Journal of Emergency Medicine最新文献

Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department 神经性白塞病伪装成癫痫持续状态和脑膜脑炎在急诊科。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.024

Rebecca Merrill MD , Kristen Septaric MPH , Negin Ceraolo MD , Erin L. Simon DO

{"title":"Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department","authors":"Rebecca Merrill MD , Kristen Septaric MPH , Negin Ceraolo MD , Erin L. Simon DO","doi":"10.1016/j.jemermed.2024.09.024","DOIUrl":"10.1016/j.jemermed.2024.09.024","url":null,"abstract":"<div><h3>Background</h3><div>Behcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions.</div></div><div><h3>Case Report</h3><div>We present a case of a 28-year-old male with neuro-BD mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis, and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid samples were obtained and computed tomography of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 76-80"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.023

Sadaf Luth MS , James Luth DO , Kelly A. Murray PharmD, BCACP , Bobby Abernathy DO

{"title":"A Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department","authors":"Sadaf Luth MS , James Luth DO , Kelly A. Murray PharmD, BCACP , Bobby Abernathy DO","doi":"10.1016/j.jemermed.2024.08.023","DOIUrl":"10.1016/j.jemermed.2024.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing, multifactorial disorder characterized by persistent unwanted physiologic genital arousal in the absence of sexual desire. This poorly understood disorder is thought to be derived from a complex dysregulation of biopsychosocial factors with common underlying neurological dysfunction that has yet to be adequately studied. With frequently evolving diagnostic criteria, lack of a standardized treatment algorithm, and few evidence-based treatment options, this disease is largely unrecognized and difficult to treat once identified.</div></div><div><h3>Case Report</h3><div>A 25-year-old woman presented to the Emergency Department (ED) with persistent and refractory symptoms of genital arousal not responsive to previously documented treatments, and the novel use of a β-adrenergic agent, terbutaline, leading to cessation of symptoms. With her initial presentation, lorazepam, haloperidol, and viscous lidocaine intravaginally provided relief for approximately 24 h until the patient returned. At her subsequent presentation, the patient received additional doses of lorazepam and intravaginal lidocaine, as well as consults with Urology and Obstetrics and Gynecology. Her symptoms eventually ceased by administration of terbutaline.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Although presentation of PGAD to the ED is rare, emergency physicians should be prepared with treatment options to assist patients with this distressing diagnosis. This case highlights the novel use of terbutaline, a β-agonist, in cessation of PGAD symptoms when first-line benzodiazepines and antipsychotics fail.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 81-83"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on the Ability to Seal by Supraglottic Airway Device During Human Cadaveric Cardiopulmonary Resuscitation

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.005

Subhasree Das MD , Rakesh Vadakkethil Radhakrishnan MSN , Amiya Kumar Barik DM , Chitta Ranjan Mohanty MD

引用次数: 0

Assessing Frailty Through Head Impact Locations in Older Adults

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.010

Waseem Jerjes MBBS, MSc, MDres, PhD, MRCGP, FHEA, FAcadMed

引用次数: 0

Qualitative Study of Dynamics, Camaraderie, and Belonging Among Emergency Physicians and Nurses

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.011

Jeffrey Phillips MD, BSN , David Jones MD, MCR

{"title":"Qualitative Study of Dynamics, Camaraderie, and Belonging Among Emergency Physicians and Nurses","authors":"Jeffrey Phillips MD, BSN , David Jones MD, MCR","doi":"10.1016/j.jemermed.2024.08.011","DOIUrl":"10.1016/j.jemermed.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (ED) must perform patient care at a safe and efficient pace, which requires an effective care team. Communication and workplace practices that foster identification as part of an emergency healthcare team have not been previously demonstrated.</div></div><div><h3>Objectives</h3><div>To explore the critical role of communication within ED healthcare teams and its impact on team belonging. This study investigates how communication practices between physicians and nurses in the ED influence team dynamics and the sense of belonging to the healthcare team.</div></div><div><h3>Methods</h3><div>A qualitative approach involving focus groups with 38 participants from nine EDs in Oregon.</div></div><div><h3>Results</h3><div>This study identifies positive influences on team belonging, such as proactivity, openness, less formal name conventions, and relationships outside of work. Conversely, negative influences include resistance to communication, obstacles to communication, and interactions leading to alienation.</div></div><div><h3>Conclusion</h3><div>The findings emphasize the importance of fostering positive communication practices to enhance team dynamics, cohesiveness, and overall well-being within ED healthcare teams. Future research may delve into specific aspects like naming conventions and the role of friendships in healthcare communication.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 43-50"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characteristics of Intracranial Hemorrhage and Acute Aortic Syndromes Resuscitated with Extracorporeal Cardiopulmonary Resuscitation (ECPR)

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.014

Fumiya Inoue MD , Takayuki Otani MD , Toshikazu Abe MD, MPH, PhD , Akihiko Inoue MD, PhD , Toru Hifumi MD, PhD , Tetsuya Sakamoto MD, PhD , Yasuhiro Kuroda MD, PhD , The SAVE-J II Study Group

{"title":"Characteristics of Intracranial Hemorrhage and Acute Aortic Syndromes Resuscitated with Extracorporeal Cardiopulmonary Resuscitation (ECPR)","authors":"Fumiya Inoue MD , Takayuki Otani MD , Toshikazu Abe MD, MPH, PhD , Akihiko Inoue MD, PhD , Toru Hifumi MD, PhD , Tetsuya Sakamoto MD, PhD , Yasuhiro Kuroda MD, PhD , The SAVE-J II Study Group","doi":"10.1016/j.jemermed.2024.08.014","DOIUrl":"10.1016/j.jemermed.2024.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial hemorrhage (ICH) and acute aortic syndrome (AAS) are etiologies associated with unfavorable outcomes in patients with out-of-hospital cardiac arrest (OHCA), even with extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Objectives</h3><div>This study aimed to describe the characteristics of refractory OHCA patients resuscitated with ECPR due to ICH and AAS.</div></div><div><h3>Methods</h3><div>This was a descriptive study and a secondary analysis of the SAVE-J II study, which was a multicenter ECPR registry.</div></div><div><h3>Results</h3><div>Among the 1589 cases, the causes of arrest were ICH in 48 patients (3%), AAS in 112 patients (7%), and cardiac causes in 1429 patients (90%). Patients in the ICH group were younger (ICH: 47 years [interquartile ranges (IQR) 40–63], AAS: 68 years [IQR 59–74], cardiac causes: 61 years [IQR 50–68]; <em>p</em> < 0.001), and had fewer signs of life on hospital arrival (ICH: 2%, AAS: 12%, cardiac causes: 19%; <em>p</em> = 0.001) compared to the cardiac causes group. Patients in the ICH and AAS groups were also less likely to present with an initial shockable rhythm (ICH, 19%; AAS, 27%; cardiac causes, 74%; <em>p</em> < 0.001). Survival to hospital discharge was significantly lower in the ICH and AAS groups than in the cardiac cause group (ICH, 4%; AAS, 4%; cardiac causes, 29%; <em>p</em> < 0.001). Of the 112 patients in the AAS group, 54 (48%) were presumptively diagnosed as cardiac etiologies before ECPR.</div></div><div><h3>Conclusion</h3><div>ICH and AAS should be considered potential causes of cardiac arrest, especially in cases with a nonshockable initial cardiac rhythm. However, differentiating them from cardiac causes of arrest remains challenging.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 1-12"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound-Guided Clavipectoral Plane Block for Analgesia of Acute Clavicular Fracture in the Emergency Department

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.020

Richard J. Gawel MD, Jeffrey A. Kramer MD, MSC

引用次数: 0

Acute Limb Ischemia: The Role of Physical Diagnosis in the Expedient Work-Up and Management in the Emergency Department—A Consultant's Perspective

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.007

Scott S. Berman MD, MHA, FACS, DFSVS

引用次数: 0

Impact of Extreme Temperature and Particulate Matter 2.5 on Outcomes of Out-of-Hospital Cardiac Arrest

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.10.014

Yongyeon Choi MPH , Sangshin Park MPH, PhD

{"title":"Impact of Extreme Temperature and Particulate Matter 2.5 on Outcomes of Out-of-Hospital Cardiac Arrest","authors":"Yongyeon Choi MPH , Sangshin Park MPH, PhD","doi":"10.1016/j.jemermed.2024.10.014","DOIUrl":"10.1016/j.jemermed.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Extreme temperature and particulate matter-2.5 (PM<sub>2.5</sub>) are known to affect the outcomes of out-of-hospital cardiac arrest (OHCA). However, studies that examine their effects at the exact time of OHCA occurrence are limited.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the impact of extreme cold, extreme heat, and PM<sub>2.5</sub> on OHCA outcomes at the time of occurrence.</div></div><div><h3>Methods</h3><div>We analyzed data from 82,497 OHCAs (aged > 18 years) in South Korea between January 2016 and December 2021. Extreme temperatures were defined as extreme cold (≤5th percentile) and extreme heat (≥95th percentile). PM<sub>2.5</sub> refers to particulate matter ≤ 2.5 micrometers, with extreme PM<sub>2.5</sub> defined as ≥95th percentile. The outcomes were survival to discharge and good neurological outcome, defined as a cerebral performance category of 1 or 2 at hospital discharge. We performed a multivariable logistic regression analysis to assess the impact of extreme temperature and PM<sub>2.5</sub> on OHCA outcomes.</div></div><div><h3>Results</h3><div>Extreme cold (-4.2°C to -20.2°C) showed no association with OHCA outcomes when compared to normal conditions (-0.9°C to 26.6°C). However, OHCAs during extreme heat (28.7°C to 39.3°C) showed a 15% significantly lower probability of survival to discharge (adjusted odds ratio [aOR]: 0.85, 95% confidence interval (CI): 0.74–0.98) compared to normal conditions. OHCAs during extreme PM<sub>2.5</sub> (56 to 218 µg/m³) were associated with 14% lower probability of survival to discharge (aOR: 0.86, 95% CI: 0.75–0.99) compared to normal PM<sub>2.5</sub> (0 to 43 µg/m³).</div></div><div><h3>Conclusion</h3><div>Extreme heat and PM<sub>2.5</sub> were significantly associated with a decreased probability of survival to discharge in OHCA patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 32-42"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

American Academy of Emergency Medicine

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/S0736-4679(25)00043-5

引用次数: 0