Understanding Authorship

Understanding Authorship

In this educational series, iEM Education Project interviewed Prof. Fikri Abu-Zidan, a world-renowned expert and researcher on trauma, POCUS, and disaster management. He shares his 40 years of experience as a clinical researcher with the young generation of doctors.

The series name is FUNDAMENTALS OF RESEARCH IN MEDICINE and will include various aspects of research. We hope you will enjoy listening to the advice of Prof. Abu-Zidan.

The first episode is “Understanding Authorship”

Professor Fikri Abu-Zidan, the head of the Trauma Group at United Arab Emirates University, is an Acute Care Surgeon who graduated (MD) from Aleppo University (Syria) in 1981 and was awarded the FRCS, Glasgow, Scotland in 1987.  He achieved his PhD in Trauma and Disaster Medicine from Linkoping University (Sweden) in 1995 and obtained his Postgraduate Diploma of Applied Statistics from Massey University (New Zealand) (1999). His clinical experience included treating war injured patients during the Second Gulf War (1990). He has been promoting the use of Point-of-Care Ultrasound (POCUS) for more than thirty years in which he is a World Leader. Furthermore, he is an international expert on trauma experimental methodology developing novel clinically relevant animal models. Establishing experimental surgical research in Auckland University, New Zealand, has led to a strong successful PhD Program.  

He has made major contributions to trauma management, education and research in Kuwait, Sweden, New Zealand, Australia and UAE.  He authored more than 415 publications, presented more than 600 invited lectures and abstracts, and received more than 40 national and international awards. He is serving as the Statistics Editor of World Journal of Emergency Surgery and European Journal of Trauma and Emergency Surgery. 

Cite this article as: Arif Alper Cevik, "Understanding Authorship," in International Emergency Medicine Education Project, October 20, 2021, https://iem-student.org/2021/10/20/understanding-authorship/, date accessed: October 22, 2021

Practicing ethically in research

Fundamentals of Research in Medicine - Episode 2

In this educational series, iEM Education Project interviewed Prof. Fikri Abu-Zidan, a world-renowned expert and researcher on trauma, POCUS, and disaster management. He shares his 40 years of experience as a clinical researcher with the young generation of doctors.

The series name is FUNDAMENTALS OF RESEARCH IN MEDICINE and will include various aspects of research. We hope you will enjoy listening to the advice of Prof. Abu-Zidan.

The first episode is “Practicing ethically in research.”

Professor Fikri Abu-Zidan, the head of the Trauma Group at United Arab Emirates University, is an Acute Care Surgeon who graduated (MD) from Aleppo University (Syria) in 1981 and was awarded the FRCS, Glasgow, Scotland in 1987.  He achieved his PhD in Trauma and Disaster Medicine from Linkoping University (Sweden) in 1995 and obtained his Postgraduate Diploma of Applied Statistics from Massey University (New Zealand) (1999). His clinical experience included treating war injured patients during the Second Gulf War (1990). He has been promoting the use of Point-of-Care Ultrasound (POCUS) for more than thirty years in which he is a World Leader. Furthermore, he is an international expert on trauma experimental methodology developing novel clinically relevant animal models. Establishing experimental surgical research in Auckland University, New Zealand, has led to a strong successful PhD Program.  

He has made major contributions to trauma management, education and research in Kuwait, Sweden, New Zealand, Australia and UAE.  He authored more than 415 publications, presented more than 600 invited lectures and abstracts, and received more than 40 national and international awards. He is serving as the Statistics Editor of World Journal of Emergency Surgery and European Journal of Trauma and Emergency Surgery. 

Cite this article as: Arif Alper Cevik, "Practicing ethically in research," in International Emergency Medicine Education Project, October 6, 2021, https://iem-student.org/2021/10/06/research-ethics/, date accessed: October 22, 2021

What makes a physician a good researcher

Fundamentals of Research in Medicine - Episode 1

In this educational series, iEM Education Project interviewed Prof. Fikri Abu-Zidan, a world-renowned expert and researcher on trauma, POCUS, and disaster management. He shares his 40 years of experience as a clinical researcher with the young generation of doctors.

The series name is FUNDAMENTALS OF RESEARCH IN MEDICINE and will include various aspects of research. We hope you will enjoy listening to the advice of Prof. Abu-Zidan.

The first episode is “What makes a doctor a good researcher.”

Professor Fikri Abu-Zidan, the head of the Trauma Group at United Arab Emirates University, is an Acute Care Surgeon who graduated (MD) from Aleppo University (Syria) in 1981 and was awarded the FRCS, Glasgow, Scotland in 1987.  He achieved his PhD in Trauma and Disaster Medicine from Linkoping University (Sweden) in 1995 and obtained his Postgraduate Diploma of Applied Statistics from Massey University (New Zealand) (1999). His clinical experience included treating war injured patients during the Second Gulf War (1990). He has been promoting the use of Point-of-Care Ultrasound (POCUS) for more than thirty years in which he is a World Leader. Furthermore, he is an international expert on trauma experimental methodology developing novel clinically relevant animal models. Establishing experimental surgical research in Auckland University, New Zealand, has led to a strong successful PhD Program.  

He has made major contributions to trauma management, education and research in Kuwait, Sweden, New Zealand, Australia and UAE.  He authored more than 415 publications, presented more than 600 invited lectures and abstracts, and received more than 40 national and international awards. He is serving as the Statistics Editor of World Journal of Emergency Surgery and European Journal of Trauma and Emergency Surgery. 

Cite this article as: Arif Alper Cevik, "What makes a physician a good researcher," in International Emergency Medicine Education Project, September 22, 2021, https://iem-student.org/2021/09/22/good-researcher/, date accessed: October 22, 2021

COVID-19 Clinical Readiness Course For Medical Students

COVID-19 clinical readiness course

Dear students,

We are pleased to open our fourth course for you; iEM/Lecturio – COVID-19 Clinal Readiness Course.

As we did in the EMCC course, we collaborated with Lecturio to provide you an excellent course to improve your knowledge in the clinical applications in COVID-19 cases.

The interactive course content is prepared by Lecturio’s expert educators Dr. Eisha Chopra, Dr. Julie Rice, Dr. Daniel Sweiden, Dr. Julianna Jung from John Hopkins University, Department of Emergency Medicine. Assessments of the course were prepared by Dr. Arif Alper Cevik from United Arab Emirates University, College of Medicine and Health Sciences.

One more time, we thank Lecturio for their amazing resources and support to our social responsibility initiative to help medical students in need during these challenging times.

As a part of our social responsibility initiative, iem-course.org will continue to provide free open online courses related to emergency medicine. We hope our courses help you to continue your education during these difficult times.

Please send us your feedback or requests about courses.

We are here to help you.

Best regards.

Arif Alper Cevik, MD, FEMAT, FIFEM

Arif Alper Cevik, MD, FEMAT, FIFEM

iEM Course is a social responsibility initiative of iEM Education Project

Course Length

This course requires 2-4 hours of study time. The course content will be available for 7 days after the enrolment.

Who can get benefit from this course?

  • Junior and senior medical students (course specifically designed for these groups)
  • Interns/Junior emergency medicine residents/registrars

Certificate

The candidates who successfully pass final summative assessment of the course will be provided course completion certificate.

Other Free Online Courses

Cite this article as: Arif Alper Cevik, "COVID-19 Clinical Readiness Course For Medical Students," in International Emergency Medicine Education Project, June 26, 2020, https://iem-student.org/2020/06/26/covid-19-clinical-readiness-course/, date accessed: October 22, 2021

RUSH Course for Medical Students

Dear students,

We are pleased to open our third course for you; Rapid Ultrasound in Shock and Hypotension (RUSH).

As a part of our social responsibility initiative, iem-course.org will continue to provide free open online courses related to emergency medicine. We hope our courses help you to continue your education during these difficult times.

Please send us your feedback or requests about courses.

We are here to help you.

Best regards.

Arif Alper Cevik, MD, FEMAT, FIFEM

Arif Alper Cevik, MD, FEMAT, FIFEM

iEM Course is a social responsibility initiative of iEM Education Project

Hypotension is a high-risk sign which is associated with increased morbidity and mortality rate. The differential diagnosis for hypotension is broad and the treatment depends on the underlying etiology. In most cases of hypotension, patients present with limited history and physical examination may be inaccurate making the management of the condition a great challenge for emergency physicians.

The use of POCUS in undifferentiated hypotension has been shown to help correctly and rapidly identify the etiology and therefore initiate the appropriate management. Since 2001, there are many protocols published describing a systematic approach to the use of POCUS in undifferentiated hypotension. 

In this course, we will focus on the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol.

This course aims to provide the necessary information on ultrasonography, its use in a hypotensive patient, and to prepare you for a RUSH practice session.

The course content is prepared and curated from iEM Education chapters, iEM image and video archives, and various FOAMed resources.

At the end of this course, you will be able to;

  • Describe the basics of ultrasound (terminology, knobology, image acquisition, artifacts, etc.)
  • Describe indications of RUSH protocol
  • Describe patient and machine preparations
  • Describe ultrasound examination views
  • Recognize normal anatomical structures
  • Recognize abnormal findings
  • Feel confident to take a practical session for RUSH protocol

Who can get benefit from this course?

  • Junior and senior medical students (course specifically designed for these groups)
  • Interns/Junior emergency medicine residents/registrars

Other Free Online Courses

Cite this article as: Arif Alper Cevik, "RUSH Course for Medical Students," in International Emergency Medicine Education Project, May 27, 2020, https://iem-student.org/2020/05/27/rush-course-for-medical-students/, date accessed: October 22, 2021

eFAST Course for Medical Students

Dear students,

We are pleased to open our second course for you; Extended Focused Assessment with Sonography for Trauma (eFAST).

As a part of our social responsibility initiative, iem-course.org will continue to provide free open online courses related to emergency medicine. We hope our courses help you to continue your education during these difficult times.

Please send us your feedback or requests about courses.

We are here to help you.

Best regards.

Arif Alper Cevik, MD, FEMAT, FIFEM

Arif Alper Cevik, MD, FEMAT, FIFEM

iEM Course is a social responsibility initiative of iEM Education Project

Extended Focused Assessment With Sonography In Trauma (eFAST) is one of the most commonly used emergency ultrasound or Point-Of-Care Ultrasound protocols. It is a protocol that we use in trauma patients. However, the eFAST examination can also be a part of another protocol, such as RUSH protocol.

The early diagnosis of a bleeding trauma patient is essential for better patient care. Unfortunately, it is proven that our physical exam findings are not perfect in every case. Therefore, using a bedside tool in addition to the physical examination can improve patient management.

As a 21st-century medical student/young physician, you must learn how to use this tool to provide more comprehensive and accurate care to your patients.

This course aims to provide the necessary information on ultrasonography, its use in a multiply injured trauma patient, and to prepare you for an eFAST practice session.

Cite this article as: Arif Alper Cevik, "eFAST Course for Medical Students," in International Emergency Medicine Education Project, May 18, 2020, https://iem-student.org/2020/05/18/efast-course-for-medical-students/, date accessed: October 22, 2021

Free Open Online Emergency Medicine Course for Medical Students

Dear colleagues,

I hope this message finds you well in the busy and risky days of COVID-19. 

As known by most of you, the International Emergency Medicine Education Project has been providing free emergency medicine educational resources for medical students since June 2018. Currently, content produced by 175 contributors from 27 countries reached thousands of students from 197 countries around the globe. 

COVID-19 pandemic made many differences in our lives. Education is no exception to this. Because of the pandemic precautions, medical students miss their normal course of education. This may be a bigger issue in countries lacking e-learning options. Therefore, we have been thinking of ways to help students and educators who might be needing such a resource. 

As some of you might know, we were already planning to start a MOOC for medical students in upcoming years. However, COVID-19 forced us to fasten our plans. We have been working for a solution to help students and educators, who lack the means to continue their education activities. Finally, we managed to create a platform: iem-course.org. This platform is designed to provide free online emergency medicine courses for medical students. 

In this platform, we activated the first course, “Emergency Medicine Core Content Course.” It is a 4-week course, covering 11 core topics of emergency medicine. The course includes video and reading assignments, multiple formative quizzes. In addition, if students prefer to receive a course completion certificate, they can take the summative assessment at the end. The reading assignments are curated from freely available online resources (e.g., iEM Education Project 2018 eBook and Society for Academic Emergency Medicine’s CDEM Curriculum chapters). Videos are provided by Lecturio, and all emergency medicine videos (200 items) are freely available for students who join the “iEM/Lecturio Emergency Medicine Core Content Course.” All students around the world are free to register and use the resources provided in this course. 

We hope that this course may help students and educators to overcome educational challenges related to pandemic. We consider this initiative as our responsibility to our international community in these difficult days. We thank all emergency medicine societies, organizations and institutions that endorsed and supported us since the beginning. We are grateful to our contributors, who made creating a project like this possible by writing chapters, providing images and videos. If you are interested in contributing, please let us know by e-mail

iEM Course is a social responsibility initiative of iEM Education Project

Also, we would like to remind you of other iEM project resources below: 

iem-student.org is the main hub of the iEM Education project. Students can reach 2018 eBook chapters, blog posts, video, image, audio archives through this website. 

Flickr image archive is where we share images and short videos provided by our contributors. All photos and short videos are free to download. You can use these items in your presentations and exams. 

Youtube video archive is where we share clinical videos and interviews with world-renowned experts. 

SoundCloud audio archive is where we share iEM 2018 ebook chapters recorded in audio so students can download and listen anytime and anywhere.

All iEM resources are cost- and copyright-free for all medical students and educators. Please share these resources with your students and colleagues in need. If you are interested in sharing your available resources through our platforms, please contact us. We are stronger together.

Best regards.

Arif Alper Cevik, MD, FEMAT, FIFEM

On behalf of iEM Education Project Team

For more information, please visit iem-course.org

Cite this article as: Arif Alper Cevik, "Free Open Online Emergency Medicine Course for Medical Students," in International Emergency Medicine Education Project, May 1, 2020, https://iem-student.org/2020/05/01/free-open-online-emergency-medicine-course-for-medical-students/, date accessed: October 22, 2021

Cellulitis – Clinical Image and Ultrasound

cellulitis

Case Presentation

A 45-years-old male with a week history of right leg swelling and redness presented to the ED. He has type II DM and hypertension. He denies fever; however, complaints about burning pain over the skin. Vitals were 156/98 mmHg blood pressure, 98 beats per minute heart rate, 16 respiration per minute, 36.7 degrees Celsius temperature and 98% oxygen saturation in room air. Physical exam revealed erythema over the right medial lower leg and calf area (images). Minimally painful with palpation. The area was hot compared to the left leg. Other examination findings were unremarkable.

Cellulitis 2

Cellulitis 1

Patients with red, swollen, painful leg may have very severe problems such as necrotizing fasciitis (infection involving muscular fascia) or infections involving muscles with or without gangrene. The patients having these infections are generally ill-looking, severely painful, and may have subcutaneous crepitations. Therefore, we should be aware of these red flags. This patient has no sign of crepitations, systemic illness, or severe pain.

Lipodermatosclerosis is chronic erythema. Patients show exacerbations because of vascular insufficiency (venous). It can be bilateral or unilateral. One of the discriminative findings from cellulitis is temperature over the lesion. Lipodermatosclerosis is not hot. In the case, the palpation showed warm skin compared to the left side.

Erysipelas is superficial and its’ borders are very sharp. The lesion is fluffy compared to the skin around the lesion. In the case, some areas of the skin were found a little bit raised compared to surrounding structures. However, its’ borders were not well-demarcated.

Other differentials are burns, contact dermatitis, urticaria, etc.

Bedside ultrasound imaging can help to identify cellulitis, abscess, foreign body, fracture, etc. Cobblestone finding is a typical finding for cellulitis.

Bedside ultrasound imaging was performed with Butterfly iQ with soft tissue settings. Cobblestone finding was found in the erythematous areas. This is a nonspecific finding and can be seen many different soft tissue infections. There were no gas/air artifacts (necrotizing fasciitis) or obvious abscess formation. However, there was a minimal fluid accumulation, which creates a suspicion of an abscess. In the case, there was no air artifact. However, x-rays can also help to show air accumulation in soft tissues.

An Example for Necrotizing Fasciitis

The ultrasound investigation in this video shows the air (white) artifacts in the soft tissue.

X-ray Image Showing Subcutaneous Air in Necrotizing Fasciitis

Case courtesy of Dr Matt Skalski, Radiopaedia.org. From the case rID: 25026

For mild uncomplicated patients – dicloxacillin, amoxicillin, and cephalexin are common choices.

If the patient has a penicillin allergy – clindamycin or a macrolide (clarithromycin or azithromycin) can be used.

Fluoroquinolones should be reserved for gram-negative organisms’ sensitivity defined by culture results because of their additional toxicity risks.

For more antibiotic options and explanations, please visit – here

The patients with co-morbidities compromising immune response, periorbital or perianal locations, unable to tolerate oral medication, deep infections should be admitted.

References and Further Reading

  • Loyer EM, DuBrow RA, David CL, Coan JD, Eftekhari F. Imaging of superficial soft-tissue infections: sonographic findings in cases of cellulitis and abscess. AJR Am J Roentgenol. 1996 Jan;166(1):149-52. PubMed PMID: 8571865.
  • Shyy W, Knight RS, Goldstein R, Isaacs ED, Teismann NA. Sonographic Findings in Necrotizing Fasciitis: Two Ends of the Spectrum. J Ultrasound Med. 2016 Oct;35(10):2273-7. doi: 10.7863/ultra.15.12068. Epub 2016 Aug 31. PubMed PMID: 27582527.
Cite this article as: Arif Alper Cevik, "Cellulitis – Clinical Image and Ultrasound," in International Emergency Medicine Education Project, December 2, 2019, https://iem-student.org/2019/12/02/cellulitis-clinical-image-and-ultrasound/, date accessed: October 22, 2021

Massive Pneumothorax Without A Tension

massive pneumothorax

Case Presentation

A 24-years-old male with shortness of breath and chest pain presented to the emergency department. He was alert and oriented. Vitals were as follows; BP: 127/65 mmHg, HR: 101 beats per min, RR: 24 breaths per min, T: 37-degree celsius, SatO2: 94%. Physical examination revealed that normal breathing sounds on the left side, but decreased breath sounds on the right side of the chest. No JVD noted. Other examination findings were unremarkable.

Shortness of breath and chest pain started suddenly while he was playing soccer about 30 minutes ago. Since then, shortness of breath and chest pain increased. He has no known medical disease, allergy.

Bedside ultrasound revealed pneumothorax on the right.

Bedside Ultrasound Examination

Above video shows left side B mode ultrasound examination. Investigation was done in lung settings by using Butterfly iQ portable ultrasound. Lung sliding and comet tail artefacts are seen on examination which is normal findings.

Above video shows right side B mode and M-mode ultrasound examination. There is no lung sliding or comet tail artefacts in B mode, and M-mode revealed “barcode sign” which is seen in pneumothorax.

Pneumothorax - US - Lung - M-mode

Image shows “barcode sign” in M-mode examination. 

Bedside Portable Chest X-ray

spontaneous pneumothorax 1 - 18yo male

Bedside portable anteroposterior chest x-ray shows right sided large pneumothorax.

Cite this article as: Arif Alper Cevik, "Massive Pneumothorax Without A Tension," in International Emergency Medicine Education Project, November 25, 2019, https://iem-student.org/2019/11/25/massive-pneumothorax-without-a-tension/, date accessed: October 22, 2021

ACEM2019 and Incredible India

ACEM 2019 and increadible India

The 10th Asian Conference on Emergency Medicine was successfully completed in New Delhi, India, during the last couple of days. The conference hosted around 1700 attendees around the globe, mainly Asia. There were approximately 300 speakers from all continents. Dr. Tamorish Kole and Dr. Sirinath Kumar were the two Emergency Medicine professionals who behind the success of this conference. Both experts are also a member of the board of directors of the Asian Society for Emergency Medicine (ASEM). At the end of the conference, Dr. Kole took over the presidency from Prof.Dr. Yildiray Cete (Turkey) who served to ASEM for two years.

ASEM board
Asian Society for Emergency Medicine, Board of Directors

Vice-President of India, Venkaiah Naidu, opened the conference with promising support to the improvement of Emergency Medicine care in India as well as highlighting the implementation of Emergency Medicine into the undergraduate curriculum. As many countries in Asia, Indian medical graduates are working in acute care settings after graduation. Therefore, focusing on undergraduate education can help many countries in the same context. 

Venkaiah Naidu
Venkaiah Naidu, Vice-President of India

This topic one of the items discussed in the ASEM Board of Directors meeting. Creating a widely acceptable undergraduate curriculum is a necessity for Asian countries, especially those in the development stage of Emergency Medicine. ASEM board formed a sub-committee to work on this highly significant problem. Dr. Mohan Tiru (Singapore) and I will be leading board members to continue and finalize the process. Because the International Federation for Emergency Medicine (IFEM) currently working on a comprehensive update process for its’ undergraduate curriculum, there is no need to reinvent the wheel for ASEM. Taking the updated version of the IFEM undergraduate curriculum as the main framework and working on it to create a precise Asian undergraduate curriculum will be enough and probably the fastest way. However, there is a need to understand the current situation and needs in Asian countries. Therefore, the sub-committee of ASEM will work on learning needs assessment and current situation analysis until the IFEM undergraduate curriculum finalized. The expected time for the new updated version of the IFEM undergraduate curriculum is April-May 2020. Completing learning needs assessment and current situation analysis of Asia by March-April 2020 will give the Asian board a chance to move forward with updated IFEM undergraduate curriculum. Probably, developing the Asian curriculum will be possible in a short period of time until the end of 2020.

ASEM board meeting
Asian Society for Emergency Medicine, Board of Directors Meeting

While ACEM2019 continues, I was able to meet a couple of contributors to the International Emergency Medicine Education Project. I visited Rob Rogers’ well-known course, Medutopia, which aims to increase the quality of the teaching skills of educators. According to Dr. Rogers, this is the most enthusiastic and knowledgable group since the Medutopia journey has begun. Dr. Andy Little and Dr. Mike Giosondi were other two experts who gave the course with Dr. Rogers. You can read and listen to Dr. Rogers’ contributions to the International Emergency Medicine Education Project here.

I also came across to Dr. Simon Carley from Manchester, who is well-known for ST.EMLYN’s blog. He gave a couple of amazing talks during the conference, including one plenary presentation.

Simon Carley, plenary session
Simon Carley, plenary session
Arif Alper Cevik and Simon Carley
Arif Alper Cevik and Simon Carley

One of the surprising things was meeting with one of our blog authors Dr. Kaushila Thilakasiri (Sri Lanka) and her team. This energetic group was not only coming for ASEM to attend meetings, but they also came to compete in SimWars. And of course, they won the first prize.

Kaushila Thilakasiri and Sri Lanka team

Two days of workshops and three days of the busy scientific program passed like lightning. In addition to scientific activities, ACEM 2019 team prepared many social events for participants. I think, socially and scientifically, ACEM 2019 was a very busy conference. This created many networking opportunities.

One of the final event was graduation ceremony of 2018-2019 class of Emergency Medicine residents. Around 120 new graduated were appreciated with a nicely setted up ceremony with attendence of leaders of Emergency Medicine such as Prof. Lee Wallis (Past President of IFEM), Dr. Taj Hassan (Pas President of Royal College of Emergency Medicine) and Prof. James Ducharme (President of IFEM) as well as local leaders of Emergency Medicine of India.

2018-2019 Indian Emergency Medicine Graduates
2018-2019 Indian Emergency Medicine Graduates

As a summary, ACEM2019 was a successful gathering for international Emergency Medicine experts and Asian emergency physicians, residents and medical students.

ACEM 2021 will be in Hong Kong. ASEM board of directors decided to give ACEM2023 to Manila, Phillipines and ACEM2025 to Dubai, United Arab Emirates. We hope to see you all in these upcoming events.

Cite this article as: Arif Alper Cevik, "ACEM2019 and Incredible India," in International Emergency Medicine Education Project, November 13, 2019, https://iem-student.org/2019/11/13/acem2019-and-incredible-india/, date accessed: October 22, 2021

Torus Fracture – Diagnosed with ultrasound

torus fracture

Case Presentation

A 9-years old male patient brought to the ED by his parents because of the right forearm pain. The patient is alert, oriented, and moderately in distress. He described that he stepped on the ball and fell while playing soccer with his friends. He denies any other injury, loss of consciousness, etc.

Physical Exam

Torus Fracture - right arm 2

The patient complaints right forearm pain, especially distal 1/4 of the radius. There was no deformity or swelling recognized on inspection. 

Torus Fracture - right arm 1

The patient refuses any movement on the right arm because of pain during the movement, especially in rotational movements. He prefers to stay in the rest position, as shown in the picture.

There was no visible deformity and swelling in the inspection. However, the patient described palpation tenderness over the forearm, especially point tenderness over the distal 1/4 – 1/5 of the radius. The patient also described minimal pain on elbow and wrist movements. The neurovascular examination was unremarkable. There are no other findings regarding trauma. Patient parents deny any disease, medication, operation, etc. He has received 250 mg paracetamol in the school after consultation with the family. However, he still shows distress because of pain.

After the physical exam, 200 ibuprofen was given. X-ray is planned, and musculoskeletal ultrasound was applied while he waits for an X-ray.

We used Butterfly iQ to investigate the radius by using musculoskeletal settings. The ultrasound showed periosteal discontinuity with a 2-3 mm step-off sign at the distal radius. 

Diagnosing fractures with ultrasound

Ultrasound showed high pooled sensitivity (91%) and specificity (94%) (Schmid et al., 2017). It is a very effective modality, especially in the detection of long bone fractures such as humerus, forearm, tibia, fibula, etc.

In forearm fractures, its’ sensitivity is between 64 and 100%, its’ specificity is between 73-100% (Katzer et al., 2016). Besides, ultrasound provides 25 minutes earlier diagnosis advantage compared to other modalities, namely X-rays. Ultrasound’s effectiveness has elbow, been shown in many articles, its’ best performance is on diaphysis fractures of long bones (Weingberg et al., 2010).

After the detection of Torus (Buckle) fracture by ultrasound, the patient was sent to X-ray in order to investigate elbow, forearm and wrist in more detail. X-rays showed Torus fracture at the distal radius, which the diagnosis aligned with the ultrasound result.​

Torus Fracture - right arm 4

Torus Fracture - right arm 3

AP X-ray showed minor periosteal step-off/bulging on both sides. Lateral X-rays showed periosteal discontinuity with a 2-3 mm step-off on the dorsal side of the radius.

The final diagnosis of the patient was Torus (Buckle) fracture.

A long arm splint was applied in the ED because of his elbow and wrist pain. The patient discharged with pain medication, ice and elevation recommendations. On the 4th day, the patient visited the orthopedic clinic, and his splint changed to short arm splint. He was pain-free on the elbow and wrist.

References

  1. Schmid GL, Lippmann S, Unverzagt S, Hofmann C, Deutsch T, Frese T. The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging. Dtsch Arztebl Int. 2017 Nov 10;114(45):757-764. doi: 10.3238/arztebl.2017.0757. PubMed PMID: 29202925; PubMed Central PMCID: PMC5729224.
  2. Katzer C, Wasem J, Eckert K, Ackermann O, Buchberger B. Ultrasound in the Diagnostics of Metaphyseal Forearm Fractures in Children: A Systematic Review and Cost Calculation. Pediatr Emerg Care. 2016 Jun;32(6):401-7. doi: 10.1097/PEC.0000000000000446. Review. PubMed PMID: 26087441.
  3. Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010 Aug;41(8):862-8. doi: 10.1016/j.injury.2010.04.020. Epub 2010 May 13. PubMed PMID: 20466368.
 
Cite this article as: Arif Alper Cevik, "Torus Fracture – Diagnosed with ultrasound," in International Emergency Medicine Education Project, November 6, 2019, https://iem-student.org/2019/11/06/torus-fracture-diagnosed-with-ultrasound/, date accessed: October 22, 2021

How to find the right journal?

You completed your research, and now, it is time to find the most suitable peer-reviewed journals for your article. This step is frequently skipped by many researchers, and they immediately start writing their study with great enthusiasm. There are several downsides to this approach, and we will be covering some of them in this post.

Who is your target audience?

Knowing your target audience is one of the first things that you need to do. Do you want to reach only field experts? Is your paper includes very specific information or results on a topic? If your answer is “yes,” then you should look for more specific journals. If your answer is “no,” then you should search for more general journals. Is your manuscript about education-related more than emergency medicine? If your answer is “yes,” go for education journals first. If your answer is “no,” emergency medicine journals may be interested. So, decide which group of readers is more suitable for your manuscript. Do not forget; the journal is just a connection/bridge between your results/message and readers. And, you want to pass the correct bridge to reach them. Submitting the manuscript to an unsuitable journal is a common mistake and knowing your target audience is the first step to avoid this error. 

Emergency Medicine Journal List

You can find various sources listing current Emergency Medicine journals. For example, WikEM listed only 7 Emergency Medicine journals. Some of the popular ones such as the European Journal of Emergency Medicine is not listed here.

However, Scimago Journal & Country Rank website gives the full list of the Emergency Medicine related journals with a wide range. Currently, 78 journals are listed in Emergency Medicine category.

Which journal is right for your manuscript?

To decide, you should ask yourself some questions.

  • First, your readings: which articles did you read before you design your study? Which journals were those articles published? It is possible that the same journals may be interested more in your manuscript.
  • Second, look for the first and corresponding authors in similar articles. Did they publish similar topic frequently, and where?
  • Third, databases! There are many databases you can use to find your target journals. Google scholar probably has the most coverage of journals, publications. However, it provides a non-specific search. PubMed is one of the well-known databases mainly focuses on the medical field. So, it is a good starting point to find similar articles and their journals. The SCOPUS, however, has sections that help us to find possible journals. In addition to these search engines, a couple of other websites can help us. JANE: Journal Author Name Estimator (http://jane.biosemantics.org/) and JOURNAL GUIDE (https://www.journalguide.com/) are two of them.

SCOPUS provides multiple and easy to use filters to find journals. In the below example, I entered undergraduate, emergency medicine, medical school, medical student, curriculum, curricula keywords to SCOPUS and here are the results. On the left side, you see the filters.

One of the filters give you the journal list according to your keywords. These journals published most of the articles related to your search.

As you can see above, we found Academic Emergency Medicine, Western Journal of Emergency Medicine, Annals of Emergency Medicine,  Journal of Emergency Medicine and BMC Medical Education journals, and number of published articles related to our search terms.

You can also click the analyze search results button, and you can see visual diagrams summarizing the search.

This page gives you information about authors, institutions, countries, sponsors which may help you to define a suitable journal. It also helps for your future research and collaborations.

In JANE platform, you can add your title, keywords or your full abstract and search for relevant journals, articles or authors. 

As a example, I enter the same keywords to see the results.

As you see, JANE listed journals with the highest confidence and influence. Academic Emergency Medicine, Medical Teacher, and BMC Medical Education are the top three journals publishing manuscripts including our keywords. Let’s see the articles published in the first journal.

In 8 years, Academic Emergency Medicine published three articles. However, one of them may not be what we are looking for according to its’ title. And, one important point, Academic Emergency Medicine has a new journal called AEM Education and Training. So, they recently started to publish these type of articles in their second journal. Knowing this type of details can be impossible for all journals, but it is important when you try to find the correct journal.

Journal Guide also has similar interface.

I entered the same keywords to Journal Guide.

If you click the first journal (Annals of Emergency Medicine), you will see more details about the journal. There is a lot information on the page below such as publication speed which we will be discussing in the following section.

If you click matches link, then you will see those articles as a list.

In addition to SCOPUS, JANE, and Journal Guide, “find my journal” and “SJFinder” can be other options. 

So, you have multiple online options to search for the best suitable journal for your research area. I recommend you to look for all and evaluate each of them carefully to reach the desired result.

Evaluate The Journals

You have found potential journals, and now you should evaluate them. This step will help you to define suitable journals to submit.

Scope

In the evaluation process, the first thing you look for is “scope” of the journals in your list. Are the journals publishing articles similar to your topic or type? You have to know and particularly look for this because being out of the scope of the journal is the number one reason to be rejected. Luckily, many of the journals share the scope on their websites (see below). Scimago Journal & Country Rank also provides the information about scope.

If the journal’s scope is overlapping with yours, then you should look to the recent years about related articles. Searching for the last five years will be fine. However, do not forget that the recent is the better because journal scopes and type of the published articles (review, research, editorial, special issues, etc.) may change in time or when their editors change.

Indexing

Another important information is where these journals are indexed. Web of Science, SCOPUS, Medline, Pubmed are some of the prestigious indexes that you can trust. Publishing articles in journals indexed in these platforms increase the visibility, download, and citation of your article. You can find this information on the journal websites. I searched Web of Science, and found a 14 Emergency Medicine journals in this prestigious index. First ten journals are listed below.

Publication Model - Open Access or Not

After all these steps, you should also know the publication model of the journals. There is an increasing trend of open access journals. The advantage of these journals are authors keep the copyright of their paper, figure and table numbers are less limited, no registration required to reach or download the article which increases accessibility. One of the major downsides of these journals is the article-processing charge (APC). This price may range between 1000 – 2000 USD per article. Please do not forget that there are many journals called PREDATOR JOURNALS asking APC. Although some websites are listing these journals and updating their list regularly, being in prestigious indexes is considered as a safety belt because indexes are looking two to five years publication periods of these journals for many details. So, being in prestigious indexes is not easy. The journal has to provide transparent information for their quality on editorial, evaluation and publishing processes.

Please check the Scimago Journal & Country Rank website and look for this sign. 

Publication speed

Publication speed is another essential information about journals you should consider. This is basically from submission to first decision or publication time. The shorter is the better. Although time period is directly related to the quality of the submitted manuscript, average decision or publication times give handy information about the editorial and evaluation process of the journal. However, it is not easy to find this information. Some journals may show this information on their website but still locate them in hidden areas.

Impact Factor

If you realize that I have not mention about impact factor of the journal yet. Of course, when you complete the writing, you want to start from a high impact journal first. Acceptance in a high impact journal depends on how novel your finding is and its potential help to improve the field. If your manuscript is a repetition and has a relatively incremental effect on the field, high impact journals will probably reject your paper. It is changing field to field, but high impact journals have less than 10% acceptance rate.

Above table gives the impact factors of Emergency Medicine journals in 2014. 

Submission Strategy

After all these steps, now it is time to decide a submission strategy, defining first, second, and third journals. Choosing multiple journals with similar manuscript format and writing your manuscript according to their guidelines will shorten your reformatting time if your manuscript is rejected. When you write, it is better to keep manuscript under the word, figure, table, reference limits. 

Selected Journal Submission List

JournalsWord LimitAbstract Word LimitFigure/Table LimitReference Limit
Journal 14000350730
Journal 23500300425
Journal 35000250540
Journal 43500200630
Journal 54500300730

Above table includes 5 different journals. For your convenience in the reformatting process, it is better that you choose the minimum numbers to fit all. For example, if your target journals are those in the above table, your manuscript should have 3500 words, abstract: 200 words, figure and tables: 4, and references: 25. 

You should also keep some backup journals in case of rejection from all selected journals. New journals can be an option because they have a higher acceptance rate than old ones. However, they probably are not in prestigious indexes yet. In this point, it is better to learn whether this journal applied for those indexes. If the answer is yes, then it is worth submitting. There are also “mega journals” which publish a wide range of researches, and they have a wide range of readers. As a result, their impact factors are high. Some examples of these journals are PlusOne, Scientific Reports, Cureus, etc.

What is next?

If your manuscript is still rejected after all measures you consider above, do not think that this is a waste of time. Your research can always be valuable and available to others. This topic is discussed in “You have done everything, but your paper can still be rejected!” chapter.

References and Further Reading

Cite this article as: Arif Alper Cevik, "How to find the right journal?," in International Emergency Medicine Education Project, May 10, 2019, https://iem-student.org/2019/05/10/how-to-find-the-right-journal/, date accessed: October 22, 2021