The walk-in wounded, detecting hypofibrinogenemia, and "time is testicle!": April 2025 Primary Survey

Hip fractures for older people are often severely painful. But, the common treatments like intravenous opioids can cause adverse effects like nausea and delirium. We discuss a new RCT that tests intravenous morphine vs. an ultrasound-guided block of the pericapsular nerve group (PENG), finding the PENG block to be a highly effective and safe alternative. We talk about the ten research priorities for paediatric emergency medicine distilled down by a mixed group of patients, carers, and healthcare professionals. Paediatrics sticks around with a Delphi approach study that delivers another ten pressing research questions for better ways to procedurally sedate kids. And, from the North West of England, we hear about a trial of reflective practice (Balint) groups with protected clinical time for resident doctors in emergency medicine training.

What social dynamics can be observed in the administration of bystander CPR? New research from Korea shows a reluctance to assist when the patient and bystander were of different sex. In the UK, a five year review of knife crime involving children and young people looks for trends in the background of the 145 victims who passed away in that period. From France, we have a study looking at the geographic distribution of cardiac arrest events, and to finish there is a scoping review highlighting the value of access to good translation.

This month, we start with a systematic review on smart ways to cut down unnecessary X-rays in kids with limb injuries. We also look at why subarachnoid haemorrhages get missed or diagnosed late, from both patient and doctor perspectives. A Best Evidence Topic (BET) review asks if simple haematoma blocks are as good as procedural sedation for resetting broken wrists. And finally, we dive into a UK study exploring what life is really like for early-career academic doctors in emergency care. Read the highlights: Primary survey (https://emj.bmj.com/content/43/7)

A new paper takes a look at fatalities in nightclubs across the UK in the last 15 years, based on media reporting and coroners' reports. It found that physical assault and overdoses of MDMA/ecstasy were the leading causes of deaths. Another paper, from Japan, addresses acute scrotum presentation. It set out to rate the use of the TWIST score and point-of-care ultrasound when identifying testicular torsion. Then here's a research paper from Australia looking at ways to avoid invasive diagnostic procedures when considering oesophageal perforation. And finally, a UK-wide study on the use of nasal-high flow asks: how widespread really is it? Read the highlights: Primary survey

Access to helicopter emergency services is improving in the UK, a recent study shows. But what impact is that access having? There's a paper for that too, with this episode declaring: "Helicopters for the win!" There's also research on the effect of epinephrine administration for out-of-hospital cardiac arrest in children - does the sequence of treatment affect the outcomes? And finally, how to fight back against spoofed survey responses when gathering data online.