Journal of Emergency Medicine最新文献

{"title":"Now You See It, Now You Don't: Point-of-Care Ultrasound Identification of Left Ventricular Thrombus-in-Transit","authors":"Zachary Boivin MD ,&nbsp;Zhayna Spooner MD ,&nbsp;Christina Jiang MS ,&nbsp;Kirstin Acus MD ,&nbsp;Christina Lu MD ,&nbsp;Trent She MD","doi":"10.1016/j.jemermed.2023.11.014","DOIUrl":"10.1016/j.jemermed.2023.11.014","url":null,"abstract":"<div><p><em><strong>Background</strong></em>: Left-sided intracardiac thrombi are most commonly seen in conditions with decreased cardiac flow, such as myocardial infarction or atrial fibrillation. They can be propagated into the systemic circulation, leading to a cerebrovascular accident. Identification of thrombus-in-transit via point-of-care ultrasound (POCUS) has the potential to change patient management given its association with high patient morbidity and mortality.</p><p><strong><em>Case Report:</em></strong> An intubated 60-year-old man was transferred to our emergency department for management of altered mental status and seizure-like activity. The patient was markedly hypotensive on arrival, and cardiac POCUS was performed to identify potential causes of hypotension. A left ventricular thrombus-in-transit was identified. The thrombus was notably absent on a repeat POCUS examination &lt; 10 min later, which led to concern for thrombus propagation. Furthermore, the patient's vasopressor requirements had significantly increased in that time period. Subsequent emergent neuroimaging revealed a large ischemic stroke in the left internal carotid and middle cerebral artery distribution. The patient was, unfortunately, deemed to not be a candidate for either thrombectomy or thrombolysis and ultimately expired in the hospital.</p><p><strong><em>Why Should an Emergency Physician Be Aware of This?</em></strong> Serial POCUS examinations identified the propagation of this patient's thrombus-in-transit, leading the physician to change the initial presumptive diagnosis and treatment course, and pursue further imaging and workup for ischemic stroke. Identification of a thrombus-in-transit is a clue to potentially underlying critical pathology and should be followed with serial POCUS examinations to assess for treatment efficacy and thrombus propagation.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e614-e618"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569542","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":"Methamphetamine Poisoning After \"Plugging\" Intentional Recreational Rectal Use","authors":"Amye Farag MD,&nbsp;Sean Patrick Nordt MDPharmD,&nbsp;Joshua Perese MD","doi":"10.1016/j.jemermed.2024.01.004","DOIUrl":"10.1016/j.jemermed.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Methamphetamine is a commonly used illicit substance. The route of administration is usually parenteral, oral ingestion, or snorting. A less common route of administration is placing in the rectum.</p></div><div><h3>Case Report</h3><p>A 28-year-old man presented to the emergency department with acute methamphetamine toxicity within 30 min after intentional rectal administration of methamphetamine for recreational purposes. The patient had hypertension, tachycardia, drug-induced psychosis, elevated creatine kinase, and required rapid sequence intubation and admission to the intensive care unit. Our patient had no clinical evidence of bowel ischemia or injury at the time of discharge.</p></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><p>Rectal administration of methamphetamine is known as “plugging,” “booty bumping,” “keestering,” and “butt whacking.” The rectal administration of methamphetamine has the increased risk of severe acute methamphetamine toxicity, as rectal administration bypasses first-pass metabolism, allowing for a more acute onset and higher bioavailability of methamphetamine compared with oral administration. There is the potential for mesenteric ischemia and bowel injury after rectal methamphetamine. Close clinical monitoring for bowel and rectal ischemia or injury are recommended, in addition to management of the sympathomimetic toxidrome.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e597-e600"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139458274","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":"Association Between Frailty and Head Impact Location After Ground-Level Fall in Older Adults","authors":"Xavier Dubucs MD, MSC ,&nbsp;Éric Mercier MD, MSC ,&nbsp;Valérie Boucher MSC ,&nbsp;Samuel Lauzon ,&nbsp;Frederic Balen MD ,&nbsp;Sandrine Charpentier MD, PHD ,&nbsp;Marcel Emond MD, MSC","doi":"10.1016/j.jemermed.2024.01.005","DOIUrl":"10.1016/j.jemermed.2024.01.005","url":null,"abstract":"<div><h3>Background</h3><p>Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.</p></div><div><h3>Objective</h3><p>This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall–related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.</p></div><div><h3>Methods</h3><p>We conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall–related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1–3), vulnerable-frail (CFS score 4–6), and severely frail (CFS score 7–9).</p></div><div><h3>Results</h3><p>A total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4–16.8]; <em>p</em> = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44–3.45; <em>p</em> = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41–13.6; <em>p</em> = 0.34) in those considered severely frail.</p></div><div><h3>Conclusions</h3><p>This study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. Although not statistically significant, the prevalence of intracranial hemorrhage seems to increase with the level of frailty.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e606-e613"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924000076/pdfft?md5=5537b8c00800181d98729b35d0f0d7d4&pid=1-s2.0-S0736467924000076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139509034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Black Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case Report","authors":"Matthew Robert Dernbach MD ,&nbsp;Joseph E. Carpenter MD ,&nbsp;Nihar Shah MBBS ,&nbsp;George Benjamin Carter MD","doi":"10.1016/j.jemermed.2024.01.003","DOIUrl":"10.1016/j.jemermed.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>Serotonin toxicity is a well-described phenomenon that is commonly attributed to a variety of drug–drug combinations. Some unregulated herbal supplements have been implicated in the onset of serotonin toxicity, however, there is currently minimal literature available on the potential for black cohosh to contribute to rhabdomyolysis and serotonin toxicity, in spite of its known serotonergic properties.</p></div><div><h3>Case Report</h3><p>A middle-aged woman presented to the emergency department with serotonin toxicity and rhabdomyolysis shortly after taking black cohosh supplements in the setting of long-term dual antidepressant use. The serotonin toxicity and rhabdomyolysis resolved with IV fluids, benzodiazepines, and discontinuation of the offending drugs.</p></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><p>Patients are sometimes not aware of how over-the-counter supplements might interact with their prescription medications. Female patients taking black cohosh to manage hot flashes and menopausal symptoms could be at risk for developing rhabdomyolysis and serotonin toxicity if they are also taking other serotonergic agents.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e592-e596"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455969","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":"Rate of Successful Shoulder Reduction on First Confirmatory Imaging in the Emergency Department","authors":"Jeffrey R. Stowell MD ,&nbsp;Levi Filler DO ,&nbsp;Carl Mitchell MD ,&nbsp;Ashkon Mahmoudi MD ,&nbsp;Thomas Whiting DO ,&nbsp;Carl Pastore MD ,&nbsp;Matthew Kunz DO ,&nbsp;Murtaza Akhter MD","doi":"10.1016/j.jemermed.2024.01.002","DOIUrl":"10.1016/j.jemermed.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Management of acute shoulder dislocation in the emergency department (ED) is common.</p></div><div><h3>Objective</h3><p>This study describes the rate, risk factors, and length of stay (LOS) associated with shoulder dislocation reduction failure in the ED.</p></div><div><h3>Methods</h3><p>The study was a retrospective case–control study of patients 18 years and older presenting to the ED with acute shoulder dislocation who underwent attempted reduction. Patients with successful reduction on post-reduction first confirmatory imaging are compared with those requiring multiple attempts.</p></div><div><h3>Results</h3><p>Of 398 ED encounters when a shoulder reduction was attempted in the ED, 18.8% (75/398 [95% CI 15.2–22.9%]) required multiple reduction attempts. Patients with successful reduction on first confirmatory imaging were more commonly male (80.2% [95% CI 75.6–84.3%] vs. 68.0% [95% CI 56.8–77.8%]; <em>p</em> = 0.0220), discharged home from the ED (95.4% [95% CI 92.6–97.3%] vs. 84.0% [95% CI 74.4–91.0%]; <em>p</em> = 0.0004), reduced using a traction/countertraction technique (42.1% [95% CI 36.8–47.6%] vs. 29.3% [95% CI 19.9–40.4%]; <em>p</em> = 0.0415), and less likely to have a pre-reduction fracture (26.0% [95% CI 21.4–31.0%] vs. 45.3% [95% CI 34.4–56.7%]; <em>p</em> = 0.0010). Mean length of stay (LOS) for those with successful reduction on first confirmatory imaging was 2 hours and 8 minutes shorter than for those with more than one attempt (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>The rate of failed first-pass reduction is higher than previously reported. Furthermore, the ED LOS was significantly longer in patients requiring multiple attempts. Knowledge of the failure rate and risk factors may raise physician awareness and guide future studies evaluating approaches for verification of reduction success.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e555-e561"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139579611","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":"Accuracy of Prehospital Services' Estimated Time to Arrival for Ground Transport to the Emergency Department","authors":"Jessica Fozard DO,&nbsp;Brent Becker MD,&nbsp;Tucker Lurie MD,&nbsp;Aizad Dasti MD","doi":"10.1016/j.jemermed.2023.12.010","DOIUrl":"10.1016/j.jemermed.2023.12.010","url":null,"abstract":"<div><h3>Background</h3><p>Emergency medical services (EMS) transporting patients to the emergency department (ED) typically call ahead to provide an estimated time to arrival (ETA). Accurate ETA facilitates ED preparation and resource allotment in anticipation of patient arrival.</p></div><div><h3>Objective</h3><p>The study purposed to determine the accuracy of ETA provided by EMS ground units.</p></div><div><h3>Methods</h3><p>We performed a single-center, prospective, observational study of ED patients arriving via EMS ground transport. The primary outcome was the time difference between EMS-reported ETA and actual time of arrival (ATA). The difference between ATA and ETA was compared using the two-sided Wilcoxon Signed-Rank Test. Subgroup analysis was performed to evaluate ETA accuracy for specific types of transports and assess variability by month and time of day.</p></div><div><h3>Results</h3><p>We included 1176 patient transports in the final analysis. The overall median difference ATA-ETA was 3 min (interquartile range 1–5 min) with a range of −26–48 minutes (<em>Z</em> = −25.139, <em>p</em> &lt; 0.001). EMS underestimated ETA in 961 cases (81.7%), and 94 ETAs (8.0%) were accurate to within 1 min. The largest difference between ATA and ETA occurred between 07:00–07:59 and 16:00–16:59 (5 min, interquartile range 2–7).</p></div><div><h3>Conclusion</h3><p>Our data demonstrate that prehospital providers underestimate time to ED arrival in most ground transports; however, the median difference between estimated and actual time to arrival is small.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e581-e588"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690493","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":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(24)00169-0","DOIUrl":"https://doi.org/10.1016/S0736-4679(24)00169-0","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e648-e649"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924001690/pdfft?md5=cdc0a699456084c63e07d001b5e731a2&pid=1-s2.0-S0736467924001690-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140951626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just a Ginger Ale","authors":"Christiana K. Prucnal MD, ScM ,&nbsp;Anne D. Isaacson MS ,&nbsp;Annelise C. Prucnal MS","doi":"10.1016/j.jemermed.2024.01.012","DOIUrl":"10.1016/j.jemermed.2024.01.012","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Page e645"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139579864","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":"Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on Mortality in Sepsis","authors":"Sun Young Lim MD, MSc ,&nbsp;Sumin Baek MD ,&nbsp;You Hwan Jo MD, PhD ,&nbsp;Jae Hyuk Lee MD, PhD ,&nbsp;Young Woo Um MD, MSc ,&nbsp;Hee Eun Kim MD ,&nbsp;Dongkwan Han MD","doi":"10.1016/j.jemermed.2023.12.008","DOIUrl":"10.1016/j.jemermed.2023.12.008","url":null,"abstract":"<div><h3>Background</h3><p>There is a lack of evidence-based guidelines for the administration methods of ceftriaxone in emergency departments (EDs), resulting in the reliance on individual institutional protocols for decision-making.</p></div><div><h3>Objective</h3><p>This study was performed to compare the effects of administering ceftriaxone via intravenous push (IVP) and intravenous piggyback (IVPB) on 28-day mortality in patients with sepsis.</p></div><div><h3>Methods</h3><p>This was a retrospective study of patients aged 18 years or older with sepsis or septic shock who visited an ED and were treated with ceftriaxone as an initial antibiotic between March 2010 and February 2019. Patients were divided into the IVP group and the IVPB group based on the administration method. The primary outcome was 28-day mortality, and multivariable Cox proportional hazards regression analysis was performed to evaluate the relationship between antibiotic administration methods and 28-day mortality.</p></div><div><h3>Results</h3><p>During the study period, a total of 939 patients were included in the final analysis, and the overall mortality rate was 12.2%. The antibiotic administration time was significantly lower in the IVP group than in the IVPB group, and the rates of antibiotic administration within 1 h and within 3 h were higher in the IVP group than in the IVPB group (<em>p</em> &lt; 0.05). However, there was no significant difference in 28-day mortality between the two groups (hazard ratio 1.07, 95% confidence interval 0.69–1.65).</p></div><div><h3>Conclusions</h3><p>IVP administration of ceftriaxone reduced the time of antibiotic administration compared with IVPB, but there was no difference in 28-day mortality.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e632-e641"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467923005954/pdfft?md5=cd00b772c035a3f750704d9e29257d4a&pid=1-s2.0-S0736467923005954-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138679770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Venlafaxine Intoxication is Required, Epileptic Seizures Alone Prolong QRS and QTC","authors":"Josef Finsterer MD, PhD ,&nbsp;Claudia Stöllberger MD","doi":"10.1016/j.jemermed.2023.11.027","DOIUrl":"https://doi.org/10.1016/j.jemermed.2023.11.027","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"66 5","pages":"Pages e646-e647"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140951625","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}