International Journal of Emergency Medicine最新文献

{"title":"Severe hypertension after atropine administration a case report.","authors":"Sara Timerga, Aynalem Befkadu","doi":"10.1186/s12245-025-00832-4","DOIUrl":"10.1186/s12245-025-00832-4","url":null,"abstract":"<p><p>Atropine, a cholinergic receptor antagonist, counteracts the parasympathetic nervous system's inhibitory effects on the sinus node, thereby increasing heart rate. It is frequently used to manage atrioventricular block, organophosphate and beta-blocker poisoning, and sinus bradycardia. This case report highlights a rare instance of hypertensive urgency induced by atropine administration, emphasizing the clinical significance of this adverse effect. We present a case report involving a 48-year-old male patient scheduled for right inguinal hernia surgery. The patient was administered atropine prior to the procedure and subsequently experienced severe hypertension and a headache, which were treated with labetalol. After 24 h of monitoring, the patient was discharged without further complications. Documenting such cases is crucial for enhancing our understanding of atropine's safety profile and refining management strategies to mitigate associated risks. CLINICAL TRIAL NUMBER: Not applicable.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"32"},"PeriodicalIF":2.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting EWS scores for altitude above sea level: is it necessary to predict sepsis mortality in the emergency room?","authors":"German Devia Jaramillo, Lilia Erazo Guerrero","doi":"10.1186/s12245-024-00761-8","DOIUrl":"10.1186/s12245-024-00761-8","url":null,"abstract":"<p><strong>Background: </strong>Sepsis mortality can be significantly reduced with early diagnosis and appropriate treatment. It is crucial to have tools that enable the early identification of patients at high risk of sepsis mortality from the triage stage. The National Early Warning Score (NEWS) and recently the International Early Warning Score (IEWS), are widely used for this purpose. However, its oxygenation parameters are primarily validated in populations at sea level. Given that patient oxygenation varies with altitude, there is a need to investigate the applicability of this scores at different altitudes. The purpose of this study is to compare the discriminatory capacity of sepsis mortality in emergency departments between the standard NEWS and IEWS scale and a NEWS and IEWS scale adjusted for barometric pressure in Bogotá, a city located 2600 m above sea level. A prospective recruitment was conducted in the triage area of the emergency department, including all patients with suspected sepsis. The scales under evaluation were calculated. Subsequently, the sensitivity, specificity, predictive values, and areas under the curve (AUC) of each scale were assessed for mortality prediction.</p><p><strong>Results: </strong>A total of 304 patients were recruited. The overall mortality rate was 19.4% and the septic shock mortality rate was 59.3%. The AUC for the standard NEWS was 0.78 (95% CI: 0.72-0.83), and for the standard IEWS was 0.81(95% CI: 0.75-0.87), altitude-adjusted NEWS, it was 0.79(95% CI: 0.73-0.84), and for the altitude-adjusted IEWS was 0.82(95% CI: 0.76-0.88).</p><p><strong>Conclusions: </strong>Adjustment of oxygen saturation for altitude above sea level in NEWS (NEWSa) does not improve its predictive capacity for mortality in patients with sepsis in the emergency department, however, this same adjustment in the IEWS value significantly improves the predictive capacity compared to NEWS and NEWSa.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"30"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point of care ultrasound in rapid diagnosis of acute cholangitis and emphysematous cholecystitis: a case report.","authors":"Min Seok Chae, Olga A Kravchuk","doi":"10.1186/s12245-025-00823-5","DOIUrl":"10.1186/s12245-025-00823-5","url":null,"abstract":"<p><strong>Background: </strong>Emphysematous cholecystitis is a rare and rapidly progressive disease that requires prompt diagnosis and intervention. Point of care ultrasound (POCUS) is a useful diagnostic imaging tool in the emergency department that can help expedite diagnosis and management of biliary etiology.</p><p><strong>Case presentation: </strong>In our case, we describe an 85 year old female with a history of diabetes mellitus with a presentation consistent with undifferentiated cholecystitis. Point of care ultrasound performed in the emergency department showed a characteristic \"champagne sign\", along with other findings including dilated common bile duct and pericholecystic fluid. These findings ultimately led to the diagnosis of emphysematous cholecystitis and acute cholangitis. The use of ultrasound expedited the patient's cholecystostomy tube placement and subsequent endoscopic retrograde cholangiopancreatography, proving to be a life-saving tool in the management of this patient.</p><p><strong>Conclusion: </strong>POCUS can be an important tool for the diagnosis of undifferentiated biliary etiology, expediting the management of these patients.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"29"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of a targeted Arab Board of Emergency Medicine examination preparation course on resident success rates.","authors":"Shahzad Anjum, Khalid Bashir, Haris Iftikhar, Biju Gafoor, Aftab Mohammad Umar","doi":"10.1186/s12245-025-00818-2","DOIUrl":"10.1186/s12245-025-00818-2","url":null,"abstract":"<p><strong>Background: </strong>The Arab Board of Emergency Medicine (ABEM) examination is a critical milestone for emergency medicine residents (EMRs) aiming to transition to independent practice. Prior to this study, no structured course had been administered to prepare EMRs for the ABEM examination. To address this gap, a five-day evening preparatory course was developed, designed to align with ABEM requirements and deliver updated, essential knowledge. This study aims to evaluate the impact of this newly introduced preparatory course on EMRs' success rates on the ABEM examination from 2017 to 2021.</p><p><strong>Methods: </strong>The five-day in-person course was conducted annually in the evenings to accommodate both EMRs and faculty, scheduled approximately six weeks before the ABEM examination. The course content was specifically aligned with ABEM standards, focusing on relevant and contemporary knowledge. EMRs participated in assessments modeled after the ABEM examination, using standardized rubrics. Pass rates were compared to historical data, and demographic variables were thoroughly analyzed. Feedback was collected from both EMRs and faculty after each course to continuously refine and improve course content and delivery.</p><p><strong>Results: </strong>Data were collected over a five-year period (2017-2021), with 49 emergency medicine residents (EMRs) (100%) participating in the course. The majority of participants were male (69.4%), and the cohort included graduates from diverse regions, including Sudan (22.4%) and Pakistan (18.4%). The overall pass rate for the Arab Board of Emergency Medicine (ABEM) examination significantly increased to 91.8%, compared to a pre-course pass rate of 60%. No significant impact on outcomes was observed based on factors such as gender, country of graduation, year of participation, or initial confidence levels. Feedback from both participants and faculty indicated high levels of satisfaction with the course, with recommendations for further content refinement and the inclusion of additional Objective Structured Clinical Examination (OSCE) stations.</p><p><strong>Conclusion: </strong>The findings demonstrate the significant impact of the newly introduced, face-to-face, five-day ABEM preparatory course on EMR pass rates, potentially serving as a model for similar programs in other specialties. The results highlight the importance of targeted, up-to-date instruction in improving the confidence and success of EMRs on the ABEM examination. Furthermore, the course's development and the incorporation of ongoing feedback played key roles in further enhancing the quality and effectiveness of the training program.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"31"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The status of emergency medicine in the state of Kuwait.","authors":"Feras Husain Abuzeyad, Abdulaziz Alburaidi, Hanan H AlRazzuqi, Fatema M Alkandari, Leena Alqasem, Sara Ahmad Al Qabandy","doi":"10.1186/s12245-025-00833-3","DOIUrl":"10.1186/s12245-025-00833-3","url":null,"abstract":"<p><strong>Background and objective of the review: </strong>There is limited literature on the emergency medicine (EM) specialty in Kuwait, and this paper evaluated the development status of the specialty under Arnold's classification.</p><p><strong>Discussion: </strong>In Kuwait, the EM specialty is recognized with an existing professional society and structured residency training program with post post-board-certification exam. The emergency departments are directed by board-certified emergency physicians with existing emergency medical services and transfer systems. However, there is still a huge demand for trained emergency physicians and a further need to advance the existing trauma system. The academic EM in the country needs further progress in research and developing a specialty journal, databases, and subspecialty training. The management systems within the emergency departments are well developed.</p><p><strong>Conclusion: </strong>The EM status is its way to reaching maturity if we overcome a few deficits and challenges in the system. Lastly, two great achievements were made through the establishment of 'the Kuwait Poison Control Center' and the simulation training in EM.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"28"},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under the coconut palm - a retrospective analysis of trauma incidents caused by falling coconuts presenting to emergency department at a tertiary care centre in coastal India.","authors":"A Sai Deepak, Aaditya Katyal, Neeraja A Nair, Tanvee Walia, Rachana Bhat","doi":"10.1186/s12245-025-00816-4","DOIUrl":"10.1186/s12245-025-00816-4","url":null,"abstract":"<p><strong>Background: </strong>Injuries due to falling coconuts are a common yet underreported form of trauma in the tropical regions. Although these might appear insignificant at first glance, the physical forces involved are potentially fatal. Despite their global prevalence, research on this subject remains scarce, making it a neglected public health concern. This study seeks to bridge these gaps by analysing the affected demographics, contributing factors and injury patterns. By enhancing the understanding of coconut fall-related injuries, this research seeks to create awareness about dangers of falling coconuts and inform the development of effective public health strategies to mitigate their impact.</p><p><strong>Methods: </strong>A retrospective study was conducted over a period of 3 years from January 2021 to December 2023 at a tertiary care centre on the southern coast of India. Patients who presented to emergency with coconut-fall related injuries were identified through a comprehensive review of nursing ledgers. Additional data including imaging, consultations & treatment details were retrieved from patient files and electronic medical records. Descriptive statistics of the recorded data like demographic variables, time of injury, injury patterns, injury severity score (ISS) and ED disposition were analysed by using Microsoft Excel 365.</p><p><strong>Results: </strong>The study population included 17 males and 12 females. Most patients were within the age group of 40-60, which comprised 48% of the total participants. The months of September and October reported the highest frequency of cases. Out of the 29 patients, 14 were farm workers who sustained coconut fall-related injuries. Injury patterns varied from mild soft tissue injuries to severe TBIs which include SDH and SAH. There were 3 patients who required surgery, and 7 patients were admitted. There were no fatalities reported, and average hospital stay was 4.5 days.</p><p><strong>Conclusion: </strong>Coconut fall-related injuries in tropical regions is a significant but less recognised public health issue. Our study shows the necessity of seasonal preventive strategies, public awareness and safety measures for high-risk population like outdoor workers and older adults. Community focussed interventions, such as regular coconut tree pruning, installation of coconut safety nets and educational campaigns will help to reduce the incidence and severity of these injuries.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"27"},"PeriodicalIF":2.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an emergency department triage tool to predict admission or discharge for older adults.","authors":"Ashraf Abugroun, Saria Awadalla, Sanjay Singh, Margaret C Fang","doi":"10.1186/s12245-025-00825-3","DOIUrl":"10.1186/s12245-025-00825-3","url":null,"abstract":"<p><strong>Background: </strong>Older adults present to Emergency Departments (ED) with complex conditions, requiring triage models that support effective disposition decisions. While existing models perform well in the general population, they often fall short for older patients. This study introduces a triage model aimed at improving early risk stratification and disposition planning in this population.</p><p><strong>Methods: </strong>We analyzed the National Hospital Ambulatory Medical Care Survey data (2015-2019) for ED patients aged ≥ 60 years, excluding those who died in the ED or left against medical advice. Key predictors were identified using a two-step process combining LASSO and backward stepwise selection. Model performance was evaluated using AUC and calibration plots, while clinical utility was assessed through decision curve analysis. Risk thresholds (< 0.1, 0.1-0.5, > 0.5) stratified patients into low, moderate, and high-risk groups, optimizing the balance between sensitivity and specificity.</p><p><strong>Results: </strong>Of 13,431 patients, 3,180 (23.7%) were admitted. Key predictors for admission included ambulance arrival, chronic conditions, gastrointestinal bleeding, and abnormal vital signs. The model showed strong discrimination (AUC 0.73) and good calibration, validated by 10-fold cross-validation (mean AUC 0.73, SD 0.02). Decision curve analysis highlighted net benefit across clinically relevant thresholds. At thresholds of 0.1 and 0.5, the model identified 18.9% as low-risk (91.2% accuracy) and 7.9% as high-risk (57.7%). Adjusting thresholds to 0.2 and 0.4 expanded low-risk (55.4%, 87.9% accuracy) and high-risk (14.1%, 53.7% accuracy) groups.</p><p><strong>Conclusions: </strong>This older adult-focused risk score uses readily available data to enhance early discharge, prioritize admissions for high-risk patients, and enhance ED care delivery.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"26"},"PeriodicalIF":2.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pit crew card game: a novel gamification exercise to improve EMS performance in critical care scenarios.","authors":"Danielle DiCesare, Bridget Scheveck, Jeffrey Adams, Maria Tassone, Vanessa I Diaz-Cruz, Christine Van Dillen, Latha Ganti, Shayne Gue, Ayanna Walker","doi":"10.1186/s12245-024-00748-5","DOIUrl":"10.1186/s12245-024-00748-5","url":null,"abstract":"<p><strong>Background: </strong>Gamification can be defined as the use of game design elements in non-game contexts, in this case, education. As such, gamification seeks to augment the interactive approach of adult learning theory which promotes ongoing motivation and engagement. The objective of this study was to develop and implement a gamified learning module to teach the pit crew approach to Emergency Medical Services personnel in an interactive, engaging format. We created a game-based simulation scenario, an introductory video, and a post-session survey to assess the effectiveness of our educational innovation. We hypothesized that gamification would strengthen classroom engagement and attitudes toward clinical education as assessed in the post-session survey.</p><p><strong>Methods: </strong>This was a pilot study to assess the characteristics of a novel, gamified educational session. We created teams of 5 personnel with various experience and levels of training. Our educational session began with an introductory video and the Pit Crew Card Game, a novel, interactive card game where the facilitator leads teams through a verbal scenario and administers task cards to the team leader based on interventions and other tasks the group verbalizes. After the game, teams were engaged in an interactive critical care simulation scenario where they were expected to perform tasks based on their pre-assigned roles. After the exercise, we administered a brief survey to assess learners' perceptions about the effectiveness of this novel educational session as well as whether participating in this activity would change their behaviors in future real-life critical care scenarios.</p><p><strong>Results: </strong>96 participants completed the post-session survey. The Pit Crew Card Game was heavily favored over traditional lecture-based learning sessions, with 84% of respondents indicating agreement. 77% agreed that the game improved their understanding of how to utilize the pit crew approach for critical care scenarios and that it was an effective teaching, teamwork, and communication tool.</p><p><strong>Conclusion: </strong>Based on these results, we conclude that gamification has potential as a preferential and feasible learning method for critical scenario training among prehospital personnel. Participants reported that the Pit Crew Card Game increased their understanding of pit crew concepts, promoted effective communication and teamwork, and was an overall effective teaching tool. We recommend further expansion of gamified teaching strategies to the prehospital education realm and support for future research in this domain.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"25"},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, outcomes, and prognostic factors in patients with penetrating and blunt traumatic diaphragmatic injury: a nationwide retrospective cohort study in Japan.","authors":"Takafumi Shinjo, Yoshimitsu Izawa, Chikara Yonekawa, Tomohiro Matsumura, Takashi Mato","doi":"10.1186/s12245-025-00826-2","DOIUrl":"10.1186/s12245-025-00826-2","url":null,"abstract":"<p><strong>Background: </strong>Traumatic diaphragmatic injury (TDI) is well-known worldwide as rare and life-threatening. However, because no nationwide cohort study of penetrating and blunt TDI has been conducted in Japan and other countries where penetrating trauma is relatively uncommon, the clinical characteristics of all TDI are unknown. We aimed to describe the characteristics of TDI patients, compare penetrating TDI with blunt TDI, and identify mortality risk factors in Japan.</p><p><strong>Methods: </strong>We retrospectively identified TDI patients between 2004 and 2019 using data from the Japan Trauma Data Bank. We extracted data on patient demographics, type of trauma, cause of trauma, physiological parameters, region of concomitant injury, associated injury, and management. We compared penetrating and blunt TDI for each variable. The primary outcome was mortality. Multivariable logistic regression was performed to identify mortality risk factors.</p><p><strong>Results: </strong>Of the 338,744 patients, 1,147 (0.3%) had TDI, of which 771 were eligible for analysis (excluding 308 in cardiac arrest on arrival). Penetrating TDI represented 29.8% and blunt TDI 70.2%, and comparing penetrating and blunt TDI, the most common cause was self-inflicted (48.7%) vs. accident (85.6%), males were 68.7% vs. 66.0% of the patients (P = 0.50), and the mortality rate was 8.3% vs. 26.4% (P < 0.001). Multivariable analysis found that age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.04), Injury Severity Score (OR 1.03, 95%CI 1.006-1.06), Revised Trauma Score (OR 0.55, 95%CI 0.45-0.67), severe concomitant abdominal injury (OR 2.45, 95%CI 1.32-4.56), severe concomitant upper extremity injury (OR 3.38, 95%CI 1.24-9.17) were independent predictors of mortality, and computed tomography (CT) (OR 0.32, 95%CI 0.15-0.69) and diaphragm repair (OR 0.44, 95%CI 0.25-0.78) were protective factors.</p><p><strong>Conclusions: </strong>In Japan, we found that penetrating TDI was mainly caused by self-injury and the male-female ratio was the same as for blunt TDI, although blunt TDI was much more frequent. TDI was considered highly lethal, with over 25% of patients in cardiac arrest on arrival. Our unique independent predictors were CT, severe concomitant abdominal injury, and severe concomitant upper extremity injury. These findings may help in the management of TDI in countries with less common penetrating trauma.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"23"},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hidden danger: lung abscess following inhalation of kerosene-based pyrethroid insecticide spray.","authors":"Kohei Ofune, Tomoya Hirose, Hiroki Kai, Yoshinori Yokono, Ryosuke Takegawa, Jun Oda","doi":"10.1186/s12245-025-00829-z","DOIUrl":"10.1186/s12245-025-00829-z","url":null,"abstract":"<p><strong>Background: </strong>Pyrethroid insecticides are widely used because of their low toxicity in humans. Spray-type pyrethroids are often formulated with kerosene as a carrier solvent, and inhalation of kerosene-containing products can lead to pneumonitis and the formation of lung abscesses. We report a case of chemical pneumonitis resulting in the development of a lung abscess due to the intentional inhalation of pyrethroids.</p><p><strong>Case presentation: </strong>A man in his 50s in a psychiatric hospital for transient psychotic disorder attempted suicide during an overnight leave from the hospital. He drank sodium hypochlorite, put a nylon bag over his head, and sprayed pyrethroid insecticide inside the bag. He was found collapsed and was transported to our emergency room. On arrival, his SpO₂ was 100% on O₂ at 10 L/min by mask (100% on room air at ambulance arrival), his circulation was stable, and his Glasgow Coma Scale score was 10 (E1V3M6), which improved to 15 (E4V5M6) in about one hour. A chest computed tomography (CT) scan showed ground-glass shading in both lungs. We diagnosed him as having pneumonia and started antimicrobial therapy. On day 13 of hospitalization, we found multifocal hypo-absorptive areas, and a diagnosis of lung abscess was made based on CT imaging, and antimicrobial therapy was continued. During the hospitalization, he expectorated bloody sputum. A contrast chest CT scan obtained on day 71 of hospitalization showed a pseudoaneurysm in the abscess cavity, for which we performed successful transcatheter coil embolization. On day 77, the abscess was shrinking, and he was transferred to another hospital for continued treatment. However, he again had bloody sputum and was transferred back to our hospital on day 113. Another contrast chest CT scan revealed the formation of a new aneurysm, and on day 114, we successfully performed coil embolization again, and he was transferred back to the other hospital on day 116.</p><p><strong>Conclusion: </strong>Spray-type pyrethroid insecticides contain the organic solvent kerosene. Inhalation of kerosene has been reported in several cases of chemical pneumonitis leading to lung abscess. Clinicians should pay attention to kerosene contained in insecticides and the circumstances under which they are used. Early recognition and aggressive treatment can likely prevent severe outcomes.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"24"},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}