Diabetic problems

There are two articles about diabetes in this month’s Journal. The first, from Goh and colleagues from Singapore, reports on their experience of using a 24-hour observation ward to manage the care of a subset of patients who attended their emergency department (ED) with severe hypoglycaemia. It is interesting to compare their approach with the common approach in Europe, where most hypoglycaemic episodes are treated in the community. The major difference with the European experience is that the vast majority of Goh’s patients were on oral hypoglycaemic agents, not insulin. The paper includes a very helpful protocol which will be of practical use to many others (see page 719).

In a short report, Natalie Hewat and others from Australia, share their early experiences of using ED random fingerprick glucose testing as a screening tool for undiagnosed diabetes. They limited the test to patients aged ⩾45 years who had not previously been found to be diabetic. Two-thirds of those tested had random glucose levels ⩾5.5 mmol/l and were advised to see their general practitioner. Just over half of these patients took that advice and eventually a quarter of those that did were diagnosed with impaired glucose metabolism. The authors quite rightly conclude that their pilot study is only the first step and that further studies are required to establish cost effectiveness; it’s a very interesting concept nonetheless (see page 732).

Children’s observations

This month, two papers deal with observations made on children and the actions that can arise from them. In a paper from Exeter, UK, Jadav and colleagues report that the proportion of children with long bone fractures or burns receiving analgesia stayed the same despite a successful intervention to increase the number whose pain was scored on arrival. An interesting discussion completes this paper—as the authors point out, the reasons for their finding are unclear but it seems that measuring pain and treating it are two distinct steps (see page 695).

Bird and co-workers looked at a simple intervention designed to increase the measurement of vital signs at triage in children. The introduction of a small normal range aide-memoire together with a 20-minute teaching session improved the recording of most parameters. The authors note that the long term effect of their intervention requires further study (see page 698).

A little bit of introspection

Stuart Reid and others from the north of England report the results of a poll of their hospital colleagues at specialist registrar and consultant level. They asked about the purpose of emergency medicine, the specialty of emergency medicine, satisfaction with the local ED and the future of emergency care. Unsurprisingly, traditional names and functions were top of the popularity list (with 3% clinging on to casualty and a great fondness for resuscitation and major trauma as core clinical skills) but there was a real mixed bag of opinion towards more recent innovations. It is interesting that 72% were happy with ED ultrasound but only 3% in this hospital agreed with emergency physicians undertaking rapid sequence induction of anaesthesia. It would be interesting to know whether the findings are in any way generalisable—or whether each ED generates its own distinct opinion profile (see page 706).

Who gets assaulted?

Sivarajasingam and co-authors from Cardiff, UK, have looked at what is different about patients who attend the ED having been assaulted. By comparing such patients with similar non-assault patients they found that although assaulted patients drank more per session, they drank less overall. They were also more likely to visit entertainment venues. Interestingly, there were marked differences between men and women—the women’s risk rising to a peak at a much lower number of units (see page 711).

Jumping (but not for joy)

Wooton and Harris from London, UK, report on the continuing plague of trampolining injuries in children. In their 2008 summer cohort, some 1.5% of children’s attendances were trampoline related. As the authors say, despite the best efforts of manufacturers, retailers and government, parents still manage to ignore safety advice. Lack of supervision, multiple bouncers and failure to use safety nets all contribute to the problem (see page 728).

A caseload of interest

In this month’s Journal we carry an interesting mix of case reports. They range from Lemierre’s syndrome (see page 750), through allergic angina (see page 755) and seamlessly on to Wellen’s syndrome (see page 751). Each month we try and select case reports that are truly novel, educational or otherwise interesting and we know that our readers enjoy them. Over the next few months we will be changing our approach to accepting and publishing such reports. We will start to work much more closely with our sister BMJ Group publication BMJ Case Reports. Our eventual intention is that BMJ Case Reports will be the first to publish all our case reports. We will, however, continue to print case reports—each month we will select a number from BMJ Case Reports and put them into Emergency Medicine Journal. In this way, we will have access to even more to choose from and can make sure those that we do print will really fulfil our editorial aims.