Pieter Francsois Fouche, Christopher Stein, Martin Nichols, Benjamin Meadley, Jason C Bendall, Karen Smith, David Anderson, Suhail A Doi
STUDY OBJECTIVE: Traumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and potentially enhance outcomes. Previous reviews suggested potential TXA benefits but did not consider the latest trials. METHODS: A systematic review and bias-adjusted meta-analysis were performed to assess TXA's effectiveness in emergency traumatic injury settings by pooling estimates from randomized controlled trials...
November 22, 2023: Annals of Emergency Medicine
Fatemeh Ramazani, Charmaine Szalay-Anderson, Arthur Volpato Batista, Phillip Park, Euna Hwang, Justin Chau, Justin Lui
OBJECTIVE: To provide family physicians and general otolaryngologists with a practical, evidence-based, and comprehensive approach to the management of patients presenting with suspected referred otalgia. SOURCES OF INFORMATION: The approach described is a review based on the authors' clinical practices along with research and clinical review articles published between 2000 and 2020. MEDLINE and PubMed were searched using the terms otalgia , referred otalgia , and secondary otalgia ...
November 2023: Canadian Family Physician Médecin de Famille Canadien
Jeffrey D Smith, Karen Lemay, Shirley Lee, Janet Nuth, Jun Ji, Kim Montague, Gary E Garber
OBJECTIVES: Physician documentation plays a central role in the delivery of safe patient care. It describes a physician's clinical decision-making and supports essential communication between healthcare providers within the patient's circle of care. Good documentation can potentially also decrease a physician's medico-legal risk. This study provides examples of documentation issues attributed to physicians practicing emergency medicine as identified by peer experts in civil legal actions, regulatory authority complaints (College) and hospital complaints (collectively, medico-legal cases) in Canada...
August 30, 2023: CJEM
Kenneth V Iserson
Magical thinking is a cognitive process characterized by beliefs in supernatural causality and the power of rituals. Grounded in personal convictions rather than objective reality, it involves subjective beliefs rather than magic tricks. Magical thinking's effects range from potentially positive, such as bringing hope and comfort, to negative consequences, including delays in seeking appropriate medical care and refusing evidence-based treatments. This article provides an overview of magical thinking, including its prevalence, diverse forms, and influence on patients, families, and emergency physicians (EPs)...
October 2023: American Journal of Emergency Medicine
Julien Déry, Béatrice Ouellet, Élaine de Guise, Ève-Line Bussières, Marie-Eve Lamontagne
BACKGROUND: Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide the prevention of persistent symptoms following mTBI. The prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors...
July 20, 2023: Systematic Reviews
Karen E Gripp, Evelyne D Trottier, Sidd Thakore, Jonathan Sniderman, Sarah Lawrence
Treatment of paediatric diabetic ketoacidosis (DKA) includes careful attention to fluids and electrolytes to minimize the risk of complications such as cerebral injury (CI), which is associated with high morbidity and mortality. The incidence of cerebral edema in paediatric DKA has not decreased despite the use of fluid-limiting protocols based on restricting early fluid resuscitation. New evidence suggests that early isotonic fluid therapy does not confer additional risk and may improve outcomes in some patients...
May 2023: Paediatrics & Child Health
Alexandra Hamelin, Dante Pascali, Jennifer Leppard
No abstract text is available yet for this article.
October 2023: CJEM
Miguel A Cortel-LeBlanc, Serena L Orr, Maeghan Dunn, Daniel James, Achelle Cortel-LeBlanc
Migraine is a leading cause of disability worldwide, and acute migraine attacks are a common reason for patients to seek care in the emergency department (ED). There have been recent advancements in the care of patients with migraine, specifically emerging evidence for nerve blocks and new pharmacological classes of medications like gepants and ditans. This article serves as a comprehensive review of migraine in the ED, including diagnosis and management of acute complications of migraine (eg, status migrainosus, migrainous infarct, persistent aura without infarction, and aura-triggered seizure) and use of evidence-based migraine-specific treatments in the ED...
December 2023: Annals of Emergency Medicine
Brian L Hoh, Nerissa U Ko, Sepideh Amin-Hanjani, Sherry Hsiang-Yi Chou, Salvador Cruz-Flores, Neha S Dangayach, Colin P Derdeyn, Rose Du, Daniel Hänggi, Steven W Hetts, Nneka L Ifejika, Regina Johnson, Kiffon M Keigher, Thabele M Leslie-Mazwi, Brandon Lucke-Wold, Alejandro A Rabinstein, Steven A Robicsek, Christopher J Stapleton, Jose I Suarez, Stavropoula I Tjoumakaris, Babu G Welch
AIM: The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS: A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022...
May 22, 2023: Stroke; a Journal of Cerebral Circulation
Andreas Sakkas, Christel Weiß, Frank Wilde, Marcel Ebeling, Mario Scheurer, Oliver Christian Thiele, Robert Andreas Mischkowski, Sebastian Pietzka
The primary aim was to evaluate the compliance of cranial CT indication with the national guideline-based decision rules in patients after mTBI. The secondary aim was to determine the incidence of CT pathologies among justified and unjustified CT scans and to investigate the diagnostic value of these decision rules. This is a retrospective, single-center study on 1837 patients (mean age = 70.7 years) referred to a clinic of oral and maxillofacial surgery following mTBI over a five-year period. The current national clinical decision rules and recommendations for mTBI were retrospectively applied to calculate the incidence of unjustified CT imaging...
May 23, 2023: Diagnostics
Alessandro Riccardi, Mario Guarino, Sossio Serra, Michele Domenico Spampinato, Simone Vanni, Dana Shiffer, Antonio Voza, Andrea Fabbri, Fabio De Iaco
Pain is the leading cause of medical consultations and occurs in 50-70% of emergency department visits. To date, several drugs have been used to manage pain. The clinical use of ketamine began in the 1960s and it immediately emerged as a manageable and safe drug for sedation and anesthesia. The analgesic properties of this drug were first reported shortly after its use; however, its psychomimetic effects have limited its use in emergency departments. Owing to the misuse and abuse of opioids in some countries worldwide, ketamine has become a versatile tool for sedation and analgesia...
May 2, 2023: Journal of Clinical Medicine
Aileen McCabe
No abstract text is available yet for this article.
July 2023: Emergency Medicine Journal: EMJ
Samuel Wilson, Kuan-Chin Jean Chen, Lucas B Chartier, Samuel G Campbell, Shawn Dowling, Suneel Upadhye, Venkatesh Thiruganasambandamoorthy
No abstract text is available yet for this article.
June 2023: CJEM
Anna Collini, Elspeth Alstead, Alec Knight, Michael Page
BACKGROUND: Uncertainty is particularly obvious in emergency medicine (EM) due to the characteristics of the patient cohort, time constraints, and busy environment. Periods of transition are thought to add to uncertainty. Managing uncertainty is recognised as a key ability for medical practice, but is often not addressed explicitly. This study explored how new consultants in EM experience uncertainty, with the aim of making explicit what is often hidden and potentially informing support for doctors to manage the uncertainty they face...
September 2023: Emergency Medicine Journal: EMJ
Brit Long, Stephen Y Liang, Michael Gottlieb
INTRODUCTION: Primary disasters may result in mass casualty events with serious injuries, including crush injury and crush syndrome. OBJECTIVE: This narrative review provides a focused overview of crush injury and crush syndrome for emergency clinicians. DISCUSSION: Millions of people worldwide annually face natural or human-made disasters, which may lead to mass casualty events and severe medical issues including crush injury and syndrome...
July 2023: American Journal of Emergency Medicine
Velina Tzankova, Werner J Becker, Tommy L H Chan
No abstract text is available yet for this article.
January 30, 2023: Canadian Medical Association Journal: CMAJ
Aaron Lacy, Amanda Smith, Alex Koyfman, Brit Long
INTRODUCTION: Testicular torsion is a serious condition that carries with it a high rate of morbidity. OBJECTIVE: This review highlights the pearls and pitfalls of testicular torsion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Testicular torsion is a urological emergency that occurs with rotation of the testicle along its supporting ligaments leading to obstruction of vascular flow...
April 2023: American Journal of Emergency Medicine
Jonathan A Edlow, Peter J Pronovost
No abstract text is available yet for this article.
February 28, 2023: JAMA
José Afonso, Jesús Olivares-Jabalera, Ricardo J Fernandes, Filipe Manuel Clemente, Sílvia Rocha-Rodrigues, João Gustavo Claudino, Rodrigo Ramirez-Campillo, Cristina Valente, Renato Andrade, João Espregueira-Mendes
BACKGROUND: Hamstrings injuries are common in sports and the reinjury risk is high. Despite the extensive literature on hamstrings injuries, the effectiveness of the different conservative (i.e., non-surgical) interventions (i.e., modalities and doses) for the rehabilitation of athletes with acute hamstrings injuries is unclear. OBJECTIVE: We aimed to compare the effects of different conservative interventions in time to return to sport (TRTS) and/or time to return to full training (TRFT) and reinjury-related outcomes after acute hamstrings injuries in athletes...
January 9, 2023: Sports Medicine
Niushen Zhang, Matthew S Robbins
Migraine affects about 1 billion people worldwide, and up to 15% of adults in the United States have migraine attacks in any given year. Migraine is associated with substantial adverse socioeconomic and personal effects. It is the second leading cause of years lived with disability worldwide for all ages and the leading cause in women aged 15 to 49 years. Diagnostic uncertainty increases the likelihood of unnecessary investigations and suboptimal management. This article advises clinicians about diagnosing migraine, ruling out secondary headache disorders, developing acute and preventive treatment plans, and deciding when to refer the patient to a specialist...
January 2023: Annals of Internal Medicine
2023-01-10 15:05:46
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