Journal of Emergency Medicine最新文献

{"title":"RICsy Business: A Tutorial on Rapid Infusion Catheter Placement and Utilization in Emergency Medicine","authors":"Jace C. Bradshaw MD ,&nbsp;David J Berman MD ,&nbsp;David Leon MD ,&nbsp;Laeben Lester MD ,&nbsp;McKenzie Warshel DO MSEd ,&nbsp;Emily Nagourney MD ,&nbsp;P. Logan Weygandt MD MPH","doi":"10.1016/j.jemermed.2024.12.002","DOIUrl":"10.1016/j.jemermed.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>In emergency medicine (EM), high-volume fluid resuscitation is often crucial to stabilize critically ill patients. This tutorial aims to provide emergency physicians with a comprehensive guide on the placement and utilization of Rapid Infusion Catheters (RICs)—a large bore peripheral IV inserted by modified Seldinger technique—in emergencies.</div></div><div><h3>Discussion</h3><div>We introduce the RIC as a resuscitation tool, describe a clinical scenario ideal for RIC placement, and provide a step-by-step guide for RIC placement. We briefly discuss the pathophysiology of hypovolemic states and how rapid correction can improve cardiac function. Additionally, we discuss the determinants of intravenous (IV) flow rates and explain why RICs offer superior flows in critical scenarios.</div></div><div><h3>Conclusions</h3><div>Rapid Infusion Catheters are useful tools in resuscitative medicine but are underutilized in the emergency department.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 70-76"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912851","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}

{"title":"Letters to the Editor Response for “Cooling Modality Effectiveness and Mortality Associated with Prehospital Care of Exertional Heat Stroke Casualties”","authors":"David W. DeGroot PhD ,&nbsp;Kari C. Goodwin MS ,&nbsp;Francis G. O'Connor MD, MPH","doi":"10.1016/j.jemermed.2024.11.018","DOIUrl":"10.1016/j.jemermed.2024.11.018","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 139-141"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912792","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}

{"title":"Socioeconomic and Demographic Modifiers of Depression's Impact on Emergency Department Utilization: A Stratified Analysis","authors":"Wei Chen BS,&nbsp;Jingjing Wang BS","doi":"10.1016/j.jemermed.2024.11.015","DOIUrl":"10.1016/j.jemermed.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>The emergency department (ED) is often considered the last line of defense for urgent health crises, and people with depression may rely more heavily on ED services to address unexpected issues related to mental health or physical health due to the acute onset of symptoms or a lack of routine medical care.</div></div><div><h3>Objective</h3><div>This study aims to investigate the association between depressive symptoms and ED utilization and to systematically evaluate the moderating effects of socioeconomic status (SES), gender, and age on this relationship.</div></div><div><h3>Methods</h3><div>The study utilized data from the National Health and Nutrition Examination Survey (NHANES) covering the period from 2005 to 2018, with a final sample of 26,299 adult participants. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and ED utilization was categorized based on participants' self-reported medical service use.</div></div><div><h3>Results</h3><div>Logistic regression analysis indicated that each 1-point increase in PHQ-9 score was associated with a 6% increase in the likelihood of ED utilization (<em>p</em> &lt; 0.001). The association between depressive symptoms and ED utilization was significantly stronger in women, particularly for those with severe depression (<em>p</em> = 0.021).</div></div><div><h3>Conclusion</h3><div>This study demonstrates that depressive symptoms are significantly associated with a higher likelihood of ED utilization, with this association strongly moderated by SES, gender, and age. The varying impact of specific depressive symptoms, such as delayed movement or speech and sleep problems, on ED utilization highlights the importance of early intervention and targeted mental health support for high-risk groups to help reduce ED visit frequency.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 31-45"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605015","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}

{"title":"Trigeminal Neuralgia Unmasked: A Case of Anaplasma Phagocytophilum Infection","authors":"Rebecca Merrill MD ,&nbsp;Isaac Pratt BS ,&nbsp;Erin L. Simon DO","doi":"10.1016/j.jemermed.2024.12.003","DOIUrl":"10.1016/j.jemermed.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div><em>Anaplasma phagocytophilum</em> is a bacteria transmitted to humans by tick bites, and like other tick-borne illnesses, its incidence has increased over the past several decades. A symptomatic patient infected with <em>A. phagocytophilum</em> typically presents with fever, chills, myalgia, other flu-like symptoms, leukopenia, thrombocytopenia, elevated liver enzymes, and inclusion bodies on a peripheral blood smear.</div></div><div><h3>Case Report</h3><div>We report a case of a 72-year-old female with an infection of <em>A. phagocytophilum</em> who presented to the emergency department (ED) with intermittent pain that originated behind her right ear and radiated to their jaw and cheek. Laboratory testing revealed leukocytopenia, thrombocytopenia, elevated liver enzymes, inclusion bodies on blood smear, and a rash was identified on their left hip. The patient was treated with doxycycline for the infection and with dexamethasone and ketorolac for the trigeminal neuralgia.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>As the incidence of Human Granulocytic Anaplasmosis (HGA) increases, emergency physicians encounter more patients presenting to the ED. HGA can have life-threatening complications such as respiratory distress, shock, organ dysfunction and death. Emergency physicians must know how to diagnose and treat HGA to avoid complications, which can be difficult when unusual presentations are seen. Our patient did not have the common symptoms of fever, myalgia, and malaise. Instead, they presented with right ear and jaw pain, which was diagnosed as trigeminal neuralgia. The diagnosis of HGA in the ED relied on laboratory findings. These typical findings included inclusion bodies on a peripheral blood smear, leukopenia, thrombocytopenia and elevated liver enzymes. The patient's infection resolved with doxycycline (100 mg oral twice daily).</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 83-86"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912782","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}

{"title":"Erratum to \"Efficact of Supplemental Oxygen During Procedural Sedation and Analgesia in Elderly Patients in the Emergency Department\" [J Emerg Med. 2023 Oct;65(4):e310-e319].","authors":"Kentaro Fukano, Yosuke Homma, Tatsuya Norii","doi":"10.1016/j.jemermed.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.12.011","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011381","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}

{"title":"Is Intravenous Contrast Associated with Increased Risk of Acute Kidney Injury?","authors":"Brit Long MD ,&nbsp;Samuel M. Keim MD, MS ,&nbsp;Michael Gottlieb MD ,&nbsp;Steven G. Schauer DO, MS ,&nbsp;Gillian Schmitz MD","doi":"10.1016/j.jemermed.2024.11.013","DOIUrl":"10.1016/j.jemermed.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Computed tomography (CT) is a common imaging modality used in the emergency department. Intravenous (i.v.) contrast can assist with visualization of pathology, particularly for inflammatory conditions and vascular structures. However, i.v. contrast has historically been associated with the risk of acute kidney injury (AKI).</div></div><div><h3>Clinical Question</h3><div>Is i.v. contrast associated with an increased risk of AKI?</div></div><div><h3>Evidence Review</h3><div>Studies retrieved included four systematic reviews and meta-analyses evaluating the use of i.v. contrast for CT and association with AKI, need for kidney replacement therapy, and mortality. These studies provide estimates of the potential association of AKI with use of i.v. contrast for CT.</div></div><div><h3>Conclusion</h3><div>Based upon the available literature, the use of i.v. contrast for CT imaging does not seem to be associated with an increased risk of AKI.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 129-136"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912790","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}

{"title":"Euglycemic Hyperosmolar Hypernatremic State: A Variant Subtype of Traditional Hyperosmolar Hyperglycemic State With Higher Mortality","authors":"Siyuan Cao MD ,&nbsp;Bijay Yadav MD ,&nbsp;Lihong Huo MD ,&nbsp;Robert Bagdasaryan MD ,&nbsp;Shanjin Cao MD, PhD","doi":"10.1016/j.jemermed.2024.12.001","DOIUrl":"10.1016/j.jemermed.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Hyperosmolar hyperglycemic state (HHS) is a serious and potentially life-threatening complication of diabetes, defined by serum glucose &gt;600 mg/dL and effective osmolality &gt;320 mOsm/kg. However, some patients present with hyperglycemia (serum glucose levels ≥180 mg/dL but &lt;600 mg/dL), hypernatremia, and effective osmolality &gt;320 mOsm/kg. We refer to this subtype of HHS as euglycemic hyperosmolar hypernatremic state.</div></div><div><h3>Objective</h3><div>We aimed to investigate its clinical characteristics compared to traditional HHS.</div></div><div><h3>Methods</h3><div>A retrospective observational study of consecutive adult patients with diabetes and effective osmolality &gt;320 mOsm/kg admitted between January 2021 and February 2023 in a single medical institution. The study analyzed age, sex, hemoglobin A1c (HbA1c), serum glucose, serum sodium, effective osmolality, and mortality of encounters of euglycemic hyperosmolar hypernatremic state and traditional HHS.</div></div><div><h3>Results</h3><div>We encountered 34 cases of euglycemic hyperosmolar hypernatremic state and 19 cases of traditional HHS. Patients with euglycemic hyperosmolar hypernatremic state were older, had less severe diabetes with lower baseline HbA1c, worse hypernatremia, lower effective osmolality, and higher mortality (35.3 % vs. 0 %; <em>p</em> = 0.002) compared to patients with traditional HHS. Euglycemic hyperosmolar hypernatremic state had a similarly high mortality rate as hypernatremia alone.</div></div><div><h3>Conclusions</h3><div>Euglycemic hyperosmolar hypernatremic state is a variant subtype of HHS. It shares the same pathophysiological mechanisms as traditional HHS but is associated with higher mortality, thus warranting increased recognition as it requires similar treatment strategy as traditional HHS.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 25-30"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912849","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}

{"title":"Male With Wrist Pain","authors":"Branden Kahen DO ,&nbsp;Alexander Song MD ,&nbsp;Amin Mohamadi MD ,&nbsp;Josh Greenstein MD ,&nbsp;Barry Hahn MD","doi":"10.1016/j.jemermed.2024.11.005","DOIUrl":"10.1016/j.jemermed.2024.11.005","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 87-88"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710288","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}

{"title":"A Community-Based Integrated Healthy Aging Program at a Tertiary Hospital (YASAM) for the Oldest Old Participants May have the Potential to Reduce Emergency Admission: Preliminary Evidence from a Pre–Post-Intervention Study","authors":"Bilal Katipoglu M.D. ,&nbsp;Suleyman Emre Kocyigit M.D. ,&nbsp;Ugur Ergun M.D. ,&nbsp;Abdullah Osman Kocak M.D. ,&nbsp;Ozkan Aydeniz M.D. ,&nbsp;Ismail Mert M.D. ,&nbsp;Serkan Kadir Keskin MD.","doi":"10.1016/j.jemermed.2024.12.009","DOIUrl":"10.1016/j.jemermed.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Frail, oldest old individuals living in the community frequently face obstacles when trying to access outpatient clinics, which results in a higher dependence on emergency departments. This trend highlights the need for improved accessibility and support services for this vulnerable population.</div></div><div><h3>Objectives</h3><div>This study aims to investigate the relationship between community-based integrated healthy aging program in tertiary hospital and healthcare utilization among the oldest old adults.</div></div><div><h3>Methods</h3><div>A before-after pilot intervention prospective study was conducted between June 2023 and December 2023. The YASAM conducted a comprehensive assessment, including the Mini-Cog, Mini Mental Status Assessment, Mini Nutrition Assessment (short form), and Geriatric Depression (Yesavage) scale, as well as the Time-up and Go test and Stand-Chair tests. Health service utilization, including emergency visits, hospitalizations, and outpatient clinic visits, was documented after and before the index date for the participants.</div></div><div><h3>Results</h3><div>The study included 312 participants, with a mean age of 85.8 ± 3.9 years. The proportion of individuals with mild cognitive impairment was 55.8 % (<em>n</em> = 159). The percentage of participants with possible sarcopenia was 43.3 % (<em>n</em> = 135), and the percentage of those with moderate or severe frailty was 53.8 % (<em>n</em> = 163). The average visits to the emergency department per month before the index date were lower than after the index date, and this difference was significant (<em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Policymakers should consider expanding community-based integrated healthy aging programs in tertiary hospitals to meet the growing healthcare needs of older adults.</div></div><div><h3>Trial registration</h3><div>The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 112-120"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911500","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}

{"title":"Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents","authors":"Andrew Fried MD ,&nbsp;Jessica A. Hathaway MD ,&nbsp;Tania Strout PHD, RN, MS ,&nbsp;David C. Mackenzie MD ,&nbsp;Peter E. Croft MD ,&nbsp;Christina N. Wilson MD ,&nbsp;August M. Felix MD","doi":"10.1016/j.jemermed.2024.11.006","DOIUrl":"10.1016/j.jemermed.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Transesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skill set. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients.</div></div><div><h3>Objectives</h3><div>The objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR).</div></div><div><h3>Methods</h3><div>A prospective study at a single academic site, enrolling volunteer postgraduate year (PGY)2 and PGY3 EM residents. Residents underwent the following: Pretest examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four-chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired <em>t</em>-test or Wilcoxon rank-sum tests.</div></div><div><h3>Results</h3><div>Fifteen residents participated. The pretest mean score was 11.07, 95% CI: 9.35 to 12.79. The post-test mean score was 19.40, 95% CI: 18.94 to 19.86. A significant difference in scores was noted, <em>t</em> = –11.996, <em>p</em> &lt; 0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01–1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable.</div></div><div><h3>Conclusion</h3><div>Simulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 89-96"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911501","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}