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Cunningham, Neil J; Farebrother, Nicholas; Miles, Jake
doi: 10.1111/1742-6723.12989pmid: 29671944
Proximal tibiofibular joint (PTFJ) dislocations are relatively rare injuries and this paper provides an up‐to‐date review and practical management approach for the assessment and management of these cases. Isolated PTFJ dislocations are a rare injury, accounting for less than 1% of all knee injuries. Thus, there does not appear to be a clear consensus on definitive management and post‐reduction care in the literature. This paper provides a review of the literature, anatomical analysis of the PTFJ in the dislocated state, and a technique for reduction. In the majority of cases, PTFJ dislocations are an injury that can be identified with simple imaging modalities and treated in the ED with manipulation under procedural sedation.
Lawton, Emily M; Pearce, Helen; Gabb, Genevieve M
doi: 10.1111/1742-6723.12990pmid: 29851280
Global temperatures are rising; extreme environmental heat can result in adverse health effects including heatstroke. Acute effects of heat are well recognised, but there is less understanding of potential long‐term adverse outcomes. Our aim was to review recent medical literature for clinical cases of environmental heatstroke with a focus on neurological outcome. Structured search strategies were designed to retrieve publications of heatstroke case reports using Ovid Medline and Embase (2000–2016). One thousand and forty‐nine abstracts were identified, and after application of exclusion criteria 71 articles deemed relevant. Ninety cases were identified from 71 articles. 100% presented with acute neurological symptoms; 87.8% presented with non‐neurological symptoms. 44.4% patients recovered fully, 23.3% died, 23.3% suffered convalescent or long‐term neurological sequelae, and in 8.9% no long‐term follow up was available. 57.1% of the patients who died or had a neurological deficit had no documented co‐morbidity. Patterns of neurological deficits included 66.7% patients with motor dysfunction, 9.5% cognitive impairment, 19% both motor and cognitive impairment and 4.7% other. In total 71.4% of the impaired patients had long‐term cerebellar dysfunction. Adverse long‐term neurological outcomes were common in surviving patients presenting with environmental heatstroke. Permanent neurological deficits were present in 34.4% of survivors where outcome was known; many were young, healthy individuals. Cerebellar injury was common suggesting cerebellar structures are vulnerable to heat. These findings highlight that people of all ages and pre‐morbid states are at risk of severe heat‐related illness. In the face of climate change, effective interventions for heat‐related illness, including both treatment and prevention are necessary.
Verma, Rishabh; Matich, Paula; Symmons, David; Vangaveti, Venkat
doi: 10.1111/1742-6723.13136pmid: 30107645
Antiemetics are medications that are frequently used in the pre‐hospital setting. However, recent evidence indicates that antiemetics are ineffective in reducing undifferentiated nausea scores and vomiting rates. The aim of this study is to evaluate the efficacy and safety of antiemetics administered in the pre‐hospital setting. This is a systematic review employing PRISMA guidelines of seven studies selected that included randomised controlled trials and prospective studies, investigating the use of antiemetics in the pre‐hospital setting. Nausea scores, vomiting rates and rates of adverse effects along with other variables were summarised. Searches of PubMed, MEDLINE, CINAHL and InformIT yielded seven relevant full text articles. Trials that investigated the efficacy of all antiemetics in the pre‐hospital setting were included in the search results. Overall, it was found that antiemetics were effective in reducing nausea and vomiting rates in the pre‐hospital setting on initial evaluation. The antiemetics included in the studies were associated with insignificant or self‐limiting side‐effects. However, after further examination, the reliability of the preliminary results can be questioned because of the poor quality of all the studies reviewed. There is insufficient evidence to establish the efficacy of antiemetics in the pre‐hospital setting despite their safety. Further rigorous studies, preferably randomised and double blinded control trials are required to establish the efficacy of antiemetics in the pre‐hospital setting. Consequently, antiemetics should be used more selectively and reserved for severe nausea and intractable vomiting in the pre‐hospital setting. PROSPERO registration number: CRD42016044090.
Harel, Nadav; Moskovitch, Jeremy T; Weiland, Tracey J; Augello, Michael R
doi: 10.1111/1742-6723.13161pmid: 30120822
Prisoners are a particularly vulnerable minority group whose healthcare needs and management differ substantially from the general population. The overall burden of disease of prisoners is well documented; however, little is known regarding the aetiology and frequency of prisoners’ acute medical complaints requiring an ED visit. Objectives of the review were to identify, review and appraise existing literature regarding prisoners’ presentations to EDs. We performed systematic electronic searches in MEDLINE, EMBASE, PsycINFO, PubMed, Cochrane, and Web of Science using MeSH terms and keywords. Two reviewers abstracted data and conducted quality appraisal using the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Nine articles met the predefined inclusion criteria. Apart from two European studies in the past 5 years, there is a scarcity of literature primarily addressing the common presenting complaints to EDs by prisoners. Existing studies demonstrated that prisoners have a disproportionately high burden of traumatic, infectious and psychiatric disease requiring emergency treatment. With the increasing number of emergency presentations made by prisoners each year, it is vital that further research is undertaken to identify trends of these acute medical complaints in order to ensure optimal therapeutic outcomes for prisoners.
Moynihan, Gerard V; Koelzow, Heike
doi: 10.1111/1742-6723.13158pmid: 30168278
Venous thromboembolic disease (VTE) increases the risk of mortality in trauma patients. To decrease the occurrence of VTE, low dose anticoagulants are commonly prescribed. This may be unacceptable in trauma patients who have a high risk of bleeding. Inferior vena cava (IVC) filters can be employed as an alternative strategy to decrease the risk of pulmonary embolism (PE). Insertion of an IVC filter is an invasive procedure that has a range of complications. The benefits of IVC filter insertion must be compared to its risk of complications in each individual patient. A search of the literature since 2005 was conducted on MEDLINE, Evidence‐Based Medicine Reviews, Cochrane Central Register of Controlled Trials and Embase. The clinical question posed was does prophylactic IVC filter insertion decrease the risk of PE in trauma patients? The available evidence was low level and unable to definitively answer this question. The majority of articles infer that IVC filter insertion is safe and may decrease the risk of PE. However, there is a need for well‐designed randomised controlled trials to be conducted in this area.
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