Articles

Emergency medicine for 25 Years in Iceland – history of the specialty in a nutshell

After the early implementation of Emergency Medicine (EM) 25 years ago, Iceland became the first Nordic country to nationally realize the benefits of this specialty. However, the road has been rocky as in many...

Authors: Jón Baldursson, Hjalti Már Björnsson and Ari Palomäki

A comparison of two emergency medical dispatch protocols with respect to accuracy

Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority lev...

Authors: Klara Torlén, Lisa Kurland, Maaret Castrén, Knut Olanders and Katarina Bohm

Proper training and use of ultrasonography facilitates lumbar puncture

With great interest, we read the study of Line Dussourd et al. concluding that ultrasonography allows better identification of anatomical structures before performing a lumbar puncture. We cannot concur with t...

Authors: Geert-Jan van Geffen, Rein Ketelaars and Jörgen Bruhn

Therapeutic hypothermia in patients with coagulopathy following severe traumatic brain injury

Coagulopathy in traumatic brain injury (TBI) has been associated with poor neurological outcomes and higher in-hospital mortality. In general principle of trauma management, hypothermia should be prevented as ...

Authors: Toru Hifumi, Yasuhiro Kuroda, Kenya Kawakita, Susumu Yamashita, Yasutaka Oda, Kenji Dohi and Tsuyoshi Maekawa

Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services

Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Car...

Authors: Mads Christian Tofte Hansen, Jesper Hvass Schmidt, Anne C. Brøchner, Jakob Kjersgaard Johansen, Stine Zwisler and Søren Mikkelsen

Impact of systolic blood pressure limits on the diagnostic value of triage algorithms

Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritiz...

Authors: Tobias Neidel, Nicolas Salvador and Axel R. Heller

Pre-hospital advanced airway management in children: a challenge that training can handle

We respond to the Tarpgaard et al. article reporting on pre-hospital endotracheal intubation (PHETI) success and complications by Danish critical care teams including critical care anaesthetists. We compare th...

Authors: Joanna B. Watterson, Cliff Reid, Brian J. Burns and Luke Regan

The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study

It has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas.

Authors: Katri Mustonen, Jarmo Kantonen and Timo Kauppila

Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients

Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department ...

Authors: Michael Kristensen, Anne Kristine Servais Iversen, Thomas Alexander Gerds, Rebecca Østervig, Jakob Danker Linnet, Charlotte Barfod, Kai Henrik Wiborg Lange, György Sölétormos, Jakob Lundager Forberg, Jesper Eugen-Olsen, Lars Simon Rasmussen, Morten Schou, Lars Køber and Kasper Iversen

S100A8/A9 and sRAGE kinetic after polytrauma; an explorative observational study

Following tissue injury after trauma, the activation of innate immune pathways results in systemic inflammation, organ failure and an increased risk of infections. The objective of this study was to characteri...

Authors: Philippe Joly, John C. Marshall, Philippe A. Tessier, Chantal Massé, Nathalie Page, Anne Julie Frenette, François Khazoom, Soazig Le Guillan, Yves Berthiaume and Emmanuel Charbonney

Letter to the Editor regarding the article: "identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study"

The aim of this Letter to the Editor was to report some methodological shortcomings in a recently published article. Issues regarding missing values and overfitting are mentioned. First, Complete Case (CC) ana...

Authors: Charlie A. Sewalt, Eveline J. A. Wiegers, Esmee Venema and Hester F. Lingsma

Treatment of splenic trauma in Norway: a retrospective cohort study

Non-operative management of splenic injuries has become the treatment of choice in hemodynamically stable patients over the last decades. The aim of the study is to describe the incidence, initial treatment an...

Authors: Trond Dehli, Jorunn Skattum, Bjørn Christensen, Ole-Petter Vinjevoll, Bent-Åge Rolandsen, Christine Gaarder, Pål Aksel Næss and Torben Wisborg

Anaphylaxis in an emergency care setting: a one year prospective study in children and adults

Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care...

Authors: Athamaica Ruiz Oropeza, Annmarie Lassen, Susanne Halken, Carsten Bindslev-Jensen and Charlotte G Mortz

A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR

Blunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI...

Authors: Daiki Wada, Koichi Hayakawa, Shuji Kanayama, Shuhei Maruyama, Hiromu Iwamura, Noriyuki Miyama, Fukuki Saito, Yasushi Nakamori and Yasuyuki Kuwagata

High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance

High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral marke...

Authors: Bjørn Helge Johnsen, Heidi Kristina Westli, Roar Espevik, Torben Wisborg and Guttorm Brattebø

Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage

Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with...

Authors: Selin Tusgul, Pierre-Nicolas Carron, Bertrand Yersin, Thierry Calandra and Fabrice Dami

Epidemiological comparison between the Navarra Major Trauma Registry and the German Trauma Registry (TR-DGU®)

International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high p...

Authors: B. Ali Ali, R. Lefering, M. Fortun Moral and T. Belzunegui Otano

Prehospital prognosis is difficult in patients with acute exacerbation of chronic obstructive pulmonary disease

Patients with acute exacerbation of chronic obstructive pulmonary disease often require prehospital emergency treatment. This enables patients who are less ill to be treated on-site and to avoid hospital admis...

Authors: Katrine P. Lindvig, Anne C. Brøchner, Annmarie T. Lassen and Søren Mikkelsen

Use of intrathoracic pressure regulation therapy in breathing patients for the treatment of hypotension secondary to trauma

Intrathoracic pressure regulation (IPR) therapy has been shown to increase blood pressure in hypotensive patients. The potential value of this therapy in patients with hypotension secondary to trauma with blee...

Authors: Victor A. Convertino, Brent A. Parquette, David A. Wampler, Craig A. Manifold, David A. Lindstrom, Lori L. Boland, Nathan T. Burkhart, Keith G. Lurie and Charles J. Lick

EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

Laryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficac...

Authors: Anna Fiala, Wolfgang Lederer, Agnes Neumayr, Tamara Egger, Sabrina Neururer, Ernst Toferer, Michael Baubin and Peter Paal

Erratum to: Shock in the emergency department; a 12 year population based cohort study

Authors: Jon Gitz Holler, Daniel Pilsgaard Henriksen, Søren Mikkelsen, Lars Melholt Rasmussen, Court Pedersen and Annmarie Touborg Lassen

Common intensive care scoring systems do not outperform age and glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

Intensive care scoring systems are widely used in intensive care units (ICU) around the world for case-mix adjustment in research and benchmarking. The aim of our study was to investigate the usefulness of com...

Authors: Marika Fallenius, Markus B. Skrifvars, Matti Reinikainen, Stepani Bendel and Rahul Raj

Specialist advice may improve patient selection for decompression therapy following diving accidents: a retrospective observational study

Even in a landlocked country like Switzerland recreational diving is becoming more and more popular. Smaller lakes in the Alps are located at an altitude of 2500 m above sea level. The incidence of diving acci...

Authors: Daniel Steffensmeier, Roland Albrecht, Jürg Wendling, Roger Melliger, Donat R. Spahn, Philipp Stein and Christophe Wyss

Post-trauma morbidity, measured as sick leave, is substantial and influenced by factors unrelated to injury: a retrospective matched observational cohort study

Mortality as an endpoint has been the focus of trauma research whereas few studies investigate long-term outcomes in terms of morbidity. An adequate analysis of post-injury morbidity includes several dimension...

Authors: Erik von Oelreich, Mikael Eriksson, Olof Brattström, Andrea Discacciati, Lovisa Strömmer, Anders Oldner and Emma Larsson

The impact of early thromboelastography directed therapy in trauma resuscitation

Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential asp...

Authors: Mohamed Mohamed, Karl Majeske, Gul R. Sachwani, Kristin Kennedy, Mina Salib and Michael McCann

Intoxication with GHB/GBL: characteristics and trends from ambulance-attended overdoses

Overdoses from so-called “club drugs” (GHB/GBL) have become a more frequent cause of overdoses attended by ambulance services. Given its availability, affordability, and lack of awareness of risks, there is a ...

Authors: Desiree Madah-Amiri, Lars Myrmel and Guttorm Brattebø

Factors influencing on-scene time in a rural Norwegian helicopter emergency medical service: a retrospective observational study

Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-sc...

Authors: Øyvind Østerås, Jon-Kenneth Heltne, Bjørn-Christian Vikenes, Jörg Assmus and Guttorm Brattebø

Barriers and facilitators towards implementing the Sepsis Six care bundle (BLISS-1): a mixed methods investigation using the theoretical domains framework

The ‘Sepsis 6’, a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. However, uptake has been variable. Tools from behavioral scie...

Authors: Neil Roberts, Guy Hooper, Fabiana Lorencatto, Wendell Storr and Michael Spivey

Neurological outcomes and duration from cardiac arrest to the initiation of extracorporeal membrane oxygenation in patients with out-of-hospital cardiac arrest: a retrospective study

We investigated the relationship between neurological outcomes and duration from cardiac arrest (CA) to the initiation of extracorporeal membrane oxygenation (ECMO) (CA-to-ECMO) in patients with out-of-hospita...

Authors: Takahiro Yukawa, Masahiro Kashiura, Kazuhiro Sugiyama, Takahiro Tanabe and Yuichi Hamabe

Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury

After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessmen...

Authors: Toni Pakkanen, Antti Kämäräinen, Heini Huhtala, Tom Silfvast, Jouni Nurmi, Ilkka Virkkunen and Arvi Yli-Hankala

The effect of a national web course “Help-Brain-Heart” as a supplemental learning tool before CPR training: a cluster randomised trial

The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of str...

Authors: Anette Nord, Leif Svensson, Andreas Claesson, Johan Herlitz, Håkan Hult, Susanne Kreitz-Sandberg and Lennart Nilsson

Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses

Point-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the cor...

Authors: Milla Jousi, Simo Saikko and Jouni Nurmi

The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study

Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five mos...

Authors: Bas de Groot, Frank Stolwijk, Mats Warmerdam, Jacinta A. Lucke, Gurpreet K. Singh, Mo Abbas, Simon P. Mooijaart, Annemieke Ansems, Laura Esteve Cuevas and Douwe Rijpsma

Fatal poisonings in Northern Finland: causes, incidence, and rural-urban differences

In this study we evaluate differences between rural and urban areas in the causes and incidence of fatal poisonings.

Authors: Lauri Koskela, Lasse Raatiniemi, Håkon Kvåle Bakke, Tero Ala-Kokko and Janne Liisanantti

We need support! A Delphi study about desirable support during the first year in the emergency medical service

New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new profession...

Authors: Anna Hörberg, Maria Jirwe, Susanne Kalén, Veronica Vicente and Veronica Lindström

Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires

Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An in...

Authors: P. Navarro Moya, M. González Carrasco and E. Villar Hoz

Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis

Although the term “polytrauma” has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient...

Authors: Stephan Frenzel, Philipp Krenn, Thomas Heinz and Lukas Leopold Negrin

Daily volume of cases in emergency call centers: construction and validation of a predictive model

Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volum...

Authors: Damien Viglino, Aurelien Vesin, Stephane Ruckly, Xavier Morelli, Rémi Slama, Guillaume Debaty, Vincent Danel, Maxime Maignan and Jean-François Timsit

Early post-traumatic seizures are associated with valproic acid plasma concentrations and UGT1A6/CYP2C9 genetic polymorphisms in patients with severe traumatic brain injury

Seizure is a common complication for severe traumatic brain injury (TBI). Valproic acid (VPA) is a first-line antiepileptic drug, though its metabolism is affected by genetic polymorphisms and varies between i...

Authors: Yirui Sun, Jian Yu, Qiang Yuan, Xing Wu, Xuehai Wu and Jin Hu

Maintaining immobilisation devices on trauma patients during CT: a feasibility study

To reduce the possibility of secondary deterioration of spinal injuries, it is desirable to maintain the spinal immobilisation that is applied in the prehospital setting throughout computed tomography (CT) sca...

Authors: Pål Johan Stokkeland, Erlend Andersen, Maria Myhre Bjørndal, Arne Morten Mikalsen, Sindre Aslaksen and Per Kristian Hyldmo

Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study

Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patien...

Authors: Lee Thompson, Michael Hill, Caroline Davies, Gary Shaw and Matthew D Kiernan

The role of whole-body computed tomography in the diagnosis of thoracic injuries in severely injured patients – a retrospective multi-centre study based on the trauma registry of the German trauma society (TraumaRegister DGU^®)

Thoracic injuries are a leading cause of death in polytrauma patients. Early diagnosis and treatment are of paramount importance. Whole-body computed tomography (WBCT) has largely replaced traditional imaging ...

Authors: Patricia Lang, Martin Kulla, Fabian Kerwagen, Rolf Lefering, Benedikt Friemert and Hans-Georg Palm

Antiarrhythmic drug therapy among patients presenting to emergency department with symptomatic atrial fibrillation – a prospective nationwide cohort

Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent...

Authors: Tero Penttilä, Heikki Mäkynen, Juha Hartikainen, Harri Hyppölä, Timo Lauri, Mika Lehto, Juha Lund and MJ Pekka Raatikainen

Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients – an observational study

Older patients are at particular risk of experiencing adverse events during hospitalisation.

Authors: Camilla Strøm, Talie Khadem Mollerup, Laurits Schou Kromberg, Lars Simon Rasmussen and Thomas Andersen Schmidt

Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial

Prehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective ...

Authors: David Häske, Stefan K. Beckers, Marzellus Hofmann, Rolf Lefering, Paul A. Grützner, Ulrich Stöckle, Vassilios Papathanassiou and Matthias Münzberg

Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

Upper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes...

Authors: Pierre-Clément Thiebaud, Youri Yordanov, Jacques-Emmanuel Galimard, Pierre-Alexis Raynal, Sébastien Beaune, Laurent Jacquin, François-Xavier Ageron and Dominique Pateron

Characteristics and outcome of rapid response team patients ≥75 years old: a prospective observational cohort study

Rapid response teams (RRTs) attend severely ill general ward patients whose average 30-day mortality is near 30%. A major part of RRT patients are over 75 years old, but there are no studies on the characteris...

Authors: Joonas Tirkkonen, Piritta Setälä and Sanna Hoppu

The Anticoagulated trauma patient in the age of the direct oral anticoagulants: a Canadian perspective

The anticoagulated trauma patient presents a particular challenge to the critical care physician. Our understanding of these patients is defined and extrapolated by experience with patients on warfarin pre-inj...

Authors: Brendan Wood, Barto Nascimento, Sandro Rizoli, Michelle Sholzberg, Amanda McFarlan, Andrea Phillips and Alun D. Ackery

Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study

Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but...

Authors: Wayne Varndell, Margaret Fry and Doug Elliott

Computed tomography during initial management and mortality among hemodynamically unstable blunt trauma patients: a nationwide retrospective cohort study

Although many hemodynamically unstable trauma patients undergo computed tomography (CT) to identify a source of bleeding, this practice is currently only recommended by a few guidelines. To clarify whether CT ...

Authors: Yusuke Tsutsumi, Shingo Fukuma, Asuka Tsuchiya, Tatsuyoshi Ikenoue, Yosuke Yamamoto, Sayaka Shimizu, Miho Kimachi and Shunichi Fukuhara