and I hope the sun is shining wherever this finds you. We have a smorgasbord of emergency medical research in this issue to keep you entertained while you might get the chance to relax with something suitably chilled. Major incident preparedness is something that we thankfully don’t have to consider on a day-to-day basis, but a bit like those critical resuscitation skills we don’t use very often, it is important nonetheless.

Resuscitation 40

Resuscitation Research Wellness 40

Emergency Medicine Journal

JUNE 19, 2025

Clinical Introduction A 36-year-old woman presented to the emergency department with a 3-day history of lower abdominal and pelvic pain, malaise, vomiting and diarrhoea. Clinical examination showed tenderness in the lower right abdominal quadrant, without rebound or guarding. She denied the possibility of being pregnant and had no prior surgical history.

Ultrasounds 40

Ultrasounds Emergency Department 40

Emergency Medicine Journal

JUNE 19, 2025

Background The Manchester Triage System (MTS) is a well-known algorithmic triage tool, designed for use in EDs with the aim of identifying patients with critical illness and prioritising patie 100 54912 0 54912 0 0 851k 0 --:--:-- --:--:-- --:--:-- 864k nts’ safety. Zaboli et al 1 aimed to assess how accurately nursing staff applied MTS through a multicentre study based on clinical vignettes previously judged by a ‘gold standard’ group of experienced MTS trainers.

Wellness 40

Wellness 40

Emergency Medicine Journal

JUNE 19, 2025

Editor's note : This study is a reanalysis of data that were used for a previously published study in the EMJ. That study concluded that there were differences in care given to patients with culturally diverse backgrounds compared to those born in Australia. In this further analysis, the authors stratified patients by specific countries of birth and subdivided age groups into four tiers (previously <65 or ≥65).

Emergency Department 40

Emergency Department Hospitals 40

Emergency Medicine Journal

JUNE 19, 2025

A patient in their 70s with a dual-chamber pacemaker presents to the emergency department due to dizziness. An ECG ( figure 1 ) was performed as part of their assessment. Question What are the findings on the ECG? Malfunction of the pacemaker: failure to capture. Undersensing. Ventricular safety pacing (VSP). Artefact. For answer see page xx For question see page xx Answer: C VSP is the correct answer.

Emergency Department 40

Emergency Department EKG/ECG 40

Emergency Medicine Journal

JUNE 19, 2025

Introduction Patients with longer waiting times at the ED have higher admission rates and increased short-term death risks. 1 2 Although there is limited evidence of the value of predicting hospital admission at an early stage, it is possible that such predictions could be used to expedite patient flow in the ED. A recent narrative review suggested that patients might possess the ability to accurately predict the necessity for hospital admission; however, it included only two articles regarding

Hospitals 40

Hospitals Academics 40

Emergency Medicine Journal

JUNE 19, 2025

Suicide is a major global concern 1 as well as a personal tragedy for each life lost and the friends and family bereaved by suicide. The National Confidential Inquiry into Suicide and Safety in Mental Health 2 publishes annual analysis of suicide deaths after contact with mental health (MH) services, but the level of contact with other healthcare services in the remaining suicide deaths in England 2 was unknown.

Emergency Department 40

Emergency Department Hospitals Wellness 40

Emergency Medicine Journal

JUNE 19, 2025

Uncertainties surrounding the COVID-19 pandemic have challenged public perceptions of healthcare organisations and providers, 1 including influencing trust, an important factor in individuals’ decisions to seek and adhere to healthcare recommendations that can ultimately impact downstream health outcomes. 2 This study aimed to understand the impact of the COVID-19 pandemic on public confidence and trust in emergency medical service (EMS) providers and compare this to the level of public mi

EMS 40

EMS Outcomes 40