Recent Submissions

  • Journal update monthly top five

    Leech, Caroline; Medical and Dental; Leech C, Virgo I, George A, et al (Emergency Medicine, 2022)
    No Abstract
  • Sedation and Field Amputation. In: Lax, P

    Leech, Caroline; Medical and Dental; Leech, C., Veitch, J (Springer, 2022)
    When a patient is physically trapped by a limb with imminent threat to life from cardiac arrest due to hypovolaemia, or a scene emergency such as fire or flooding, and there is no other method of rapid extrication then life-saving limb amputation may be necessary. Advanced prehospital practitioners should have the equipment, training and organisational governance to be able to undertake these rare time-critical procedures in the field. Whilst the actual surgical procedure of a guillotine amputation is very simple, the decision-making to undertake the procedure is more stressful and a successful outcome requires adequate preparation and briefing of the team. This chapter covers the key indications and considerations for field amputation including helpful advice to support the decision, as well as considerations before starting the procedure, after the patient has been extricated and after handover at hospital. This chapter describes the use of procedural sedation for amputation as well as other painful procedures which may be undertaken in the prehospital environment. Practitioners should have a comprehensive understanding of the pharmacology, dosing and potential side effects of the sedative drugs available in their formulary, as well as having experience and training to optimally provide sedation in the field.
  • PreHOspital Trainee Operated research Network (PHOTON). Determining the top research priorities in UK prehospital critical care: a modified Delphi study

    Leech, Caroline; Medical and Dental; Ramage L, McLachlan S, Williams K (Emergency Medicine, 2023)
    No Abstract
  • Shock in Trauma.

    Leech, Caroline; Medical and Dental; Leech C, Turner J (Elsevier, 2023)
    No Abstract
  • ABC of Prehospital Emergency Medicine 2nd edition

    Leech, Caroline; Medical and Dental; Co-Editor) Nutbeam T, Boylan M, Leech C, Bosanko C (Wiley, 2023)
    No Abstract
  • Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial.

    Leech, Caroline; Medical and Dental; Davenport R, Curry N, Fox EE, et al (JAMA, 2023-10-12)
    No Abstract
  • Summarising in medical emergencies: The role of the discourse marker so

    Leech, Caroline; Polina Mesinioti, Jo Angouri, Chris Turner, (Journal of Pragmatics, 2024)
    This article is concerned with the in situ negotiation of epistemic authority through the mobilisation of summaries in the context of medical emergencies. It focuses on the use of the discourse marker so in prefacing summaries as a strategy for claiming epistemic primacy, with particular attention being paid to so's multimodal accomplishment. Taking an interactional sociolinguistic approach, we bring together simulated and real-life trauma emergencies and zoom in on the role of the institutionally defined team leader.
  • Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial.

    Jansen, Jan O; Hudson, Jemma; Cochran, Claire; MacLennan, Graeme; Lendrum, Robbie; Sadek, Sam; Gillies, Katie; Cotton, Seonaidh; Kennedy, Charlotte; Boyers, Dwayne; et al. (American Medical Association, 2023-10-12)
    To determine the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) when used in the emergency department along with standard care vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage.
  • Misplaced attribution for malpractice claims further frays the safety net provided by emergency departments.

    Weber, Ellen J; Leech, Caroline; Leech, Caroline; Ellen J Weber 1, Caroline Leech 2 3, 1 Emergency Medicine, University of California San Francisco, San Francisco, California, USA ellen.weber@ucsf.edu. 2 Emergency Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. 3 HEMS, The Air Ambulance Service, Rugby, UK. (BMJ Publishing Group, 2023-07-05)
    No Abstract Available
  • Pyruvate Kinase Deficiency

    Enegela, Ogboche; Anjum, Fatima; Enegela, Ogboche; Emergency Medicine; Medical and Dental (StatPearls Publishing, 2023-04)
    Pyruvate kinase deficiency (PKD) is the most common enzyme-related glycolytic defect that results in red cell hemolysis. This disorder is characterized by clinical heterogeneity. Heterogeneity results in a variable degree of hemolysis, causing irreversible cellular disruption. Invariably, PKD results in hereditary non-spherocytic anemia. Manifestations occur from the neonatal period through adult life. A myriad of complications could arise from hemolytic anemia.
  • Fatigue: It Is Not Always in the Head.

    Zeb, Jehan; Zafar, Sana; Irshad, Zehra; Zeb, Jehan; Zafar, Sana; Irshad, Zehra; Emergency Medicine; Medical; Medical and Dental (Springer, 2023-06-04)
    Fatigue is a common presenting complaint in patients seen in clinics and same-day emergency care. Although it has a simple presentation, it can be challenging to diagnose and manage, particularly when an underlying medical condition presents atypically as fatigue. Here we present an interesting case of giant cell arteritis (GCA) with only fatigue as the presenting complaint. GCA is the inflammation of medium and large vessels in the body, including the aortic arch and its branches. It typically manifests above the age of 50 with headaches, jaw claudication, temporal tenderness, arthralgia, night sweats, and unintentional weight loss. Early diagnosis and treatment are of paramount importance to prevent complications, particularly permanent blindness.
  • Nonfreezing Cold Injuries Among Long-Distance Polar Rowers.

    Longman, Daniel P; Brown, Emily L; Imray, Christopher H E; imray, chris; imray, chris; Surgical Services; Medical and Dental (Elsevier, 2020-04-16)
    Nonfreezing cold injury (NFCI) is a peripheral cold injury that occurs when the extremities are exposed to cold temperatures, at or near the freezing point, for sustained periods of time (48-96 h at temperatures of usually around 0 to 6°C with associated wind chill). Although NFCI often goes unreported and may be underdiagnosed, it is a cause of significant morbidity in those working in cold conditions, particularly those in the military. Thus, further research into the prevention, recognition, and treatment of NFCI is warranted.
  • The cerebral venous system and hypoxia.

    Wilson, Mark H; Imray, Christopher H E; imray, chris; imray, chris; Surgical Services; Medical and Dental (American Physiological Society, 2015-08-20)
    Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static "Monro-Kellie" doctrine, which forms the basis of the "Tight-Fit" hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure
  • Nonfreezing cold-induced injuries.

    Imray, C H E; Richards, P; Greeves, J; Castellani, J W; imray, chris; Surgical Services; Medical and Dental (BMJ Publishing Group, 2011)
    Non-freezing cold injury (NFCI) is the Cinderella of thermal injuries and is a clinical syndrome that occurs when tissues are exposed to cold temperatures close to freezing point for sustained periods. NFCI is insidious in onset, often difficult to recognize and problematic to treat, and yet the condition accounts for significant morbidity in both military and civilians who work in cold conditions. Consequently recognition of those at risk, limiting their exposure and the appropriate and timely use of suitable protective equipment are essential steps in trying to reduce the impact of the condition. This review addresses the issues surrounding NFCI.
  • Pre-hospital emergency medicine.

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E; imray, chris; imray, chris; Surgical Services; Medical and Dental (Elsevier, 2015-12-18)
    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.
  • A woman with syncope and acidosis

    Malik, Adnan Ather; Nanthakumar, Aran; Mahdi, Dana; Alluri, Sai Venkatesh; Dhungana, Salonee; Bleehen, Laura; Maynard, Charlsea; Butt, Umar; Chacko, Jerry; Ali, M. Adam; et al. (Wiley Open Access, 2022-11)
    Case report on a woman with syncope and acidosis